Incentives and disincentives for reducing sugar in manufactured foods: An exploratory supply chain analysis

This policy brief presents the results of a novel food supply chain analysis that identifies insights for governments to consider when designing sugar reduction strategies. It explores the incentives and disincentives to using sugar in manufactured foods throughout the “sugar supply chain” – the actors and activities that take sugar from farm to fork. It draws on the perspectives of entities working inside this sugar supply chain to explore the following key questions: • What are the incentives and disincentives for industry to reduce the amount of sugar in manufactured food and drink products? • At what point along the supply chain do these incentives and disincentives operate? • Are there opportunities to effectively enhance the incentives and/or lessen the disincentives for reducing sugar

Poultry producers’ perceptions of changing market conditions : a field study of the poultry production in Khartoum state of Sudan

Sudan has always showed great potential in the poultry industry, but it has not been until now that this potential has blossomed and is growing quickly. As large agribusinesses1are taking over the market shares within the urban areas, smallholders2 have been put out of business. They are not able to compete with mass production and lack financial assets to improve their production techniques. Contract farming is defined as initiatives from agro industrial companies to secure access to smallholder produce and has in developing countries become a way of allowing the poor to participate in a larger market (Farrington, 1999). The aim with this study was to investigate the suitability of implementing the contract farming concept within the poultry industry in Sudan today. The study is a qualitative field study and the authors have conducted qualitative interviews with respondents involved in the poultry industry in Sudan. For an overall perspective the respondents represented different parts of the poultry industry. The empirical results were later analysed in relation to the assumptions of agency theory. The results found imply that it would be difficult to introduce contract farming in Sudan’s poultry industry today. This is mainly explained by the agribusinesses unwillingness to take on more responsibility as they already are under stress because of government interference. Other findings are that the agribusinesses see no benefits from entering a contract agreement with a smallholder. The study also found that nor the smallholders did see much benefits other than financial from cooperation with the agribusinesses. Political issues cause problems for agribusinesses as well as smallholders, and have created a nervous society where independence seems to be the goal of each party. 1 Agribusiness refers to the various businesses that are connected with producing, preparing and selling farm product (www.dictionary.cambridge.org, 2012). 2 Smallholder refers to farmers operating a farm of 2 ha or less (www.ifpri.org , 2007).Sudan har alltid visat stor potential för kycklingproduktion men det är först nu som denna potential tillåts blomstra och växer snabbt. Då stora företag tar över marknadsandelar i städerna, tvingas småproducenterna lägga ner sin verksamhet. De inte har möjlighet att konkurrera med massproduktion och saknar finansiella tillgångar för att förbättra sina produktionssystem. Kontraktsproduktion definieras som initiativ tagna av stora företag för att säkra tillgången till småföretagarnas produktion och har i utvecklingsländer varit ett sätt för småproducenter att nå en större marknad (Farrington, 1999). Syftet med denna studie var att undersöka lämpligheten att införa kontraktsproduktion inom fjäderfäindustrin i Sudan i dag. Studien är en kvalitativ fältstudie och författarna har genomfört kvalitativa intervjuer med respondenter involverade i Sudans fjäderfäindustri. För ett helhetsperspektiv representerade de intervjuade olika delar av fjäderfäbranschen. De empiriska resultaten analyserades i förhållande till Agenteorins teorier. Resultaten antyder att det skulle vara svårt att införa kontraktsproduktion inom Sudans fjäderfäindustri idag. Detta förklaras främst av att de stora företagens ovilja att ta ett större ansvar, eftersom de redan är under stress på grund av regeringens inblandning. Dessutom ser de stora företagen inga fördelar med att ingå avtal med småproducenter. Studien fann även att även småproducenterna såg få förmåner utöver finansiella från samarbete med stora företag. Politiska problem gör det svårt för både företag och småproducenter och har skapat ett oroligt samhälle där autonomi tycks vara varje parts mål

Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): Study protocol for a randomised controlled trial

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. Trial registration number ACTRN12617001084370; Pre-results

A GIS-based methodological framework to identify superficial water sources and their corresponding conduction paths for gravity-driven irrigation systems in developing countries

The limited availability of fresh water is a major constraint to agricultural productivity and livelihood security in many developing countries. Within the coming decades, smallholder farmers in drought-prone areas are expected to be increasingly confronted with local water scarcity problems, but their access to technological knowledge and financial resources to cope with these problems is often limited. In this article, we present a methodological framework that allows for identifying, in a short period of time, suitable and superficial water sources, and cost-effective water transportation routes for the provisioning of gravity-driven irrigation systems. As an implementation of the framework, we present the automated and extensible geospatial toolset named “AGRI’’, and elaborate a case study in Western Honduras, where the methodology and toolset were applied to provide assistance to field technicians in the process of identifying water intake sites and transportation routes. The case study results show that 28 % of the water intake sites previously identified by technicians (without the support of AGRI) were found to be not feasible for gravity-driven irrigation. On the other hand, for the feasible water intake sites, AGRI was able to provide viable and shorter water transportation routes to farms in 70 % of the cases. Furthermore, AGRI was able to provide alternative feasible water intake sites for all considered farms, with correspondingly viable water transportation routes for 74 % of them. These results demonstrate AGRI’s potential to reduce time, costs and risk of failure associated with the development of low-cost irrigation systems, which becomes increasingly needed to support the livelihoods of some of the world’s most vulnerable populations

Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial

<p><b>Background:</b> Fear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people. The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain. The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice, in adults attempting smoking cessation.</p> <p><b>Methods:</b> Cluster randomised controlled design. Classes randomised to intervention commenced a 24-week intervention, focussed on improving food choice and minimising weight gain. Classes randomised to control received "usual care".</p> <p><b>Results:</b> Twenty-seven classes in Greater Glasgow were randomised between January and August 2008. Analysis, including those who continued to smoke, showed that actual weight gain and percentage weight gain was similar in both groups. Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects (3.9 (SD 3.1) vs. 2.7 (SD 3.7) kg). Between group differences were not significant (p=0.23, 95% CI -0.9 to 3.5). In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group. A higher percentage of control participants continued smoking (74% vs. 66%).</p> <p><b>Conclusions:</b> The intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants. Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain. Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence.</p&gt

Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

A comparison of walk-in counselling and the wait list model for delivering counselling services

Background: Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. Aims: To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list Method: Mixed methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow ups, and qualitative analysis of interviews with a subsample. 524 participants 16 years and older were recruited from two Family Counselling Agencies; the General Health Questionnaire assessed change in psychological distress; prior use of other mental health and instrumental services was also reported. Results: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the 4-week follow-up compared to the traditional service delivery model. At the 10-week follow-up, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. Qualitative interviews confirmed participants valued the accessibility of the walk-in model. Conclusions: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery that is not conducive to randomized controlled trials

Iodine and pregnancy – a qualitative study focusing on dietary guidance and information

Iodine is essential for thyroid hormones synthesis and normal neurodevelopment; however, ~60% of pregnant women do not meet the WHO (World Health Organization) recommended intake. Using a qualitative design, we explored the perceptions, awareness, and experiences of pregnancy nutrition, focusing on iodine. Women in the perinatal period (n = 48) were interviewed and filled in a food frequency questionnaire for iodine. Almost all participants achieved the recommended 150 μg/day intake for non-pregnant adults (99%), but only 81% met the increased demands of pregnancy (250 μg/day). Most were unaware of the importance, sources of iodine, and recommendations for iodine intake. Attitudes toward dairy products consumption were positive (e.g., helps with heartburn; easy to increase). Increased fish consumption was considered less achievable, with barriers around taste, smell, heartburn, and morning sickness. Community midwives were the main recognised provider of dietary advice. The dietary advice received focused most often on multivitamin supplements rather than food sources. Analysis highlighted a clear theme of commitment to change behaviour, motivated by pregnancy, with a desired focus on user-friendly documentation and continued involvement of the health services. The study highlights the importance of redirecting advice on dietary requirements in pregnancy and offers practical suggestions from women in the perinatal period as the main stakeholder group

Mainstreaming prevention: Prescribing fruit and vegetables as a brief intervention in primary care

This is the author's PDF version of an article published in Public health© 2005.This articles discusses a project at the Castlefields Health Centre in Halton whereby primary care professionals issue a prescription for discounts on fruit and vegetables. The prescription is explicitly linked to the five-a-day message

National Foreclosure Mitigation Counseling Program Evaluation: Final Report, Rounds 1 and 2

The National Foreclosure Mitigation Counseling (NFMC) program is a special federal appropriation, administered by NeighborWorks (NW) America, to support a rapid expansion of foreclosure intervention counseling in response to the nationwide foreclosure crisis. As this is a federal appropriation, NW America must inform Congress and other entities of the NFMC program's progress. The Urban Institute (UI) was selected by NW America to evaluate the NFMC program. This report presents the final results from UI's evaluation of the first two rounds of the NFMC program (people receiving counseling in 2008 and 2009), including a detailed analysis of program outcomes first described in preliminary reports of November 2009 (Mayer et al.) and December 2010 (Mayer et al.). According to those reports, homeowners receiving NFMC counseling avoided entering foreclosure, successfully cured existing foreclosures, and obtained more favorable loan modifications. This report updates previous analyses and also includes revised models of several homeowner outcomes for NFMC clients counseled in 2008 and 2009. These new models use an improved comparison sample selection design, which addressed potential issues raised by reviewers of earlier analyses, and a better method for controlling for possible selection bias in the NFMC sample. The additional analyses in this report include models of non-modification cures, non-modification redefaults, and foreclosures avoided