New measures to assess the "Other" three pillars of food security-availability, utilization, and stability.

BACKGROUND: In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars-predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM). METHODS: A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). RESULTS: The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525-0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248-0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. CONCLUSIONS: The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.

The Effectiveness of a New Model in Managing Pregnant Women with Iron Deficiency Anemia in Indonesia: A Nonrandomized Controlled Intervention Study.

BACKGROUND: Indonesia has a major problem with iron deficiency anemia among pregnant women. A new model named the Four Pillars Approach was designed to improve antenatal care for these women. This study aimed to measure the effectiveness of the model in managing pregnant women with iron deficiency anemia. METHOD: We used a nonrandomized controlled intervention study. The study, with the Four Pillars Approach as intervention versus usual care as its control, was conducted in two provinces in Java (Indonesia) during the period from March 2012 until May 2013. Main outcome measures were a difference of Hb level ≥ 0.5 g/dL, the number of women who attended five or more antenatal care visits, and birthing with a skilled birth attendant. RESULTS: Three hundred fifty-four participants were enrolled in the study. Participants in the intervention group had an adjusted odds ratio of 25.0 (95% CI 12.03-52.03, p = 0.001) for increased hemoglobin of ≥ 0.5 g/dL at 35-37 weeks of gestation, compared with the control group. In the intervention group, 95.0 percent of women had five or more antenatal care visits, compared with 57.2 percent (p = 0.001) in the control group. All births in both groups were assisted by skilled birth attendants. CONCLUSION: The Four Pillars Approach is effective in increasing the hemoglobin level and the frequency of antenatal care visits of participants when compared with the usual care for pregnant women with anemia.

Teaching retirement financial literacy in an undergraduate gerontology classroom: broadening the concept of the tripod or three-legged stool of retirement income utilizing active learning.

The three-legged stool concept is widely used in gerontological and geriatric education as an explanation on how one should fiscally approach his or her retirement. Financial managers, planners, retirees, business owners, even the Social Security Administration uses this metaphor of fiscal soundness in retirement planning. Gerontologists are moving away from the "tripod of retirement income" and "three-legged stool" term, as more often market work is needed for financial security. This activity focuses on the tripod or three-legged stool concepts of retirement planning using active learning, allowing the students to work collaboratively in a group, reflect upon the activity, and most importantly have fun. The game also allows for an expansion of the tripod concepts into the four pillars of economic security, broaching the use of personal assets and the possible need for longer employment. Game scenarios also emphasize macro- and microlevel forces, such as race, gender, health status, education, or marital status, which can influence timing of retirement or the level of retirement income available. The authors include instructions on how to set up the learning experience including worksheets, as well as reflection questions posed throughout the process.

"It's going to get pretty tippy": Stakeholder perspectives on the (dys)function of a four pillars drug strategy.

A 'drug strategy' is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A 'pillars' drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders' perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of 'balance' of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars' architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged.

Health equity in heart failure.

The treatment of heart failure (HF) with reduced ejection fraction (HFrEF) has substantially developed over the past decades. More than ever before, the application of appropriate evidence-based medical therapy for HFrEF is associated with remarkable improvements in survival, noteworthy increases in quality of life, and a marked reduction in symptomatic HF sufficient to warrant hospitalization. These enhanced clinical outcomes are driven by the "four pillars" of HF therapy: 1) evidence-based beta blockers, 2) Renin-angiotensin-aldosterone system inhibitors (angiotensin-converting enzyme inhibitors /angiotensin II receptor blockers or angiotensin receptor-neprilysin inhibitors, 3) mineralocorticoid receptor antagonists, and most recently, 4) sodium-glucose cotransporter-2 inhibitors. Despite robust evidence from well-conducted randomized clinical trials, guideline-directed medical therapies with established cardiovascular benefits remain significantly underutilized in clinical practice, particularly among under-represented minority populations. This phenomenon has led to class 1 level recommendations from the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines to address HF disparities among vulnerable populations as follows. In this article, we highlight the difference between health equality and health equity and discuss the need to address equity in the treatment of heart failure, ensuring that the impressive progress made in the treatment of HFrEF is equally beneficial to all individuals. We discuss strategies to reduce and ultimately eliminate disparities in the determinants of health that particularly affect marginalized groups, including the socioeconomic determinants and racism as a threat to public health. Finally, we discuss and propose a combination of the four pillars of ethics with the four pillars of GDMT to optimize and personalize treatment of all patients with HFrEF, to achieve true equity in the treatment of HF.

A study to investigate undergraduate diagnostic radiographer preferences and expectations of clinical role development: Quantitative findings.

INTRODUCTION: Whilst United Kingdom (UK) student ambitions for role development have been surveyed previously, no literature has explored their specialisation preferences. This study aimed to explore these ambitions and preferences in final year diagnostic radiography undergraduates at a Higher-Education Institute (HEI) in the North-West of England. METHODS: University ethical approval was granted for a survey-based study. A questionnaire consisting of 4 closed questions and 6 open questions was distributed in paper format after a taught session. Responses were collated and summarised in Excel (descriptive statistics), and transferred into SPSS (inferential statistics). RESULTS: The response rate was 75.6% (n = 34/45). Respondents were predominantly female (73.5%), had A-level as their highest qualification (79.4%) and were of 'school-leaver' age (76.5%) at the start of the degree. By overall total, preferences were for reporting (n = 24/101; 23.8%), computed tomography (CT) (n = 20/101; 19.8%) and MRI/ultrasound (both 12/101; 12.5%). CT had more first choices (n = 8) than reporting (n = 7). 73.5% anticipated specialising in less than 2 years, and 100% within 4 years. CONCLUSION: Other than a larger percentage having A-level as their highest qualification, the participant demographics were similar to the UK radiography workforce. Reporting, CT, MRI and ultrasound are the specialisation preferences of final year undergraduate diagnostic radiography students. Expectations for the timeline of role development were slightly more ambitious than previously found. IMPLICATIONS FOR PRACTICE: Identification of reporting as the preferred area of specialisation is a novel finding in the context of UK HEIs. Harnessing this ambition will help meet the goals of successive government policy. Ensuring the ambitions of graduate diagnostic radiographers can be satisfied has clear implications for staff retention within the NHS.

How educational are 'educational' apps for young children? App store content analysis using the Four Pillars of Learning framework.

Experts have expressed concerns about the lack of evidence demonstrating that children's "educational" applications (apps) have educational value. This study aimed to operationalize Hirsh-Pasek, Zosh, et al.'s (2015) Four Pillars of Learning into a reliable coding scheme (Pillar 1: Active Learning, Pillar 2: Engagement in the Learning Process, Pillar 3: Meaningful Learning, Pillar 4: Social Interaction), describe the educational quality of commercially-available apps, and examine differences in educational quality between free and paid apps. We analyzed 100 children's educational apps with the highest downloads from Google Play and Apple app stores, as well as 24 apps most frequently played by preschool-age children in a longitudinal cohort study. We developed a coding scheme in which each app earned a value of 0-3 for each Pillar, defining lower-quality apps as those scoring ≤ 4, summed across the Four Pillars. Overall scores were low across all Pillars. Free apps had significantly lower Pillar 2 (Engagement in Learning Process) scores (t-test, p < .0001) and overall scores (t-test, p < .0047) when compared to paid apps, due to the presence of distracting enhancements. These results highlight the need for improved design of educational apps guided by developmental science.

Conceptualising COVID-19's impacts on household food security.

COVID-19 undermines food security both directly, by disrupting food systems, and indirectly, through the impacts of lockdowns on household incomes and physical access to food. COVID-19 and responses to the pandemic could undermine food production, processing and marketing, but the most concerning impacts are on the demand-side - economic and physical access to food. This paper identifies three complementary frameworks that can contribute to understanding these effects, which are expected to persist into the post-pandemic phase, after lockdowns are lifted. FAO's 'four pillars'- availability, access, stability and utilisation - and the 'food systems' approach both provide holistic frameworks for analysing food security. Sen's 'entitlement' approach is useful for disaggregating demand-side effects on household production-, labour-, trade- and transfer-based entitlements to food. Drawing on the strengths of each of these frameworks can enhance the understanding of the pandemic's impacts on food security, while also pinpointing areas for governments and other actors to intervene in the food system, to protect the food security of households left vulnerable by COVID-19 and public responses.

The four pillars of health coaching: preserving the heart of a movement.

In this special themed issue of Global Advances in Health and Medicine and in articles published on the journal's website (www.gahmj.com), you will read all about this new and maturing approach to health behavior change and the social and cultural conditions in modern medicine that have called this practice into being. You will learn about its inception and history,(1) the philosophic constructs of its application,(2) (,) (3) and its proposed mechanism of action.(4) There are multiple case reports(5) (-) (7) and clinical studies(8) (-) (10) expanding our scientific understanding of coaching in health and wellness and descriptions about how to educate professionals to provide this new service.(11) (,) (12) A review of existing literature in the field demonstrates the rapidly growing reported demonstration of its impact.(13) I believe coaching is poised to have a major transformative impact on health and healthcare internationally; it also is at risk of being usurped and thereby deformed by the power of the existing paradigm of Western disease care and reductionistic scientific thought. That is the issue I wish to raise: How do we ensure the integrity of this new approach so that it can serve as a bridge from a broken system to a new horizon of holistic health and well-being?