Generating Demand for Alternative Protein in Low- and Middle- Income Countries: Opportunities and Experiences from Nutritious and Sustainable Market Solutions.

Protein consumption and the demand for high-value nutritional products is growing rapidly in emerging markets. The projected growth of the alternative protein industry may position it well to meet this demand while addressing environmental sustainability and ethical standards. However, adoption of alternative protein products over traditional animal-sourced proteins is not always a clear choice, with factors such as consumer preferences and habitual behaviors influencing consumer decisions. Insights and considerations associated with generating demand for alternative protein products in low- and middle-income countries (LMIC) were identified through 3 case studies: the OBAASIMA Project in Ghana, the Egg Initiative in Ethiopia, and the World Food Programme Farming Coalition project in Armenia. Key findings emphasize the importance of local sourcing, positive messaging, and integration within existing diets and behaviors. Therefore, these factors will be essential for the adoption of novel alternative protein products in LMIC.

Young People's Attitudes, Perceptions and Experiences of Social Distancing and Self-Isolation During the Second Wave of the COVID-19 Pandemic.

Objectives: Social distancing and self-isolation were key parts of the UK's strategy for reducing the spread of COVID-19. This study explored young people's attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39 years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules-trust in their friends to be careful and say if they are unwell; 2) own rule making-making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support-confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19.

Support Needs in Carers of People With Parkinson's From Early to Later Stages: A Qualitative Study With 36 Carers in 11 European Countries.

BACKGROUND: Parkinson's Disease (PD) is associated with considerable carer burden, but there has been little qualitative research on the support needs of carers of People with Parkinson's (PwP). METHODS: Semi-structured in-depth interviews with carers of PwP in 11 European countries. RESULTS: Interviews with 36 carers of PwP were analysed. At the time of diagnosis, carers often felt that they had a role in helping get a diagnosis and then in dealing with the impact of the diagnosis on the family. Information on medication was seen as particularly important for carers, and many of the carers felt that their informational needs differed from that of the PwPs. Many of the carers also felt that they needed to be present at all appointments to request referrals or ask for medication changes. Carers of those in the later stages of the disease often reported feeling isolated and not having any time for themselves. CONCLUSIONS: The involvement of carers should be addressed more actively in the management of Parkinson's.

Knowledge, Attitudes and Practices of Pregnant Women and Healthcare Providers in Bangladesh regarding Multivitamin Supplements during Pregnancy.

Micronutrient deficiencies are widespread among pregnant women in low- and middle-income countries (LMIC) and lead to potentially adverse effects for mother and baby. In Bangladesh, maternal malnutrition remains a severe problem, with high rates of anemia (49.6% of pregnant women and 47.8% of lactating women are anemic) and other nutritional deficiencies. A Knowledge, Attitudes, and Practices (KAP) study was conducted to assess Bangladeshi pregnant women's perceptions and related behaviors, as well as awareness and knowledge among pharmacists and healthcare professionals concerning prenatal multivitamin supplements. This was done in both rural and urban areas across Bangladesh. A total of 732 quantitative interviews were conducted (330 with providers and 402 with pregnant women, with an equal split between urban and rural areas for both sets of audiences; 200 women were users of prenatal multivitamin supplements, while 202 women were aware non-users). The study identified a few findings that can guide further research or market-based interventions to reduce micronutrient deficiencies. These include most pregnant women not knowing the right time to start multivitamin supplements (56.0%, [n = 225], stating that a woman should start taking supplements 'after the first trimester'), not knowing their benefits, and how they help both the mother and baby-only 29.5% [n = 59] stated that they believed the supplements helped their baby to grow well). Further, barriers to taking the supplements include women believing a nutritious diet is a substitute (88.7% [n = 293]), and a perceived lack of support from other family members (21.8%, [n = 72]). This suggests that there is a need for further awareness-raising among all pregnant women, their family members, and providers.

Becoming breastfeeding friendly in Great Britain-Does implementation science work?

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017-2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus-oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action.

Print media coverage of breastfeeding in Great Britain: Positive or negative?

Media can be a powerful communication tool to promote breastfeeding, influence mothers' breastfeeding behaviour, create positive social norms and generate support among stakeholders and policymakers for breastfeeding. However, negative stories could deter women from starting or continuing to breastfeed. This study aimed to describe the breadth and focus of the media coverage of breastfeeding and the message frames that are found in three of the most widely read national newspapers and three popular women's magazines in Great Britain over a 12-month period, as part of the Becoming Breastfeeding Friendly in Great Britain (BBF-GB) study. For this retrospective media analysis, 77 articles were identified and 42 were included in the study for coding and analysis. We conducted two content analyses to examine the articles' (1) message framing and (2) alignment with the eight components of an 'enabling breastfeeding environment' using the BBF Gear framework. Articles featuring breastfeeding appear in British newspapers and women's magazines all year round. Twenty-four per cent had a neutral tone, while 59% predominantly focused on the positive aspects or positive social support for breastfeeding, and 17% were predominantly focused on the negative aspects or negative social attitudes towards breastfeeding. The articles mainly focused on personal stories reflecting societal barriers and positive shifts (68%), with 12% presenting an analysis of breastfeeding evidence or barriers. There were fewer references to the legislation (5%) and availability of funding (2%) and support (9%). There was no coverage of national coordination and strategy, evaluation systems, or the political will to raise breastfeeding rates.

