Modeling the cost effectiveness of child care policy changes in the U.S.

INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.

The stability of weight status through the early to middle childhood years in Australia: a longitudinal study

OBJECTIVES: To investigate the sociodemographic and behavioural factors associated with incidence, persistence or remission of obesity in a longitudinal sample of Australian children aged 4-10 years. SETTING: Nationally representative Longitudinal Study of Australian Children (LSAC). PARTICIPANTS: The sample for this analysis included all children in the Kinder cohort (aged 4-5 years at wave 1) who participated in all four waves of LSAC (wave 1, 2004, aged 4-5 years; wave 2, 2006, aged 6-7 years; wave 3, 2008, aged 8-9 years and wave 4, 2010, aged 10-11 years). Of the 4983 children who participated in the baseline (wave 1) survey, 4169 (83.7%) children completed all four waves of data collection. PRIMARY AND SECONDARY OUTCOME MEASURES: Movement of children between weight status categories over time and individual-level predictors of weight status change (sociodemographic characteristics, selected dietary and activity behaviours). RESULTS: The study found tracking of weight status across this period of childhood. There was an inverse association observed between socioeconomic position and persistence of overweight/obesity. Sugar-sweetened beverages and fruit and vegetable intake and screen time appeared to be important predictors of stronger tracking. CONCLUSIONS: Overweight and obesity established early in childhood tracks strongly to the middle childhood years in Australia, particularly among children of lower socioeconomic position and children participating in some unhealthy behaviour patterns.

An examination of the prevalence, consumer profiles, and patterns of energy drink use, with and without alcohol, in Australia

BACKGROUND: There has been a significant growth in the energy drink (ED) market in Australia and around the world; however, most research investigating the popularity of ED and alcohol and energy drink (AED) use has focused on specific subpopulations such as university students. The aim of this study was to estimate the prevalence, consumption patterns, and sociodemographic correlates of ED and combined AED use among a representative Australian population sample. METHODS: A computer-assisted telephone interview survey (n = 2,000) was undertaken in March-April 2013 of persons aged 18 years and over. Half of the interviews were obtained through randomly generated landline telephone numbers and half through mobile phones. Approximately half of the sample was female (55.5%; n = 1,110) and the mean age of participants was 45.9 (range 18 to 95, SD 20.0). RESULTS: Less than 1 in 6 Australians reported ED use (13.4%, n = 268) and 4.6% (n = 91) reported AED use in the past 3 months. Majority of ED and AED users consumed these beverages monthly or less. ED and AED users are more likely to be aged 18 to 24 years, live in a metropolitan area, and be moderate risk or problem gamblers. AED consumers are more likely to report moderate levels of psychological distress. CONCLUSIONS: Our findings in relation to problem gambling and psychological distress are novel and require further targeted investigation. Health promotion strategies directed toward reducing ED and AED use should focus on young people living in metropolitan areas and potentially be disseminated through locations where gambling takes place.

Protocols for finding the most orthogonal dimensions for two-dimensional high performance liquid chromatography

The selection of two high performance liquid chromatography (HPLC) columns with vastly different retention mechanisms is vital for performing effective two-dimensional (2D-) HPLC. This paper reports on a systematic method to select a pair of HPLC columns that provide the most different separations for a given sample. This was completed with the aid of a HPLC simulator that predicted retention profiles on the basis of real experimental data, which is difficult when the contents of sample matrices are largely-or completely-unknown. Peaks from the same compounds must first be matched between chromatograms to compare the retention profiles and optimised 2D-HPLC column selection. In this work, two methods of matching peaks between chromatograms were explored and an optimal pair of chromatography columns was selected for 2D-HPLC. First, a series of 17 antioxidants were selected as an analogue for a coffee extract. The predicted orthogonality of the standards was 39%, according to the fractional surface coverage 'bins' method, which was close to the actual space utilisation of the standard mixture, 44%. Moreover, the orthogonality for the 2D-HPLC of coffee matched the predicted value of 38%. The second method employed a complex sample matrix of urine to optimise the column selections. Seven peaks were confidently matched between chromatograms by comparing relative peak areas of two detection strategies: UV absorbance and potassium permanganate chemiluminescence. It was found that the optimal combinations had an orthogonality of 35% while the actual value was closer to 30%.

