40% Glucose Gel for the Treatment of Asymptomatic Neonatal Hypoglycemia.

BACKGROUND: The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. PURPOSE: To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. METHODS: Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. RESULTS: Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. IMPLICATIONS FOR PRACTICE: The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. IMPLICATIONS FOR RESEARCH: More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits.

Association between diet quality and food waste in Canadian families: a cross-sectional study.

BACKGROUND: Higher diet quality has been associated with greater amounts of food waste among adults in the United States. This study aims to build on previous work by examining the association between diet quality and food waste, as assessed using detailed waste audits, among a sample of Canadian families. METHODS: This cross-sectional study used data from 85 Canadian families with young children. Parent and children diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015), calculated from 3-day food records. Household food waste was measured using detailed waste audits conducted over multiple weeks and these data were used to calculate daily per capita food waste. Linear regression was used to explore the association between parent and child HEI-2015 scores and daily per capita total avoidable and unavoidable food waste, as well as daily per capita avoidable and unavoidable food waste in the following categories: 1) fruits and vegetables, 2) milk, cheese and eggs, 3) meat and fish, 4) breads and cereals, 5) fats and sugars. RESULTS: Parent HEI-2015 scores ranged from 37 to 92 (out of 100) and 81% of parents' diets scored in the "Needs Improvement (51-80)" category. Parent and child diet quality scores were significantly correlated (r = 0.61; P < 0.0001) and 82% of children's diets scored in the "Needs Improvement" category. On average, households produced 107 g of avoidable food waste and 52 g of unavoidable food waste per person per day. Fruits and vegetables were the highest contributor for both avoidable and unavoidable food waste. Both parent and child HEI-2015 scores were not significantly associated with total daily per capita avoidable or unavoidable food waste. However, parent HEI-2015 scores were positively associated with daily per capita avoidable fruit and vegetable waste (Unstandardized ß = 1.05; 95%CI: 0.11, 1.99; P = 0.03) and daily per capita unavoidable fruit and vegetable waste (Unstandardized ß = 0.60; 95%CI: 0.03, 1.17; P = 0.04), after adjusting for household income. CONCLUSION: This is the first study to explore the association between diet quality and food waste using detailed waste audits. Future research should explore effective strategies towards improving diet quality while simultaneously reducing food waste, especially of fruits and vegetables.

Dairy and Plant-Based Dairy Alternatives Purchasing Habits of Guelph-Based Families with Preschool-Aged Children.

Purpose: To investigate dairy and plant-based dairy alternatives (DPBDA) purchasing habits, including comparisons among locations of purchase and among subtypes of DPBDA, of families with preschool-aged children.Methods: Expenditures on food and DPBDA were calculated using grocery and food receipts collected for 3 weeks from 51 households in and around Guelph, Ontario, Canada. DPBDA were coded by subtypes (alternatives, cheese/yogurt, cow's milk, cream, and ice cream/other) and by locations of purchase, which were coded as big-box, discount, high-end, local/other, and midrange stores. Logistic regression using generalized estimating equations was used to investigate odds of purchasing DPBDA by location of purchase. All models included family income and number of children as potential confounders.Results: Ninety-eight percent of families purchased cheese/yogurt, 92% purchased cow's milk, and 35% of families purchased plant-based dairy alternatives. Families were more likely to purchase DPBDA from big-box stores than discount, midrange, or local/other stores (P < 0.01) and were more likely to purchase cheese/yogurt than dairy alternatives, cream, or ice cream/other subtypes (P < 0.01). Odds of purchasing were not different between cheese/yogurt and cow's milk.Conclusion: Families' DPBDA purchasing habits differ by purchase location and subtype. Further research is warranted to understand the factors affecting these purchasing habits.

Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children.

Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2-5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent's perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.

The cost-effectiveness of call-back counselling for smoking cessation.

OBJECTIVE: To assess the cost-effectiveness of the Quitline, a call-back counselling service for smoking cessation, in the states of Queensland, Western Australia and the Northern Territory. METHODS: A cost-effectiveness analysis using a deterministic Markov model, and cost per disability-adjusted life year (DALY) averted over a lifetime as the outcome measure. POPULATION: Current smokers, motivated to quit. RESULTS: Call-back counselling for smoking cessation provided by the Quitline is an intervention that both improves health with additional quitters, and achieves net cost savings due to the cost offsets being greater than the cost of the intervention. If cost offsets are excluded, the cost per quitter is $A773 (95% uncertainty interval $A769$-$A779), and the incremental cost-effectiveness ratio is $A294 per DALY (95% uncertainty interval $A293-$A298). CONCLUSIONS: Call-back counselling is a cost-effective intervention for smoking cessation that can be provided by a centralised service for a large population, and to reach people in isolated communities.