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF).

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.

Using Community-Based Prevention Marketing to Generate Demand for Healthy Diets in Jordan.

Jordan has been experiencing a nutrition transition with high rates of micronutrient deficiencies and rising overweight and obesity rates. This highlights the need to generate demand for healthy diets. This study used a community-based prevention marketing approach and worked with local communities as partners to develop a set of behavior change interventions to improve healthy eating within vulnerable communities. Individual, family, and paired-friendship interviews, and co-creation workshops were conducted with 120 people. The aim of these interviews was to gain an in-depth understand of school-aged children and their families' nutrition knowledge, attitudes, and practices, including social and cultural norms and behavioral determinants, and then use this information to co-create interventions, activities and materials targeted at supporting school-aged child nutrition. Analysis of the interviews revealed that dietary habits are both deeply personal and profoundly entwined by emotions and social norms, and that parents often gave in to their children's demands for unhealthy foods and beverages due to their perception of what a 'good parent' looks like and the desire to see their child 'smile'. These key insights were then shared during the co-creation workshops to develop behavior change interventions-ensuring that interventions were developed by the community, for the community.

Enhancing Behavior Change Skills in Health Extension Workers in Ethiopia: Evaluation of an Intervention to Improve Maternal and Infant Nutrition.

Maternal and infant nutrition are problematic in areas of Ethiopia. Health extension workers (HEWs) work in Ethiopia's primary health care system, increasing potential health service coverage, particularly for women and children, providing an opportunity for health improvement. Their roles include improving maternal and infant nutrition, disease prevention, and health education. Supporting HEWs' practice with 'non-clinical' skills in behavior change and health communication can improve effectiveness. This intervention study adapted and delivered a UK-developed training intervention for Health Extension Workers (HEWs) working with the United Nations World Food Programme in Ethiopia. The intervention included communication and behavioral training adapted with local contextual information. Mixed methods evaluation focused on participants' reaction to training, knowledge, behavior change, and skills use. Overall, 98 HEWs were trained. The intervention was positively received by HEWs. Pre-post evaluations of communication and behavior change skills found a positive impact on HEW skills, knowledge, and motivation to use skills (all p < 0.001) to change women's nutritional behavior, also demonstrated in role-play scenarios. The study offered substantial learning about intervention delivery. Appropriate cultural adaptation and careful consideration of assessment of psychological constructs are crucial for future delivery.

A qualitative study to explore fathers' attitudes towards breastfeeding in South West England.

AIM: To explore the beliefs, attitudes, and behaviours of fathers towards breastfeeding and how they impact either positively or negatively on their partners' decisions to initiate or continue breastfeeding. BACKGROUND: Despite policy initiatives at a national and international level and the increased number of baby-friendly hospitals within the UK, breastfeeding rates are slow to rise. Support from both parents has been proven to increase uptake and continuation rates, but there is little research into the emotional experience of fathers when it comes to breastfeeding. METHODS: We conducted qualitative interviews with 18 fathers in Wiltshire, England. Principles of grounded theory were used throughout this study to guide the sampling, data collection, and data analysis. FINDINGS: Fathers knew the health benefits of breastfeeding and wanted their child to breastfeed but were unsure of their place in the feeding process because they felt it was not their body. While they were aware of the benefits of breast milk for infants, fathers felt less informed of the practicalities of breastfeeding and the potential challenges they and their partner might have to overcome to breastfeed successfully for the recommended six-month period. Based on these findings, three segments were identified: the problem bonders, the dual bonders, and the pragmatists. All segments were concerned with the well-being of their partner and child and wanted their child to be breastfed. Health professionals can use the results of this study to create prenatal educational resources that take more of a preventive and problem-solving approach as opposed to promoting breastfeeding in efforts to comply with National Health Service guidelines, without offering solutions to common breastfeeding problems.

Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network.

Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not, however, focused upon how patient support groups and advocacy networks can help with the management of these conditions; therefore, it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation's Breathe Easy (BE) groups have on patients managing their lung and respiratory conditions. A semistructured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer support; patient self-management and self-education; attendance of healthcare professionals; and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups, and members expressed a social and educational benefit. BE networks were working with the local National Health Service to become an integral part of the respiratory pathway, yet there was evidence of resistance from the health service in incorporating the networks.

Sources of parental burden in a UK sample of first-generation North Indian Punjabi Sikhs and their white British counterparts.