Food sources of total energy and nutrients among U.S. infants and toddlers: national health and nutrition examination survey 2005-2012

Understanding the dietary intakes of infants and toddlers is important because early life nutrition influences future health outcomes. The aim of this study was to determine the dietary sources of total energy and 16 nutrients in a nationally representative sample of U.S. infants and toddlers aged 0-24 months. Data from the 2005-2012 National Health and Nutrition Examination Survey were analyzed. Dietary intake was assessed in 2740 subjects using one 24-h dietary recall. The population proportion was used to determine the contribution of foods and beverages to nutrient intakes. Overall infant formulas and baby foods were the leading sources of total energy and nutrients in infants aged 0-11.9 months. In toddlers, the diversity of food groups contributing to nutrient intakes was much greater. Important sources of total energy included milk, 100% juice and grain based mixed dishes. A number of foods of low nutritional quality also contributed to energy intakes including sweet bakery products, sugar-sweetened beverages and savory snacks. Overall non-flavored milks and ready-to-eat cereals were the most important contributors to micronutrient intakes. In conclusion this information can be used to guide parents regarding appropriate food selection as well as inform targeted dietary strategies within public health initiatives to improve the diets of infants and toddlers.

Improving availability, promotion and purchase of fruit and vegetable and non sugar-sweetened drink products at community sporting clubs: a randomised trial

BACKGROUND: Amateur sporting clubs represent an attractive setting for health promotion. This study assesses the impact of a multi-component intervention on the availability, promotion and purchase of fruit and vegetable and non sugar -sweetened drink products from community sporting club canteens. We also assessed the impact the intervention on sporting club revenue from the sale of food and beverages. METHOD: A repeat cross-sectional, parallel group, cluster randomized controlled trial was undertaken with amateur community football clubs in New South Wales, Australia. The intervention was conducted over 2.5 winter sporting seasons and sought to improve the availability and promotion of fruit and vegetables and non sugar-sweetened drinks in sporting club canteens. Trial outcomes were assessed via telephone surveys of sporting club representatives and members. RESULTS: Eighty five sporting clubs and 1143 club members participated in the study. Relative to the control group, at follow-up, clubs allocated to the intervention were significantly more likely to have fruit and vegetable products available at the club canteen (OR = 5.13; 95% CI 1.70-15.38), were more likely to promote fruit and vegetable selection using reduced pricing and meal deals (OR = 34.48; 95% CI 4.18-250.00) and members of intervention clubs were more likely to report purchase of fruit and vegetable (OR = 2.58 95% CI; 1.08-6.18) and non sugar -sweetened drink (OR = 1.56; 95% CI 1.09-2.25) products. There was no significant difference between groups in the annual club revenue from food and non-alcoholic beverage sales. CONCLUSION: The findings demonstrate that the intervention can improve the nutrition environment of sporting clubs and the purchasing behaviour of members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000224224 .

Child and adolescent obesity: part of a bigger picture

The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Eat, drink and gamble: marketing messages about 'risky' products in an Australian major sporting series

BACKGROUND: To investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia. METHODS/APPROACH: Using the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games. RESULTS: There were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays. CONCLUSIONS: Sport is increasingly used as a vehicle for the promotion of range of 'risky consumption' products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption.

Digital marketing of unhealthy foods to Australian children and adolescents

The emergence of new media—including branded websites, social media and mobile applications—has created additional touch points for unhealthy food and beverage companies to target children and adolescents. The aim of this study was to perform an audit of new media for three top selling food and beverage brands in Australia. The top selling brand in three of the most advertised food and beverage categories was identified. Facebook, websites and mobile phone applications from these three brands were assessed using a combination of descriptive analyses and structured data collection during June and July 2013. Information on target audience, main focus of the activity, marketing strategies employed and connectivity were collected. Promotional activities were assessed against industry self-regulatory codes. McDonald's, Coca-Cola and Cadbury Dairy Milk were audited, with 21 promotional activities identified. These promotional activities appeared to use a number of marketing strategies, with frequent use of indirect product association, engagement techniques and branding. We identified strategic targeting of both children and adolescents. We found that while all promotional activities technically met self-regulatory codes (usually due to media-specific age restrictions) a number appeared to employ unhealthy food or beverage marketing directed to children. Brands are using engaging content via new media aimed at children and adolescents to promote unhealthy food and beverages. Given the limitations of self-regulatory codes in the context of new media, strategies need to be developed to reduce exposure of children and adolescents to marketing of unhealthy food and beverage products via these avenues.

