Public health nutrition in Europe : workforce development and policy change

Public health nutrition workforce development is an important prerequisite for developing a nation’s capacity to achieve public health nutrition objectives. Presently, there is a lack of knowledge about public health nutrition workforce development in Europe, in particular, about how governments have developed strategies for promoting a skilled and adaptable public health nutrition workforce and about the current workforce in terms of roles, competencies and functions. The aim of this thesis is to explore workforce development in order to identify current needs and to develop a better understanding of the policy processes that lead to public health nutrition policy changes. Initially, a qualitative study comprising semi-structured face-to-face interviews was conducted to identify enabling and constraining factors of workforce development in seven European countries (Study I). In the following case-study, the agenda setting of a food and nutrition policy in Slovenia was scrutinised by applying Kingdon’s streams model (Study II). In Study IV, the Swedish public health policy process from 1960- 2006 was examined to distinguish policy learning patterns. Finally, we conducted a Delphi-study in order to develop a set of core functions to guide strategic workforce development (Study III). This thesis shows that public health nutritionists as a workforce is largely missing in practice. In countries where public health nutritionists were recognised in policies and organisational aims and programmes, it was more likely that employers supported the roles and saw the value of employing public health nutritionists (Study 1). Investigation of specific cases showed how a food and nutrition policy could be established in Slovenia despite weak initial interest from dominant coalitions in the government (Study II). It specifically points to the importance of particular individuals and their cognitive characteristics (i.e. analytical, strategic and entrepreneurial skills) in order to influence the policy process. Study IV points to the importance of the Swedish committee system as a decision-making arena where public health ideas can be debated and consensus agreed upon in order to enable public health policy learning across groups and influence policy change. Consensus on the core functions of the public health nutrition workforce emphasized the importance of analytical, advisory and interventionist functions in the context of preventing diet-related diseases in populations (Study III). In order to secure public health nutrition processes and change, we need to learn about the context of policy subsystems (actors who have decision-making power in public health nutrition issues, expert networks, governmental agencies, intergovernmental organisations) and the relationships between actors and institutions, including their power and authority. Potential implications based on the findings presented in this thesis are that it is necessary to stimulate relationships between governmental agencies, public health organisations at regional level, practitioners and private sector in order to improve public health nutrition agendas and workforce development strategies. Considering the current gap of knowledge about public health nutrition workforce development in Europe, there is a need to learn from countries that have been successful in increasing the national and sub-national institutional capacity to lead, coordinate and implement public health nutrition objectives

Premarital Agreements in the ALI Principles of Family Dissolution

Syftet med denna rapport är att beskriva arbetet kring utvecklingen av en webbapplikation för försäljning av t-shirts - Shrt - och utreda möjligheterna för att lansera varumärket på marknaden. Projektet utgick ifrån visionen ”att ge våra kunder verktygen som behövs för att uttrycka sin personlighet, genom mode som kunden själv designar, via webben”. Under projektet har utvecklingsmetodiken scrum använts tillsammans med andra verktyg som är vanliga vid agila projekt. Vid konkretisering av varumärket Shrt och dess produkt genomfördes brainwriting. För att skapa en produktbacklogg använde sig utvecklingsgruppen av arbetsmetoderna funktionsanalys, konceptdivergens, konceptutvärdering och prototyping. Funktionerna i produktbackloggen delades sedan in i kategorierna nödvändiga, önskvärda samt onödiga funktioner. Produktbackloggen låg sedan till grund för hur arbetet delades upp i tre olika sprintar med separata mål och redovisningar. Den första sprinten fokuserade på funktion, den andra på upplevelse för användaren och den tredje på underhåll samt förbättring av kod – refaktorering. Under slutet av utvecklingen genomfördes användartester utifrån Task-based scenarios där användaren får försöka utföra en uppgift utan instruktioner på hur den ska utföras.   Resultatet av projektet blev en webbapplikation med all funktionalitet som klassificerades som nödvändig och önskvärd. Detta var något som utvecklingsgruppen ansåg vara ett acceptabelt resultat. Om tiden för utveckling hade varit längre är det möjligt att ytterligare funktionalitet hade kunnat implementeras. Det hade säkerligen varit positivt för varumärket Shrt, som hade kunnat ge ett mer professionellt intryck för slutanvändaren.

Two Distinct Pathways of B-Cell Development in Peyer’s Patches

The developmental biology of sheep ileal and jejunal Peyer’s patches (PP) was investigated using corticosteroids to deplete immature B lymphocytes. During a 7-day treatment with dexamethasone, ileal PP follicular (iPf)B-cell proliferation was arrested and most iPfB-cells died. This resulted in follicular involution with the survival of mesenchymal cells. No iPfB-cell proliferation was detected in follicular remnants for 4 weeks postdexamethasone treatment, and during a subsequent 3-month period, there was limited iPfB-cell proliferation that resulted in a partial regeneration of follicles. Ileal PP involution was also associated with a severe B lymphopenia that persisted for over 14 weeks and was characterized by the survival of primarily isotype-switched and CD5+ sIgM+ B-cells in blood. In contrast, the size of jejunal PP follicles was reduced following dexamethasone treatment, but intrafollicular B-cell proliferation was not arrested. Furthermore, within 4 weeks, the jejunal PP follicles had recovered in size and cellularity and there was no disruption in IgA plasma-cell production. Thus, dexamethasone selectively depleted iPfB-cells and revealed that the ileal and jejunal PPs contain functionally distinct B-cell populations. The partial regeneration of the iPfB-cell population indicated that either an intrafollicular, corticosteroid-resistant B-stem cell existed or that ileal PP follicles can be repopulated by circulating B-cells. Finally, the association between ileal PP involution and the absence of circulating, CD5- B-cells confirmed that this lymphoid tissue provides an essential environment for conventional sIgM+ B-cell development

The role of nitrogen in achieving sustainable food systems for healthy diets

The ‘food system’ urgently needs a sustainable transformation. Two major challenges have to be solved: the food system has to provide food security with healthy, accessible, affordable, safe and diverse food for all, and it has to do so within the safe operating space of the planetary boundaries, where the pollution from reactive nitrogen turned out to be the largest bottleneck. Here we argue that thinking strategically about how to balance nitrogen flows throughout the food system will make current food systems more resilient and robust. Looking from a material and a governance perspective on the food system, we highlight major nitrogen losses and policy blind spots originating from a compartmentalization of food system spheres. We conclude that a participatory and integrated approach to manage nitrogen flows throughout the food system is necessary to stay within regional and global nitrogen boundaries, and will additionally provide synergies with a sustainable and healthy diet for all. © 2020 The Author

Establishing Levels of Indications for Cataract Surgery: Combining Clinical and Questionnaire Data into a Measure of Cataract Impact

This article is made available with the permission of the publisher, Association for Research in Vision and OphthalmologyPurpose.: To develop a model for establishing indications for cataract surgery that incorporates clinical and questionnaire data on a single linear scale using Rasch analysis. Methods.: In this prospective study, 293 preoperative cataract surgery patients (mean age, 72.8 ± 10 years; age range, 33–98 years; 174 female, 119 male; 49% with ocular comorbidity) completed two questionnaires, and visual acuity was measured in each eye. A cataract impact model was developed using Rasch analysis incorporating questionnaire scores and visual acuity. Participants were ranked from 1 to 293 based on the order in which they presented (first in first out [FIFO]) and then were ranked based on the cataract impact model. The main outcome measure was the number of participants moving 49 (16.7% change) rank positions, which represented a likelihood to change priority category. Results.: The cataract impact model was unidimensional (fit statistics within 0.66–1.68) and had adequate precision (person separation of 2.58), and the components were well targeted to the population (0.05 logits between the mean item difficulty and person ability). Two hundred twenty-seven (77.5%) patients moved by at least 49 rank positions. Conclusions.: It is possible to combine clinical and questionnaire data and rank patients on a single linear scale. This approach modifies the ranking that occurs with the FIFO model and can be used for prioritizing patients for surgical intervention. More sophisticated models incorporating more clinical information may provide a better measure of the cataract impact latent trait

A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease

Objective: Celiac disease (CD) is associated with type 1 diabetes (T1D). In the current study, we examined whether CD affects the risk of diabetic retinopathy (DRP) in patients with T1D. Research design and methods: This was a population-based cohort study. Through the Swedish National Patient Register, we identified 41,566 patients diagnosed with diabetes in 1964–2009 and who were ≤30 years of age at diagnosis. CD was defined as having villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments. During follow-up, 947 T1D patients had a diagnosis of CD. We used Cox regression analysis with CD as a time-dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and CD and compared them with patients with T1D but no CD. Results: Duration of CD correlated with the risk of DRP. When results were stratified by time since CD diagnosis, individuals with T1D and CD were at a lower risk of DRP in the first 5 years after CD diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to <10 (1.03 [0.68–1.57]). With longer follow-up, coexisting CD was a risk factor for DRP (10 to <15 years of follow-up, aHR 2.83 [95% CI 1.95–4.11]; ≥15 years of follow-up, 3.01 [1.43–6.32]). Conclusions: Having a diagnosis of CD for >10 years is a risk factor for the development of DRP in T1D. Long-standing CD in patients with T1D merits intense monitoring of DRP

Temperature triggers immune evasion by Neisseria meningitidis.

Neisseria meningitidis has multiple strategies to evade complement-mediated killing, which contribute to its ability to cause septicaemic disease and meningitis. However, the meningococcus is primarily an obligate commensal of the human nasopharynx, and it is unclear why the bacterium has evolved exquisite mechanisms to avoid host immunity. Here we demonstrate that mechanisms of meningococcal immune evasion and resistance against complement increase in response to an elevation in ambient temperature. We have identified three independent RNA thermosensors located in the 5′-UTRs of genes necessary for capsule biosynthesis, the expression of factor H binding protein, and sialylation of lipopolysaccharide, which are essential for meningococcal resistance against immune killing(1,2). Therefore increased temperature (which occurs during inflammation) acts as a ‘danger signal’ for the meningococcus which enhances defence against human immune killing. Infection with viral pathogens, such as influenza, leads to inflammation in the nasopharynx with an elevated temperature and recruitment of immune effectors(3,4). Thermoregulation of immune defence could offer an adaptive advantage to the meningococcus during co-infection with other pathogens, and promote the emergence of virulence in an otherwise commensal bacterium