Care and comfort rounds: improving standards.

Person-centred, safe and effective care is at the heart of the fundamentals of caring. However, there are many challenges to achieving this reliably and consistently. This article describes one nursing team's experience of implementing 'care and comfort' rounds, which has led to proactive rather than reactive nursing care delivery. The number of patient falls and the use of call buzzers have reduced, patient experience has been enhanced, a more controlled environment is provided for patients, and staff satisfaction in care delivery has improved.

Nearshore fish community changes along the Toronto waterfront in accordance with management and restoration goals: Insights from two decades of monitoring.

Aquatic habitat in the Greater Toronto Area has been subject to anthropogenic stressors. The subsequent aquatic habitat degradation that followed led to the Toronto and Region waterfront being listed as an Area of Concern in 1987. Thus, extensive shoreline and riparian habitat restoration have been implemented as part of the Toronto and Region Remedial Action Plan in conjunction with local stakeholders, ministries, and NGOs in an overall effort to increase fish, bird, and wildlife habitat. A key aspect of current fish habitat restoration efforts, monitored by Toronto and Region Conservation Authority, is to account for long-term community changes within the target ecosystem to better understand overall changes at a larger spatial scale. Here we use electrofishing data from the past 20 years with over 100,000 records and across 72km of coastline to show how declines and fluctuations in fish biomass and catch along the waterfront are driven by a few individual species across three main ecotypes, such as coastal wetlands, embayments, and open coast sites, with the remaining species showing a high level of stability. Using community traits and composition for resident species we demonstrate native warmwater species have become more dominant along the waterfront in recent years, suggesting that restoration efforts are functioning as intended. Additionally, piscivore and specialist species have increased in their relative biomass contribution, approaching existing restoration targets. Altogether this waterfront-wide evaluation allows us to detect overall changes along the waterfront and can be beneficial to understand community changes at an ecosystem level when implementing and monitoring restoration projects.

Development, validity and reliability assessment of the Canadian Food Literacy Measure.

Food literacy is a growing area of interest given its potential to support healthy and sustainable diets. Most existing food literacy measures focus on nutrition and food skills but fail to address food systems and socio-environmental aspects of food literacy. Further, measures developed and tested in the Canadian context are lacking. The objective of this project was to develop and test the validity and reliability of a brief self-administered measure, in French and English, designed to assess multiple dimensions of food literacy among adults living in Canada. The 23-item Canadian Food Literacy Measure was developed through an iterative process that included assessment of face and content validity through expert review (n=20) and cognitive interviews (n=20), and construct validity and reliability, i.e., internal consistency through an online survey (n=154). The results indicate that the measure is well understood by both English- and French-speaking adults. The measure's construct validity is demonstrated by the observed differences in total scores in hypothesized directions by gender (p=0.003), age (p=0.007), education level (p=0.002), health literacy (p<0.001) and smoking status (p=0.001) and the significant positive correlation (r = 0.29; p=0.002) between total scores and fruit and vegetable intake. The measure also has high internal consistency with a Cronbach's coefficient alpha of 0.80. This measure can be used in surveillance studies to provide insight into the food literacy of adults living in Canada and in epidemiologic research that aims to explore how food literacy is associated with a variety of health outcomes.

Are Toronto's streams sick? A look at the fish and benthic invertebrate communities in the Toronto region in relation to the urban stream syndrome.

Impacts of urbanization on aquatic ecosystems are intensifying as urban sprawl spreads across the global land base. The urban stream syndrome (USS) identifies "symptoms" associated with urban development including changes in biotic communities, hydrology, water chemistry, and channel morphology. Direct relationships between road density (as surrogate of urbanization) and indicators of the USS were identified for streams in the Toronto region. Significant negative relationships were revealed between road density and biological (fish and benthic macroinvertebrate) richness, diversity, and fish Index of Biotic Integrity scores. Significant positive relationships were found between road density and tolerant fish/benthic macroinvertbrates, benthos Family Biotic Index scores, mean summer stream temperature, stream flashiness, and several water quality variables. Analysis of biological data showed that only four fish species and a reduced number of benthic macroinvertebrate families remained at the most urbanized sites. Road density was found to be a major determinant in both the fish and benthic macroinvertebrate community structure.

