Nation-wide failure of voluntary folic acid fortification of corn masa flour and tortillas with folic acid.

BACKGROUND: The United States Food and Drug Administration (FDA) required all enriched cereal grains to be fortified with folic acid in 1998. In April 2016, the FDA published regulations allowing voluntary fortification of corn masa flour with folic acid to address the high prevalence of folic acid-preventable spina bifida and anencephaly among Hispanics. Our objective was to survey folic acid-fortified corn masa and corn tortilla products in the country using a national social media campaign. METHODS: In January 2019, we conducted a social media campaign (#FindFolicAcid) engaging citizens nationwide to survey local stores for folic acid in corn masa flour and corn tortilla products. Photos of products and nutrition labels were shared with the researchers on various social media portals (e.g., Twitter, Facebook, and Instagram). The posts were summarized for a descriptive analysis. RESULTS: People from 28 states shared photos of 132 products, including 43 unique corn masa flour or corn tortilla products. Of those, only three corn masa flour products included folic acid: (a) Maseca Instant White (4.4 lb bag); (b) Masa Brosa Instant; and (c) Masa Brosa Instant Blue. None of the corn tortilla products were fortified. CONCLUSION: There is a failure of voluntary folic acid fortification of corn masa flour and products nationally. Until folic acid fortification of corn masa products is implemented fully in the country, Hispanic women of reproductive age should take a daily vitamin supplement which includes at least 400 mcg of folic acid to prevent spina bifida and anencephaly.

National Voluntary Public Health Accreditation: Are More Local Health Departments Intending to Take Part?

OBJECTIVE: This article examines local health department (LHD) participation and intentions to participate in national voluntary accreditation and reasons for not seeking accreditation. Specifically, it compares the results of national surveys among LHDs in 2010, 2013, and 2014. DESIGN: Longitudinal cohort study. SETTING: United States. PARTICIPANTS: LHDs that responded to the 2014 Forces of Change Survey and the 2010 and 2013 National Association of County and City Health Officials Profile studies. MAIN OUTCOME MEASURES: LHD level of engagement in Public Health Accreditation Board (PHAB) accreditation. RESULTS: Data of 2014 indicated that 1% of LHDs achieved accreditation and 11% had submitted an application or a statement of intent, compared with 6% of LHDs that submitted an application or a statement of intent in 2013. The percent of LHDs that indicated they planned to apply for accreditation but had not submitted a statement of intent declined from 27% in 2013 to 22% in 2014. In multivariate models, controlling for governance category and jurisdiction population size, LHDs in states where the state health department (SHD) participated in e-PHAB had higher odds of being favorably inclined toward accreditation than those located in states where the SHD was not in the e-PHAB system (odds ratio = 2.82, 95% confidence interval: 1.81-4.41). Across 2013 and 2014, and across small and large LHDs, the top 2 reasons for deciding not to apply for accreditation were the time/effort required exceeded the benefits (67%) and fees were too high (46%). CONCLUSIONS: SHDs are powerful mediators of LHDs' perceptions of the PHAB accreditation program. Health department governance structure and jurisdiction population size are associated with LHD accreditation participation decisions. With the launch of PHAB's program, fewer LHDs are undecided about accreditation participation and many have taken affirmative steps to become accredited. The top 2 reasons LHDs indicated for not proceeding with accreditation were time/effort exceed benefit and fees perceived as too high.

Impact of improved fat-meat products consumption on anthropometric markers and nutrient intakes of male volunteers at increased cardiovascular risk / Impacto del consumo de productos cárnicos con calidad grasa mejorada sobre marcadores antropométricos e ingesta de nutrientes en voluntarios con riesgo cardiovascular elevado

Introduction: meat products have been recognized to be adequate matrix for incorporating functional ingredients. The impact of meat products formulated by replacing animal fat with a combination of olive, linseed and fish oils on energy and nutrient intakes and anthropometric measurements were tested in a non-randomized-controlled-sequential study. Methods: eighteen male volunteers at high-CVD risk consumed weekly 200 g frankfurters and 250 g pâtés during three 4-wk periods (reduced fat (RF); n3-enriched-RF (n-3RF), and normal fat (NF)), separated by 4-wk washout. Energy and nutrient intakes, healthy eating index (HEI), and anthropometric changes were evaluated. Results: body fat mass rate-of-change and the waist/ hip ratio significantly differs (p=0.018 and p=0.031, respectively) between periods, decreasing body fat mass, waist circumference and waist/hip ratio in RF period and increasing body fat mass in NF one (all p=0.05). Significant inverse correlations were observed between rate-of-change of BMI and ideal body weight with dietary carbohydrate/SFA ratio in n-3RF period (p=0.003 and p=0.006, respectively). Initial diets presented low HEIs (means<60). Carbohydrate, fat and protein energy contribution was 40%, 41%, and 16%, respectively. More than 33% of volunteers did not initially cover 70% of several minerals and vitamins RDAs. Product consumption improved dietary Zn, Ca, retinol equivalent, folate and vitamin B12 contents in all periods, and ameliorated n-3 PUFA contents and n-6/n-3 PUFA ratio over the n-3RF period. Conclusion: improved-fat meat products appear as functional foods for overweight/obeses since their consumption improved selected body-fat markers, without affecting HEI, macronutrient and energy but their n-3 PUFA and n6/n3 ratio intakes (AU)

Introducción: la carne es una matriz adecuada para la inclusión de ingredientes funcionales. En un estudio no secuencial controlado y aleatorio se evaluó el impacto del consumo de productos cárnicos, en los que se sustituyó la grasa animal por una combinación de aceite de oliva, de linaza y de pescado, sobre la ingesta de energía y nutrientes y sobre los marcadores antropométricos. Métodos: dieciocho voluntarios con elevado riesgo cardiovascular consumieron semanalmente 200 g de salchichas tipo frankfurt y 250 g de paté durante tres períodos sucesivos de 4 semanas (bajo en grasa (RF); enriquecidos en n-3 (n-3RF), y grasa normal (NF)), separados por un lavado de 4 semanas. Se evaluó la ingesta de nutrientes y energía, el índice de alimentación saludable (HEI) y los cambios antropométricos. Resultados: hubo diferencias significativas entre períodos para las tasas de cambio de la grasa corporal y de la relación cintura/cadera (p=0,018 y p=0,031, respectivamente), disminuyendo la masa grasa, el perímetro de la cintura y la relación cintura/cadera en el periodo RF, e incrementándose la grasa corporal en el periodo NF (todos p=0,05). En el período n-3RF las tasas de cambio de IMC y del peso ideal correlacionaron inversa y significativamente (p=0.003 y p=0.006, respectivamente) con el cociente hidratos de carbono/AGS. El HEI inicial de las dietas fue muy bajo (valor medio <60). La contribución energética de carbohidratos, grasa y proteínas fue 40%, 41% y 16%, respectivamente. Más del 33% de los voluntarios no cubrían al inicio el 70% de las RDA para minerales y vitaminas. La intervención mejoró en todos los períodos la ingesta de Zn, Ca, equivalentes de retinol, folatos y vitamina B12. En el período n-3RF incrementó los AGPn-3 y redujo el cociente n-6/n-3. Conclusión: los productos cárnicos con menos grasa o enriquecidos en AGP n-3 son alimentos funcionales para personas con sobrepeso/obesidad, ya que su consumo mejora los marcadores de grasa corporal, los niveles de AGP n-3 y el cociente n-6/n-3 sin afectar al HEI ni a la ingesta de energía y macronutrientes (AU)

Cannabis use during a voluntary quit attempt: an analysis from ecological momentary assessment.

BACKGROUND: There is little research that has sought to identify factors related to quit success and failure among cannabis users. The current study examined affective, cognitive, and situational factors related to cannabis use among current cannabis users undergoing a voluntary, self-guided quit attempt. METHOD: The sample consisted of 30 (33% female) current cannabis users, 84% of whom evinced a current cannabis use disorder. Ecological momentary assessment was used to collect multiple daily ratings of cannabis withdrawal, negative affect, peer cannabis use, reasons for use, and successful coping strategies over two weeks. RESULTS: Findings from generalized linear models indicated that cannabis withdrawal and positive and negative affect were significantly higher during cannabis use than non-use episodes. Additionally, when negative and positive affect were entered simultaneously, negative affect, but not positive affect, remained significantly related to use. Participants were significantly more likely to use in social situations than when alone. When participants were in social situations, they were significantly more likely to use if others were using. Participants tended to use more behavioral than cognitive strategies to abstain from cannabis. The most common reason for use was to cope with negative affect. CONCLUSIONS: Overall, these novel findings indicate that cannabis withdrawal, affect (especially negative affect), and peer use play important roles in cannabis use among self-quitters.

Participation of people with physical disabilities: three-year trend and potential for improvement.

OBJECTIVE: To provide an insight into developments in participation over the period 2008 to 2010 among Dutch people with physical disabilities and into their demands for additional participation. DESIGN: Trend study with additional cross-sectional survey. SETTING: Community-dwelling people with physical disabilities. PARTICIPANTS: A sample of 1868 (2008), 1900 (2009), and 2163 (2010) people (≥15y) with mild, moderate, or severe physical disability. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Eight indicators of participation within International Classification of Functioning, Disability and Health domains: use of neighborhood facilities, going out of the house, having paid work, performing volunteer services, visiting leisure facilities, performing club activities, meeting friends, and use of public transport. RESULTS: No increase in participation rates was found over the years 2008 to 2010. In 2010, 18% of the people who did not have a paid job wanted to work, especially younger (<40y) people and more highly educated people, 30% wanted to do more activities in their leisure time, and 23% wanted more social contacts. People who did not participate in a specific activity in 2010 were more likely to have a desire for additional participation than were people who already participated. People with severe disability were less likely to want work; however, they did express a wish to increase their social activities. CONCLUSIONS: Although no increase in participation was found, this does not imply that participation rates among people with physical disabilities have already reached optimal levels. Respondents' stated wish for additional participation provides potential for improvement. Further research should focus on individual values, participation appraisal, and interaction between individual and environmental characteristics to enhance participation.

The mandatory census: tension between individual rights and the public good.

The discontinuation of the Canadian long-form mandatory census presents a crisis for data users. Examined as a tension between the need to preserve individual civil liberties and the need to curtail those liberties for the public good, the census crisis presents an opportunity for a public discussion on the specifics of our national values, beliefs and expectations.

Evaluación de la calidad percibida en programas de voluntariado deportivo: Un estudio piloto / Perceived quality assessment in sports program voluntary: Pilot study

En la actualidad la gran demanda de participantes de las actividades deportivas y la importancia de la gestión en la organización de los diferentes eventos deportivos hacen necesaria la elaboración de un plan estratégico de gestión para buscar la calidad y el bienestar de dicha población. Desde este planteamiento se crea la necesidad de analizar la importancia de la Gestión Integral de la Calidad que podríamos describir como un conjunto de procedimientos y estrategias importantes en la búsqueda, manejo y dirección de una mejora continua. Consideramos que una metodología de evaluación que permita la participación de personas implicadas en el desarrollo de los programas (evaluación formativa), es un instrumento necesario (..) (AU)

Nowadays the vast majority of participants in sport activities and the importance in the organization management concerning sport events made a necessity the design of a strategic plan of management in order to reach the quality and confort of the mentioned population.Considering this approach, the need for analyzing the importance of the Integral Management of Quality, which can be described as a set of procedures and important strategies in the search, management and direction of a continuos improvement, is created. We consider that an evaluative methodology which makes possible the participation of the people involved in the (..) (AU)

Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation.

As part of the Pan American Health Organization/World Health Organization Trans-Fat-Free Americas initiative, 12 representatives from food industries in Latin America and the Caribbean signed a declaration stating their intention to voluntarily eliminate industrially produced trans-fatty acids (TFA) from the Americas. A year later, in order to document the extent of the voluntary reduction, each declarant was asked to describe all reformulations and reductions in the TFA content of their products. After up to six requests for data, only three declarants provided such information in detail, and three others offered an overall summary of their reformulations. Additionally, three declarants reported the barriers that limit this process: availability of oil substitutes, cost, and consumers' sensory acceptance. The content of TFA and saturated fat in the food supply in the Americas should be regulated and strictly monitored in order to adequately evaluate a reduction of TFA in the region.

Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation / Disminución voluntaria del contenido de ácidos grasos trans en América Latina y el Caribe: situación actual

As part of the Pan American Health Organization/World Health Organization Trans-Fat-Free Americas initiative, 12 representatives from food industries in Latin America and the Caribbean signed a declaration stating their intention to voluntarily eliminate industrially produced trans-fatty acids (TFA) from the Americas. A year later, in order to document the extent of the voluntary reduction, each declarant was asked to describe all reformulations and reductions in the TFA content of their products. After up to six requests for data, only three declarants provided such information in detail, and three others offered an overall summary of their reformulations. Additionally, three declarants reported the barriers that limit this process: availability of oil substitutes, cost, and consumers' sensory acceptance. The content of TFA and saturated fat in the food supply in the Americas should be regulated and strictly monitored in order to adequately evaluate a reduction of TFA in the region.

Como parte de la iniciativa "Las Américas sin grasas trans" de la Organización Panamericana de la Salud/Organización Mundial de la Salud, 12 representantes de empresas alimentarias de América Latina y el Caribe firmaron una declaración en la que se comprometieron a eliminar voluntariamente los ácidos grasos trans (AGT) de los alimentos producidos industrialmente. Un año después, a fin de verificar el progreso en este sentido, se solicitó a cada firmante que describiera todas las reformulaciones y la disminución del contenido de AGT de sus productos. Después de solicitar los datos hasta seis veces en algunos casos, solo tres de las empresas firmantes suministraron información detallada y otras tres ofrecieron un resumen general de las distintas reformulaciones incorporadas. Además, tres proporcionaron información acerca de los obstáculos que dificultan este proceso: la disponibilidad de sucedáneos del aceite, el costo y la aceptación de los consumidores. Es preciso reglamentar y vigilar con rigurosidad el contenido de AGT y grasas saturadas de los alimentos comercializados en la Región de las Américas con el fin de efectuar un seguimiento adecuado de la disminución de los AGT.

Comparing outcomes of 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe.

AIM: This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. METHODS: Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure and self-efficacy, and the Readiness-to-Change Questionnaire at treatment entry and after 6, 12, and 18 months. RESULTS: Reductions in substance use and crime as well as improvements in health and social integration were observed in QCT and voluntary treatment groups. After controlling for various factors, subjects in the QCT and the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable in both groups. CONCLUSION: QCT is as effective as voluntary treatment provided in the same services in reducing substance use and crime.

Ethics of mandatory premarital HIV testing in Africa: the case of Goma, Democratic Republic of Congo.

Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse ('opt out'). While these policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of 'provider-initiated' testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS.