Relational conceptions of paternalism : a way to rebut nanny-state accusations and evaluate public health interventions

This work is funded by NHMRC grant 1023197. Stacy Carter is funded by an NHMRC Career Development Fellowship 1032963.

Non-prescription medicine misuse, abuse and dependence : a cross-sectional survey of the UK general population

This study was supported by the Society of the Study of Addiction in the form of a PhD studentship awarded to NF.

Association of fever and severe clinical course in bronchiolitis

Little attention has been given to the relation between fever and the severity of bronchiolitis. Therefore, the relation between fever and the clinical course of 90 infants (59 boys, 31 girls) hospitalised during one season with bronchiolitis was studied prospectively. Fever (defined as a single recording > 38.0°C or two successive recording > 37.8°C) was present in 28 infants. These infants were older (mean age, 5.3 v 4.0 months), had a longer mean hospital stay (4.2 v2.7 days), and a more severe clinical course (71.0%v 29.0%) than those infants without fever. Radiological abnormalities (collapse/consolidation) were found in 60.7% of the febrile group compared with 14.8% of the afebrile infants. These results suggest that monitoring of body temperature is important in bronchiolitis and that fever is likely to be associated with a more severe clinical course and radiological abnormalities.

The food multimix concept: potential of an innovative food based approach on nutritional status in pregnant women in resource-poor communities

RATIONALE & OBJECTIVES: The food multimix (FFM)concept states that limited food resources can be combined using scientific knowledge to meet nutrient needs of vulnerable groups at low cost utilizing the ‘nutrient strengths’ of individual or candidate foods in composite recipes within a cultural context. METHODS: The method employed the food-to-food approach for recipe development using traditional food ingredients. Recipes were subjected to proximate and micronutrient analysis and optimized to meet at tleast 40% of recommended daily intakes. End products including breads, porridge and soup were developed. RESULTS: FMM products were employed in a feeding trial among 120 healthy pregnant women in Gauteng, South Africa resulting in improvements in serum iron levels from baseline values of 14.59 (=/-7.67) umol/L and 14.02 (=/-8.13) umol/L for control and intervention groups (p=0.71), to 16.03 (=/-5.67) umol/L and 18.66 (=/-9.41) umol/L (p=0.19). The increases from baseline to post-intervention were however statistically significant within groups. Similarly Mean Cell Volume values improved from baseline as well as serum ferritin and transferritin levels. CONCLUSION: The FMM concept has potential value in feeding programs for vulnerable groups including pregnant and lactating mothers.

Assessment of the nutritional value of wild leafy vegetables consumed in the Buhera District of Zimbabwe: a preliminary study

Wild leafy vegetables play a vital role in the livelihoods of many communities in Africa. The focus of this study was to investigate the nutritional value of wild vegetables commonly consumed by the people of Buhera District in the Manicaland province of Zimbabwe. A variety of vegetables including Amaranthus hybridus, Cleome gynandra, Bidens pilosa, Corchorus tridens, and Adansonia digitata were collected during a survey in Buhera District. Samples were processed employing traditional methods of cooking and drying, then subjected to proximate and micronutrient analyses. The results indicate that these vegetables were particularly high in calcium, iron, and vitamin C. Compared with Brassica napus (rape), Amaranthus hybridus contained twice the amount of calcium, with other nutrients almost in the same range. Compared with Spinacia oleracea (spinach), Amaranthus hybridus contained three times more vitamin C (44 mg/100 g). Calcium levels were 530 mg/100 g. Amaranthus hybridus was also found to contain 7, 13, and 20 times more vitamin C, calcium, and iron respectively compared with Lactuca sativa (lettuce). Cleome gynandra contained 14 mg/100 g, 115 mg/100 g, 9 mg/100 g of vitamin C, calcium, and iron respectively. Bidens pilosa was found to be a valuable source of vitamin C (63 mg/100 g), iron (15 mg/100 g), and zinc (19 mg/100 g), compared with Brassica oleracea (cabbage). The leaves of Corchorus tridens were an excellent source of vitamin C (78 mg/100 g), calcium (380 mg/100 g), and iron (8 mg/100 g). The Adansonia digitata leaves were also rich in vitamin C (55 mg/100 g), iron (23 mg/ 100 g), and calcium (400 mg/100 g). Based on these nutrient contents, the above vegetables will have potential benefits as part of feeding programmes, as well as their promotion as part of composite diet for vulnerable groups.

Age and gender influences on sensory perceptions of novel low cost nutrient-rich food products developed using traditional Ghanaian food ingredients

Background: A number of factors are known to influence food preferences and acceptability of new products. These include their sensory characteristics and strong, innate neural influences. In designing foods for any target group, it is important to consider intrinsic and extrinsic characteristics which may contribute to palatability, and acceptability of foods. Objective: To assess age and gender influences on sensory perceptions of novel low cost nutrient-rich food products developed using traditional Ghanaian food ingredients. Materials and Methods: In this study, a range of food products were developed from Ghanaian traditional food sources using the Food Multimix (FMM) concept. These products were subjected to sensory evaluation to assess the role of sensory perception on their acceptability among different target age groups across the life cycle (aged 11-68 years olds) and to ascertain any possible influences of gender on preference and choice. Variables including taste, odour, texture, flavour and appearance were tested and the results captured on a Likert scale and scores of likeness and acceptability analysed. Multivariate analyses were used to develop prediction models for targeted recipe development for different target groups. Multiple factor analysis of variance (ANOVA) and logistic linear regression were employed to test the strength of acceptability and to ascertain age and gender influences on product preference. Results: The results showed a positive trend in acceptability (r = 0.602) which tended towards statistical significance (p = 0.065) with very high product favourability rating (91% acceptability; P=0.005). However, age [odds ratios=1.44 (11-15 years old) odds ratios=2.01 (18-68 years old) and gender (P=0.000)] were major influences on product preference with children and females (irrespective of age) showing clear preferences or dislike of products containing certain particular ingredients. Conclusion: These findings are potentially useful in planning recipes for feeding interventions involving different vulnerable and target groups.