OBJECTIVE: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. METHOD: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. RESULTS: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. CONCLUSION: The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.

A comparison of levels of burden in Indian and white parents with a son or daughter with schizophrenia.

BACKGROUND: Caregiver burden in mental illness is believed to differ between ethnic groups, but few studies have examined this in schizophrenia in the UK. AIM: To measure burden in British North Indian Sikh and white British parents with a son or daughter with established schizophrenia managed in outpatient care. METHOD: A cross-cultural cohort study measuring family factors, patient psychopathology and levels of burden and distress. RESULTS: Overall levels of burden were low with no significant differences between the groups. Burden subscale scores showed Indian parents were more affected by psychotic behaviours than white parents. The groups also differed on several sociodemographic variables. CONCLUSION: In stabilized community patients, the overall extent of burden experienced by both Indian and white parents is low and comparable. However, Indian parents were more burdened by psychotic behaviours. This may be a result of co-residence as Indian patients are more likely to live with their families. Social and economic factors in the country of residence and levels of acculturation may also influence levels of burden and the illness behaviours found most bothersome by parents.

Neurological disorders and violence: a systematic review and meta-analysis with a focus on epilepsy and traumatic brain injury.

The objectives of this study were to systematically review and meta-analyze the research literature on the association of common neurological disorders and violence. Keywords relating to neurological disorders and violence were searched between 1966 and August 2008. Case-control and cohort studies were selected. Odds ratios of violence risk in particular disorders compared with controls were combined using fixed-effects meta-analysis with the data presented in forest plots. Sensitivity analyses were conducted to identify possible differences in risk estimates across surveys. Information on risk factors for violence was extracted if replicated in more than one study. Nine studies were identified that compared the risk of violence in epilepsy or traumatic brain injury compared with unaffected controls. For the epilepsy studies, the overall pooled odds ratio for violent outcomes was 0.67 [95% confidence interval (CI) 0.46-0.96]. For traumatic brain injury, the odds ratio was 1.66 (95% CI 1.12-2.31). An additional 11 case-control studies investigated factors associated with violence in epilepsy and traumatic brain injury. It was not possible to meta-analyze these data. Comorbid psychopathology was associated with violence. Data on other neurological conditions was limited and unreplicated. In conclusion, although the evidence was limited and methodological quality varied, epilepsy and traumatic brain injury appeared to differ in their risk of violence compared with control populations. Longitudinal studies are required to replicate this review's provisional findings that epilepsy is inversely associated with violence and that brain injury modestly increases the risk, and further research is needed to provide information on a broader range of risk factors.

Long term outcome of primary care depression.

We conducted a follow up over 23 years of depressed patients originally presenting to general practice in 1981 and studied in detail at that time. Aims were to assess the long term course and outcome of depression in primary care. Patterns of recovery and recurrence of major depressive episodes, together with other aspects of course, treatment and current state, were assessed at interview. 78% (129) of the original sample were traced to current general practice and outcome data obtained on 54. One third had a prior history of depression. Interview data were obtained on 37 patients. Time to recovery from baseline averaged 10.3 months. The recurrence rate was 64% (23). Most participants suffered at least 2 further episodes that were frequently chronic lasting 2 years on average. Time before first recurrence appeared considerably longer than in comparable psychiatric inpatient samples. No participants were continuously ill. Although loss to follow up limits our conclusions, the course of primary care depression appears worse than suggested by previous, shorter follow ups. Our data suggest that long term risk of a recurrence may be high, but with recurrence delayed.

A cluster randomized controlled trial to assess the effectiveness of an intervention to educate students about depression.

BACKGROUND: Depression is an important cause of disability worldwide, with many people experiencing their first depressive episode before the age of 18. University students are particularly vulnerable to depression. Depression can be treated successfully in most patients. However, for treatment to be successful, depressed people need to recognize their symptoms as illness, present to medical care, and be aware that effective treatment is available. A thoughtful health campaign might therefore increase the likelihood of successful treatment. METHOD: A cluster randomized controlled trial was conducted to determine the effectiveness of an educational intervention. A total of 3313 undergraduate students participated in the study. The intervention consisted of postcards and posters on depression and its treatment. The primary outcome was student awareness that depression can be treated effectively. Secondary outcomes included the proportion of students reading the postcards, recognition of symptoms and knowledge of treatments. RESULTS: The postcards were read by 69% of students. Less than half of participants reported that depression could be treated effectively, and there was no evidence of a difference between the intervention and control groups [341 (49.1%) v. 379 (49.7%), difference -0.7, p=0.8, 95% confidence interval (CI) -5.1 to 3.7]. However, intervention group participants were more likely than control group participants to recognize depressive symptoms and to report that antidepressants are not addictive. CONCLUSIONS: Many university students lack knowledge about depression and its treatment. Simple and cheap media, such as postcards and posters, might help to improve awareness in areas where current knowledge is low.