Comparing the Demographic Characteristics of Victims of Sexual Assault in Rural Versus Urban Areas.

BACKGROUND: In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed. PURPOSE: This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2. METHODS: Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association. RESULTS: Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers. CONCLUSION: Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities).

The Canadian Food Intake Screener for assessing alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations: scoring system and construct validity.

NOVELTY: The Canadian Food Intake Screener was developed to rapidly assess alignment of dietary intake with the Canada's Food Guide-2019 healthy food choices recommendations. Scoring is aligned with the Healthy Eating Food Index-2019 to the extent possible. Among a sample of adults, reasonable variation in screener scores was noted, mean screener scores differed between some subgroups with known differences in diet quality, and a moderate correlation between screener scores and total Healthy Eating Food Index-2019 scores based on repeat 24 h dietary recalls was observed. The Canadian Food Intake Screener has moderate construct validity for rapid assessment of overall alignment of adults' dietary intake with the Canada's Food Guide-2019 healthy food choices recommendations.

Construct validity and reliability of the Canadian Eating Practices Screener to assess eating practices based on 2019 Canada's Food Guide recommendations.

For the first time since its introduction, the 2019 Canada's Food Guide (2019-CFG) highlighted specific guidance on eating practices, i.e., recommendations on where, when, why, and how to eat. The Canadian Eating Practices Screener / Questionnaire court canadien sur les pratiques alimentaires was developed to assess eating practices based on the 2019-CFG healthy eating recommendations. The objective of this cross-sectional study was to assess the construct validity and reliability of the Canadian Eating Practices Screener. From July to December 2021, adults (n = 154) aged 18-65 years completed a sociodemographic questionnaire and the screener. Construct validity was assessed by examining variability in screener scores, by comparing screener scores among subgroups with hypothesized differences in eating practices, and by examining the correlation between screener scores and fruit and vegetable intake. Reliability, i.e., internal consistency, was assessed by calculating Cronbach's coefficient alpha. Screener item scores were summed to provide a total score ranging from 21 to 105. The mean screener score was 76 (SD = 8.4; maximum, 105), ranging from 53 (1st percentile) to 92 (99th percentile). Differences in total scores in hypothesized directions were observed by age (p = 0.006), perceived income adequacy (p = 0.09), educational attainment (p = 0.002), and smoking status (p = 0.09), but not by gender or health literacy level. The correlation between screener scores and fruit and vegetable intake was 0.29 (p = 0.002). The Cronbach's coefficient alpha was 0.79, suggesting acceptable to high internal consistency. Study findings provide preliminary evidence of the screener's construct validity and reliability, supporting its use to assess eating practices based on the 2019-CFG healthy eating recommendations.

Development of the Canadian Food Intake Screener to assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations.

NOVELTY: The Canadian Food Intake Screener was developed to rapidly assess alignment of adults' dietary intake over the past month with the Food Guide's healthy food choices recommendations. The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts. The 16-question screener is intended for use with adults, aged 18-65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible.

Development of the Canadian Eating Practices Screener to assess eating practices based on 2019 Canada's Food Guide recommendations.

In 2019, Health Canada released a new iteration of Canada's Food Guide (2019-CFG), which, for the first time, highlighted recommendations regarding eating practices, i.e., guidance on where, when, why, and how to eat. The objective of this study was to develop a brief self-administered screener to assess eating practices recommended in the 2019-CFG among adults aged 18-65 years. Development of the screener items was informed by a review of existing tools and mapping of items onto 2019-CFG recommendations. Face and content validity were assessed with experts in public health nutrition and/or dietary assessment (n = 16) and individuals from Government of Canada (n = 14). Cognitive interviews were conducted with English-speaking (n = 16) and French-speaking (n = 16) adults living in Canada to assess face validity and understanding of the screener items. While some modifications were identified to improve relevance or clarity, overall, the screener items were found to be relevant, well-constructed, and clearly worded. This comprehensive process resulted in the Canadian Eating Practices Screener/Questionnaire court canadien sur les pratiques alimentaires, which includes 21 items that assess eating practices recommended in the 2019-CFG. This screener can facilitate monitoring and surveillance efforts of the 2019-CFG eating practices as well as research exploring how these practices are associated with various health outcomes.