Health status of an elderly population in Sharpeville, South Africa

The objective of this cross-sectional study was a comprehensive nutrition and health assessment to provide a basis for future intervention strategies for an elderly population attending a day-care centre. Socio-demographic, health and 24-hour recall dietary intake questionnaires were administered and anthropometric and biochemical measurements taken. The results indicate that the majority of respondents had an income of between R501 and R1 000 (South African rand) per month and most of them reported an occasional lack of funds to meet basic household needs, confirming the presence of food insecurity. Daily dietary intakes (mean [+ or -] Standard Deviation [SD]) of the women were 5 395 [+ or -] 2 946 kJ energy, 47 [+ or -] 27 g protein, 28 [+ or -] 21 g fat and 196 [+ or -] 123 g carbohydrates compared to 8 641 [+ or -] 3 799 kJ, 86 [+ or -] 48 g, 49 [+ or -] 32 g and 301 [+ or -] 139 g of the men, respectively. The majority (83.6%) of the women were overweight (body mass index [BMI] [greater than or equal to] 25) or obese (BMI [greater than or equal to] 30) whilst 78% had a mid-upper arm circumference (MUAC) of [greater than or equal to] 21.7 cm. Mean intakes of micronutrients were low in comparison to reference standards and serum zinc levels were suboptimal. Obesity, hypertension and raised total serum cholesterol levels indicated an increased risk for coronary heart disease. It can be concluded that a low income, household food insecurity and risk factors associated with malnutrition and non-communicable diseases were prevalent in this elderly population. OPSOMMING Die doelwit van hierdie dwarssnitstudie was ‘n omvattende bepaling van voeding- en gesondheidstatus om as basis te dien vir toekomstige intervensiestrategieë vir ’n groep bejaardes wat ’n dagsentrum besoek. Sosiodemografiese, gesondheid- en 24-uur herroep-dieetinname vraelyste is voltooi en antropometriese en biochemiese metings is geneem. Die resultate het bevestig dat die meerderheid respondente ‘n maandelikse inkomste van tussen R501 en R1 000 (Suid-Afrikaanse rand) gehad het. Die meeste het ‘n geldtekort vir basiese huishoudelike behoeftes gerapporteer wat dui op huishoudelike voedselinsekuriteit. Daaglikse dieetinnames (gemiddeld±standaardafwyking [SA]) van die vroue was onderskeidelik 5 395±2 946 kJ energie, 47±27 g proteïen, 28±21 g vet en 196±123 g koolhidrate in vergelyking met 8 641±3 799 kJ, 86±48 g, 49±32 g en 301±139 g vir die mans. Die meerderheid (83.6%) van die vroue was oorgewig (liggaamsmassa-indeks [LMI] >25) of vetsugtig (LMI > 30) en 78% het ’n middel-bo-armomtrek (MUAC) van > 21.7 cm gehad. Gemiddelde mikronutriëntinnames was laag in vergelyking met die verwysingstandaarde en serumsink was suboptimaal. Vetsug, hipertensie en verhoogde totale serumcholesterolvlakke het op ‘n verhoogde risiko van kardiovaskulêre siekte gedui. Die resultate het dus bewys dat lae inkomste, huishoudelike voedselinsekuriteit en die risikofaktore wat met wanvoeding en leefstylsiektes geassosieer word, teenwoordig was.

Female frequent internet gamblers: a qualitative study of their gambling, its impact and their views on treatment and policy

Aims: to study the gambling history and stories of participants, motivations, impact and helpseeking. Method: Details were advertised on websites and newspapers. 30 frequent gamblers were interviewed over the telephone for approximately one hour. Verbatim transcriptions were analysed using NVIVO and grounded theory. Results/conclusions: Not all women had gambled before. However, internet accessibility meant prolonged periods were spent gambling to the neglect of other life areas. Some were originally motivated by excitement but others gambled to escape from current difficulties. Depression, anxiety, panic attacks and suicide ideation were common. The women were ambivalent towards their gambling and receiving help.

We could make a meal out of nothing: contested explanations of inequalities in health

This paper reports on the qualitative findings from a comparative study of public health and lifestyles in South East England and Northern France, regions with similar geographic and economic characteristics. Data from health surveys showed that both countries had an increasing BMI with age, particularly in Northern France. This was despite the finding that the percentage eating fresh fruit and vegetable at least five days a week in Northern France increased with age (from well over 50% to over 90%) compared to around 50% to around 75% in South East England. Qualitative data on health inequalities and how they could be addressed were gathered by focus groups sampling from five tiers using the Townsend Index for comparability (14 in England with 106 participants overall; 13 in France with 143 participants). Both had about two thirds women participants, with a preponderance of middle aged and older people. There was a striking difference in the salience of diet between the two countries; in the French data it was raised only 14 times, whereas in England there were 165 occurrences, and these were often distinguished by their use of narrative. Older respondents contrasted the pressures on families today and the expense of fresh fruit and vegetables with their own childhood or childrearing, when cheap meals could be created using skills which have now been lost. These data therefore provide further evidence that providing food is a moral activity.