A process evaluation of the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial

BACKGROUND: Supermarket Healthy Eating for Life (SHELf) was a randomized controlled trial that operationalized a socioecological approach to population-level dietary behaviour change in a real-world supermarket setting. SHELf tested the impact of individual (skill-building), environmental (20 % price reductions), and combined (skill-building + 20 % price reductions) interventions on women's purchasing and consumption of fruits, vegetables, low-calorie carbonated beverages and water. This process evaluation investigated the reach, effectiveness, implementation, and maintenance of the SHELf interventions.

METHODS: RE-AIM provided a conceptual framework to examine the processes underlying the impact of the interventions using data from participant surveys and objective sales data collected at baseline, post-intervention (3 months) and 6-months post-intervention. Fisher's exact, χ (2) and t-tests assessed differences in quantitative survey responses among groups. Adjusted linear regression examined the impact of self-reported intervention dose on food purchasing and consumption outcomes. Thematic analysis identified key themes within qualitative survey responses.

RESULTS: Reach of the SHELf interventions to disadvantaged groups, and beyond study participants themselves, was moderate. Just over one-third of intervention participants indicated that the interventions were effective in changing the way they bought, cooked or consumed food (p < 0.001 compared to control), with no differences among intervention groups. Improvements in purchasing and consumption outcomes were greatest among those who received a higher intervention dose. Most notably, participants who said they accessed price reductions on fruits and vegetables purchased (519 g/week) and consumed (0.5 servings/day) more vegetables. The majority of participants said they accessed (82 %) and appreciated discounts on fruits and vegetables, while there was limited use (40 %) and appreciation of discounts on low-calorie carbonated beverages and water. Overall reported satisfaction with, use, and impact of the skill-building resources was moderate. Maintenance of newly acquired behaviours was limited, with less than half of participants making changes or using study-provided resources during the 6-month post-intervention period.

CONCLUSIONS: SHELf's reach and perceived effectiveness were moderate. The interventions were more effective among those reporting greater engagement with them (an implementation-related construct). Maintenance of newly acquired behaviours proved challenging.

24-h urinary sodium excretion is associated with obesity in a cross-sectional sample of Australian schoolchildren

Emerging evidence indicates that dietary Na may be linked to obesity; however it is unclear whether this relationship is independent of energy intake (EI). The aim of this study was to assess the association between Na intake and measures of adiposity, including BMI z score, weight category and waist:height ratio (WHtR), in a sample of Australian schoolchildren. This was a cross-sectional study of schoolchildren aged 4-12 years. Na intake was assessed via one 24-h urine collection. BMI was converted to age- and sex-specific z scores, and WHtR was used to define abdominal obesity. In children aged ≥8 years, EI was determined via one 24-h dietary recall. Of the 666 children with valid urine samples 55 % were male (average age 9·3 (sd 1·8) years). In adjusted models an additional 17 mmol/d of Na was associated with a 0·10 higher BMI z score (95 % CI 0·07, 0·13), a 23 % (OR 1·23; 95 % CI 1·16, 1·31) greater risk of being overweight/obese and a 15 % (OR 1·15; 95 % CI 1·09, 1·23) greater risk of being centrally obese. In the subsample of 8-12-year-old children (n 458), adjustment for EI did not markedly alter the associations between Na and adiposity outcomes. Using a robust measure of daily Na intake we found a positive association between Na intake and obesity risk in Australian schoolchildren, which could not be explained by total energy consumption. To determine whether this is a causal relationship, longitudinal studies, with high-quality measures of Na and EI, are required.

Normal backwardation é normal no mercado futuro brasileiro?

A pesquisa testa a existência, no mercado futuro brasileiro, do fenômeno que Keynes denominou de normal backwardation, isto é, a hipótese de que os preços futuros não são estimadores não viesados (unbiased estimators) do preço à vista esperado para o futuro. Quatro contratos futuros negociados na BM&F Bolsa de Mercadorias e Futuros foram estudados, a saber, futuro de Ibovespa, futuro de dólar comercial, futuro de boi gordo e futuro de café arábica, cobrindo o período de julho de 1994 a setembro de 1997. Cada contrato futuro citado foi submetido a quatro testes, sugeridos pelas implicações da hipótese de Keynes. Nossos resultados indicam que normal backwardation não é normal no mercado futuro brasileiro, repetindo as conclusões de vários estudos internacionais.

Os possíveis efeitos da modalidade de licitação pregão em um órgão representante da administração pública direta: o exército brasileiro

Comércio eletrônico é um assunto que envolve múltiplos aspectos relacionados à utilização de infra-estrutura digital para suportar a transação de negócios. V árias são as formas de se exemplificar a aplicação de comércio eletrônico, como, por exemplo: utilização de quiosques de auto atendimento para a aquisição de refrigerantes, cartões telefônicos e café, obtenção de saldos bancários e pagamento de contas; utilização de armazenamento de dados de clientes que para fins de implantação de um programa de marketing de relacionamento; utilização de redes que interliguem organizações diversas, internamente ou externamente, para fins de otimização logística e permitir o fluxo de dados necessários à gestão das organizações Apesar das diversas possibilidades de se adotar práticas de comércio eletrônico, não se deve esperar que essas práticas sejam passíveis de serem replicadas, genericamente, por todas as organizações, pois estas diferem em sua composição, no que se trata das suas culturas, estruturas, estratégias e outros componentes. Devido ao caráter amplo do tema comércio eletrônico, este trabalho traz uma abordagem conceitual do mesmo e algumas das suas aplicações nas áreas de marketing, logística e governo eletrônico; apresenta alguns comentários sobre sistemas de informações e tecnologias de comunicação que os suportam; caracteriza as diferenças que existem entre as organizações, utilizando-se de um modelo organizacional que retrata as organizações como sendo um conjunto de forças: cultura e estrutura, estratégia, pessoas e seus papéis e tecnologia, em equilíbrio dinâmico entre si e inseridas no ambiente social, tecnológico, econômico e político e, como exemplo, infere a respeito de possíveis resultados que podem ser esperados a partir da adoção da modalidade de licitação pregão, eletrônico ou presencial, no âmbito de organizações militares do Exército Brasileiro, no que se refere à cultura, às pessoas e seus papéis e à tecnologia.

Padrões de concorrência no mercado brasileiro de torrefação e moagem de café e 1997 - 2005

This dissertation aims at analysing the patterns of competition from the period of 1997-2005 in the Brazilian roasted and grounded market. For the development of this research, a questionary elaborated by the researchers Maria Sylvia M. Saes and Elizabeth M. M. Q. Farina, that was utilized with the firms associated to the Associação Brasileira da Indústria de Café (ABIC) in 1997, will be used. The same questionary will be replicated in the year 2006 in order to capture changes within the patterns of competition along those 9 years. The methodology applied in this study is the case study, with unit of analysis being the Brazilian roasted and grounded industry. The research will be descripitive, since it will describe the pattern of competition in the Brazilian roasted and grounded market. However, the study is also exploratory due to the fact that there isn't any research that analyzes the specific object of study. The results obtained suggest that, taking into consideration the relevant variables of structure, conduct and performance of the industry of roasted and grounded coffee, the pattern of competition remained the same throughout the period 1997-2005.

Uso estratégico da tecnologia de informação no agribusiness: modelo conceitual para a gestão de estoques e custos de café por qualidade

Os produtores e as Cooperativas de Produtores de Café atuam em um ambiente incerto e competitivo, e estão enfrentando dificuldades de adaptação ao novo cenário econômico e tecnológico mundial. Para ter sucesso no empreendimento é necessário não apenas saber produzir, mas principalmente saber comercializar o café. O tradicional problema de decisão sobre como determinar o melhor momento de vender o café foi agravado pela globalização econômica (aumento da concorrência e crescente exigência em qualidade) e pelo advento da Tecnologia da Informação - TI - (grande quantidade de informações sobre o mercado de café, obtidas de modo desestruturado e às vezes de idoneidade duvidosa). Para avaliar oportunidades e realidades do uso estratégico da TI para a gestão das cooperativas de cafeicultores, considerou-se neste trabalho um problema específico: a questão do controle de estoques de café e a apuração de seus custos por qualidade. Os modelos gerenciais tradicionalmente utilizados envolvem sistemas convencionais de controle de estoque e análise de custos, mas controlam apenas as quantidades estocadas por tipo de café, não controlando seus custos. Normalmente consideram como custo a média dos preços de compra de café, em um determinado período. Assim impossibilitam o conhecimento do verdadeiro custo do produto vendido de acordo com sua qualidade, comprometendo a apuração de sua real margem de lucro em cada operação de venda. Logo, o resultado real das compras e vendas de café só é conhecido quando analisado um longo período, porque sofre influência das flutuações dos vários tipos de café que são comercializados. Partiu-se da hipótese de que o conhecimento da dinâmica da informação no complexo agroindustrial do café e o uso da Tecnologia de Informação como estratégia para instrumentalizar as decisões e melhorar o desempenho na comercialização de café pelas cooperativas de produtores possibilitam uma melhor organização e avaliação das informações necessárias para o planejamento da comercialização por essas cooperativas, aumentando a rentabilidade e contribuindo para a profissionalização do setor. Utilizando a TI para a integração do sistema de controle de estoques, comercialização e custos, foi desenvolvido um modelo conceitual para o gerenciamento dos estoques e custos de café por qualidade, visando a contribuir para a melhoria dos resultados obtidos pelas cooperativas. O estudo partiu da determinação das variáveis envolvidas no processo de comercialização do café. Desenvolveu-se um modelo conceitual para auxiliar o controle e o conhecimento do real custo do café por qualidade, possibilitando a correta apuração do resultado econômico, contribuindo para melhorar o controle estratégico dos estoques de café e o planejamento operacional do preparo dos blends. Em anexo, apresentam-se planilhas simulando a operação do modelo. O uso deste modelo permite que os administradores se antecipem aos problemas, reduzindo riscos e descobrindo oportunidades através de um melhor uso do recurso informação, gerando ganhos em competitividade. O modelo conceitual apresentado integra a gestão de estoques com o gerenciamento de custos de café por qualidade. Parte de uma visão ampliada da administração da cooperativa, considerando o trabalho dentro e fora da empresa, relacionando os controles de estoques da cooperativa e do cooperado, fisico e "virtual" (estoque do cooperado que EAESP/FGV - COA - Luciel Henrique de Oliveira - 1998 6 foi utilizado) e o mercado consumidor, possibilitando um controle mais eficiente para a redução do risco da cooperativa. O conhecimento das caracteristicas dos tipos de café por qualidade, que compõem o controle de estoque fisico e que fazem flutuar a conta opção, traz maior autonomia e segurança. O modelo atende ao desafio da melhoria contínua da qualidade da gestão, através da visão integrada da empresa, possibilitando o conhecimento real dos custos envolvidos e da margem de lucro, por qualidade, em cada operação. Busca-se um melhor controle das operações, dos custos dos produtos vendidos, de acordo com sua qualidade e sua margem de lucro em cada operação de venda, possibilitando um melhor planejamento da comercialização pelas cooperativas. Ao propor um novo modelo, integrando a análise custos e qualidade, o trabalho provocou o exame de vários procedimentos atualmente em uso, preparando o ambiente da empresa para uma nova mentalidade gerencial. Fez com que procedimentos relacionados à qualidade do café fossem devidamente estruturados no modelo de operação da empresa, servindo de referência para os trabalhos rumo à integração gerencial e à certificação ISO 9002, exigência do mercado externo e tendência no mercado interno. Deste modo, a cooperativa iniciou um processo de melhoria contínua, com a constante identificação de oportunidades, inspecionando e atualizando índices, levantando problemas e propondo soluções. O trabalho traz uma colaboração aos estudos de gestão integrada no agribusiness do café. A inovação ocorre através do desenvolvimento de um modelo conceitual de gestão de estoques e custos por qualidade, aliado ao modelo de gestão econômica, contribuindo para a melhoria da administração e do desempenho do setor. Aponta uma oportunidade de se dar um avanço para a gerência de custos e riscos, tornando o setor mais competitivo e de acordo com a nova cultura empresarial e com os padrões de competição de mercado.