Food Skills: Associations With Diet Quality and Food Waste Among Canadian Parents.

OBJECTIVE: To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents. DESIGN: Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits. SETTING: Guelph-Wellington, Ontario. PARTICIPANTS: Parents (n = 130) with children aged 2-8 years. MAIN OUTCOME MEASURES: HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams). ANALYSIS: Linear regression using generalized estimating equations to determine unstandardized ß estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education. RESULTS: Food safety knowledge for cooking hot foods (ß = 4.3, P = 0.05), planning (ß = 4.5, P = 0.001), and conceptualizing food (ß = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (ß = 25.3, P = 0.05; ß = 12.1, P = 0.04), conceptualizing food (ß = 34.1, P = 0.01; ß = 13.8, P = 0.02), and mechanical techniques (ß = 39.2, P = 0.01; ß = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively. CONCLUSIONS AND IMPLICATIONS: Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings.

Valuing the Multiple Impacts of Household Food Waste.

The Commission for Environmental Cooperation (CEC) has estimated that Canadian households waste 85 kg of food per person annually. Food waste has become an increasingly common focus for policy, regulation, interventions, and awareness-raising efforts in Canada. However, there is still a relative dearth of data to inform such decision-making processes or to provide narratives to contextualize behavior change efforts. In this paper, we describe the results of an uncommonly detailed observational study of household food waste. A total of 94 families with young children living in Guelph, Ontario chose to participate in this study. Over the course of multiple weeks, we collected data on their food purchases, food consumption, and waste generation. All three streams of waste (garbage, recycling, and organic waste) were audited and the food type, degree of avoidability, and weight of each individual component of the organic waste stream was recorded. Using this highly granular data set, we found that the average household in our study generated approximately 2.98 kg of avoidable food waste per week. This estimate was then contextualized in terms of economic losses (dollar value), nutritional losses (calories, vitamins, and minerals) and environmental impacts (global warming potential, land, and water usage). In short, weekly avoidable food waste per household was calculated to be equivalent to $18.01, 3,366 calories, and 23.3 kg of CO2. These multiple valuation frameworks, which are based in detailed observations of family food behaviors rather than estimations derived from system-wide data, will enable more informed and urgent conversations about policy, programming, and interventions in order to reduce the volume of wasted food at the consumer level.

Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study.

BACKGROUND: Swedish snus is a smokeless tobacco product that has been suggested as a tobacco harm reduction product. Our aim was to assess the potential population health effects of snus. METHODS: We assessed the potential population health effects of snus in Australia with multistate life tables to estimate the difference in health-adjusted life expectancy between people who have never been smokers and various trajectories of tobacco use, including switching from smoking to snus use; and the potential for net population-level harm given different rates of snus uptake by current smokers, ex-smokers, and people who have never smoked. FINDINGS: There was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus (difference of 0.1-0.3 years for men and 0.1-0.4 years for women). For net harm to occur, 14-25 ex-smokers would have to start using snus to offset the health gain from every smoker who switched to snus rather than continuing to smoke. Likewise, 14-25 people who have never smoked would need to start using snus to offset the health gain from every new tobacco user who used snus rather than smoking. INTERPRETATION: Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus.

The experiences and perceptions of heavy vehicle drivers and train drivers of dangers at railway level crossings.

Heavy vehicle-train collisions have the potential to be catastrophic in terms of fatalities, environmental disaster, delays in the rail network, and extensive damage to property. Heavy vehicles, such as 'Road Trains' and 'B-Doubles', are vulnerable road users due to their size and mass and require specific risk management solutions. The present study aimed to capture the experiences of heavy vehicle drivers and train drivers at road-rail level crossings, with a view to exploring the contributing factors toward such accidents. A series of semi-structured focus groups was conducted, with a total of 17 train drivers and 26 heavy vehicle drivers taking part. Though there were some differences between the groups in perceptions of the causes of heavy vehicle-level crossing incidents, discussion in both groups centred on design issues an behavioural issues. With regard to design, the configuration of level crossings was found to affect heavy vehicle driver visibility and effective vehicle clearance. With regard to behaviour, discussion centred around wilful violation of crossing protocols, often as a time-saving measure, as well as driver complacency due to high levels of familiarity. The implications of these factors for future level crossing safety initiatives are discussed.

Accuracy of Parental Reporting of Preschoolers' Dietary Intake Using an Online Self-Administered 24-h Recall.

Parents are typically relied upon to report young children's dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children's intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting.