Instrumental swallowing assessment in adults in residential aged care homes : Practice patterns and opportunities

Objective To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). Methods A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns. Results Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2[1] = 7.06, p = 0.008), texture modification (χ2[1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2[1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators. Conclusions Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management

Local food systems: concepts, impacts, and issues

Consumer demand for food that is locally produced,marketed, and consumed is generating increased interest in local food throughout the United States. As interest grows, so do questions about what constitutes local food and what characterizes local food systems. What Is the Issue? This study provides a comprehensive literature-review-based overview of the current understanding of local food systems, including: alternative defi nitions; estimates of market size and reach; descriptions of the characteristics of local food consumers and producers; and an examination of early evidence on the economic and health impacts of such systems. What Did the Study Find? There is no generally accepted definition of “local” food. Though “local” has a geographic connotation, there is no consensus on a definition in terms of the distance between production and consumption. Definitions related to geographic distance between production and sales vary by regions, companies, consumers, and local food markets. According to the definition adopted by the U.S. Congress in the 2008 Food, Conservation, and Energy Act,the total distance that a product can be transported and still be considered a “locally or regionally produced agricultural food product” is less than 400 miles from its origin, or within the State in which it is produced. Definitions based on market arrangements, including direct-to-consumer arrangements such as regional farmers’ markets, or direct-to-retail/foodservice arrangements such as farm sales to schools, are well-recognized categories and are used in this report to provide statistics on the market development of local foods. Local food markets account for a small but growing share of total U.S. agricultural sales. • Direct-to-consumer marketing amounted to $1.2 billion in current dollar sales in 2007, according to the 2007 Census of Agriculture, compared with$551 million in 1997. • Direct-to-consumer sales accounted for 0.4 percent of total agricultural sales in 2007, up from 0.3 percent in 1997. If nonedible products are excluded from total agricultural sales, direct-to consumer sales accounted for 0.8 percent of agricultural sales in 2007. • The number of farmers’ markets rose to 5,274 in 2009, up from 2,756 in 1998 and 1,755 in 1994, according to USDA’s Agricultural Marketing Service. • In 2005, there were 1,144 community-supported agriculture organizations, up from 400 in 2001 and 2 in 1986, according to a study by the National Center for Appropriate Technology. In early 2010, estimates exceeded 1,400, but the number could be much larger. • The number of farm to school programs, which use local farms as food suppliers for school meals programs and promote relationships between schools and farms, increased to 2,095 in 2009, up from 400 in 2004 and 2 in the 1996-97 school year, according to the National Farm to School Network. Data from the 2005 School Nutrition and Dietary Assessment Survey, sponsored by USDA’s Food and Nutrition Service, showed that 14 percent of school districts participated in Farm to School programs, and 16 percent reported having guidelines for purchasing locally grown produce. Production of locally marketed food is more likely to occur on small farms located in or near metropolitan counties. Local food markets typically involve small farmers, heterogeneous products, and short supply chains in which farmers also perform marketing functions, including storage, packaging, transportation, distribution, and advertising. According to the 2007 U.S. Census of Agriculture, most farms that sell directly to consumers are small farms with less than $50,000 in total farm sales, located in urban corridors of the Northeast and the West Coast. In 2007, direct-to-consumer sales accounted for a larger share of sales for small farms, as defi ned above, than for medium-sized farms (total farm sales of$50,000 to $499,999) and large farms (total farm sales of$500,000 or more). Produce farms engaged in local marketing made 56 percent of total agricultural direct sales to consumers, while accounting for 26 percent of all farms engaged in direct-to-consumer marketing. Direct-to-consumer sales are higher for the farms engaged in other entrepreneurial activities, such as organic production, tourism, and customwork (planting, plowing, harvesting, etc. for others), than for other farms. In 2007, direct sales by all U.S. farms surpassed customwork to become the leading on-farm entrepreneurial activity in terms of farm household participation. Barriers to local food-market entry and expansion include: capacity constraints for small farms and lack of distribution systems for moving local food into mainstream markets; limited research, education, and training for marketing local food; and uncertainties related to regulations that may affect local food production, such as food safety requirements. Consumers who value high-quality foods produced with low environmental impact are willing to pay more for locally produced food. Several studies have explored consumer preferences for locally produced food. Motives for “buying local” include perceived quality and freshness of local food and support for the local economy. Consumers who are willing to pay higher prices for locally produced foods place importance on product quality, nutritional value, methods of raising a product and those methods’ effects on the environment, and support for local farmers. Federal, State, and local government programs increasingly support local food systems. Many existing government programs and policies support local food initiatives, and the number of such programs is growing. Federal policies have grown over time to include the Community Food Project Grants Program, the WIC Farmers’ Market Nutrition Program, Senior Farmers’ Market Nutrition Program, Federal State Marketing Improvement Program, National Farmers’ Market Promotion Program, Specialty Crop Block Grant Program, and the Community Facilities Program. State and local policies include those related to farm-to-institution procurement, promotion of local food markets, incentives for low-income consumers to shop at farmers’ markets, and creation of State Food Policy Councils to discuss opportunities and potential impact of government intervention. (WIC is the acronym for the Special Supplemental Nutrition Program for Women, Infants, and Children). As of early 2010, there were few studies on the impact of local food markets on economic development, health, or environmental quality. • Empirical research has found that expanding local food systems in a community can increase employment and income in that community. • Empirical evidence is insuffi cient to determine whether local food availability improves diet quality or food security. • Life-cycle assessments—analyses of energy use at all stages of the food system including consumption and disposal—suggest that localization can but does not necessarily reduce energy use or greenhouse gas emissions. How Was the Study Conducted? Existing analyses of local food markets by universities, government agencies, national nonprofit organizations, and others of local food markets were synthesized to evaluate the definition of local foods and the effects of local food systems on economic development, health and nutrition, food security, and energy use and greenhouse gas emissions. The report’s content relies on data collected through the 2007 Census of Agriculture, as well as other surveys by USDA’s Agricultural Marketing Service, the National Farm to School Network, university extension departments, and others, to provide a comprehensive picture of types of local food markets, their characteristics, and their importance over time.Local food systems; farmers’ markets; direct-to-consumer marketing; direct-to-retail/foodservice marketing; community supported agriculture; farm to school programs; Farmers’ Market Promotion Program; food miles; ERS; USDA

Stakeholders' perceptions on sustainability transition pathways of the cocoa value chain towards improved livelihood of small-scale farming households in Cameroon

Given the persistent poor livelihood of cocoa-farming households, future climate predictions and the worldwide demand pressure for higher cocoa quality and productivity, there is still a strong need to find new approaches that guarantee a sustainable cocoa future in cocoa-producing countries amongst which Cameroon is one of them. This exploratory research investigates potential future pathways for the cocoa sector in Cameroon by mapping the perceptions of actors involved in the socio-technical regime. Qualitative expert interviews, structured questionnaires and field observation, as well as a focus group discussion have been applied to understand how a sustainability transition can be triggered. The study shows that actors envisage a sustainability change which determines their actions; however, their perceptions towards future transitions are not actively coordinated. Actors are not finding a way of adopting new organizational structures and letting a transition occur effectively, like in the case of certification standards. An alignment of perceptions and activities, and a stronger cooperation between the private and public are strongly recommended. The study encourages to consider a coordination of actors' perceptions towards future scenarios as a starting point to study sustainability transitions

Stakeholders' perceptions on sustainability transition pathways of the cocoa value chain towards improved livelihood of small-scale farming households in Cameroon

Given the persistent poor livelihood of cocoa-farming households, future climate predictions and the worldwide demand pressure for higher cocoa quality and productivity, there is still a strong need to find new approaches that guarantee a sustainable cocoa future in cocoa-producing countries amongst which Cameroon is one of them. This exploratory research investigates potential future pathways for the cocoa sector in Cameroon by mapping the perceptions of actors involved in the socio-technical regime. Qualitative expert interviews, structured questionnaires and field observation, as well as a focus group discussion have been applied to understand how a sustainability transition can be triggered. The study shows that actors envisage a sustainability change which determines their actions; however, their perceptions towards future transitions are not actively coordinated. Actors are not finding a way of adopting new organizational structures and letting a transition occur effectively, like in the case of certification standards. An alignment of perceptions and activities, and a stronger cooperation between the private and public are strongly recommended. The study encourages to consider a coordination of actors' perceptions towards future scenarios as a starting point to study sustainability transitions

A Qualitative Study Exploring Healthy Eating and Physical Activity in Families with Young Children

Overweight and obesity in childhood affects health long-term. Parent attitudes and behaviours play major roles in their child’s weight despite no consensus on appropriate and effective family-focused interventions to successfully tackle childhood obesity. This research aims to explore caregiver perceptions, attitudes, and behaviours around children’s diet, exercise, and weight in East Sussex. In-depth qualitative interviews with mothers, fathers, and grandparents of children aged 2-11 years were conducted. Caregivers wanted to influence their children’s diet and exercise habits but were unable due to perceived and actual barriers. Barriers included cost, time, and a lack of control over food choices as children aged. Moreover, caregivers admitted to providing unhealthy sweets and snacks to please their children. While caregivers openly discussed their own weight concerns, they were less likely to discuss concerns about their children’s or grandchildren’s weight. When asked about the ideal amount of exercise, caregivers found it easy to describe a regime for adults but did not know the ideal amount of exercise for children. Many caregivers found it difficult to quantify exercise when it came to their children because children naturally played in ways that could be considered exercise. Family-based interventions should begin in early childhood and promote walking and dog-walking as forms of exercise, parental education on childhood exercise guidelines, and preparing and eating healthy home-cooked meals in the home

Local Food Systems: Concepts, Impacts, and Issues

This comprehensive overview of local food systems explores alternative definitions of local food, estimates market size and reach, describes the characteristics of local consumers and producers, and examines early indications of the economic and health impacts of local food systems. There is no consensus on a definition of “local” or “local food systems” in terms of the geographic distance between production and consumption. But defining “local” based on marketing arrangements, such as farmers selling directly to consumers at regional farmers’ markets or to schools, is well recognized. Statistics suggest that local food markets account for a small, but growing, share of U.S. agricultural production. For smaller farms, direct marketing to consumers accounts for a higher percentage of their sales than for larger farms. Findings are mixed on the impact of local food systems on local economic development and better nutrition levels among consumers, and sparse literature is so far inconclusive about whether localization reduces energy use or greenhouse gas emissions.local food systems, farmers’ markets, direct-to-consumer marketing, direct-to-retail/ foodservice marketing, community supported agriculture, farm to school programs, Farmers’ Market Promotion Program, food miles, Community/Rural/Urban Development,

A qualitative study to explore fathers’ attitudes towards breastfeeding in South West England

Aim: To explore the beliefs, attitudes, and behaviours of fathers towards breastfeeding and how they impact either positively or negatively on their partners’ decisions to initiate or continue breastfeeding. Background: Despite policy initiatives at a national and international level and the increased number of baby-friendly hospitals within the UK, breastfeeding rates are slow to rise. Support from both parents has been proven to increase uptake and continuation rates, but there is little research into the emotional experience of fathers when it comes to breastfeeding. Methods: We conducted qualitative interviews with 18 fathers in Wiltshire, England. Principles of grounded theory were used throughout this study to guide the sampling, data collection, and data analysis. Findings: Fathers knew the health benefits of breastfeeding and wanted their child to breastfeed but were unsure of their place in the feeding process because they felt it was not their body. While they were aware of the benefits of breast milk for infants, fathers felt less informed of the practicalities of breastfeeding and the potential challenges they and their partner might have to overcome to breastfeed successfully for the recommended six-month period. Based on these findings, three segments were identified: the problem bonders, the dual bonders, and the pragmatists. All segments were concerned with the well-being of their partner and child and wanted their child to be breastfed. Health professionals can use the results of this study to create prenatal educational resources that take more of a preventive and problem-solving approach as opposed to promoting breastfeeding in efforts to comply with National Health Service guidelines, without offering solutions to common breastfeeding problems

In vivo Observation of Tree Drought Response with Low-Field NMR and Neutron Imaging

Using a simple low-field NMR system, we monitored water content in a livingtree in a greenhouse over two months. By continuously running thesystem, we observed changes in tree water content on a scale of halfan hour. The data showed a diurnal change in water content consistentboth with previous NMR and biological observations. Neutron imaging experiments showthat our NMR signal is primarily due to water being rapidly transported through the plant, and not to other sources of hydrogen, such as water in cytoplasm, or water in cell walls. After accountingfor the role of temperature in the observed NMR signal, we demonstratea change in the diurnal signal behavior due to simulated drought conditionsfor the tree. These results illustrate the utility of our system toperform noninvasive measurements of tree water content outside of a temperature controlled environment

Estado nutricional, uso de suplementos alimentares e insatisfação corporal em praticantes de exercício físico

Thus, the objective of the study was to evaluate body dissatisfaction and the use of dietary supplements and associate those with the nutritional status of physical exercise practitioners of a gym in the city of Lajeado-Rio Grande do Sul. Material and Methods: Sociodemographic data, use of dietary supplements and perception of the body itself and body dissatisfaction were collected through structured questionnaires. Weight, height and skinfolds were measured and the Body Mass Index (BMI) and the perceptual of body fat were calculated. Results: Regarding the nutritional status, 57.4% of the individuals in the sample had normal weight and 41.5% were overweight / obese; and only 17.0% the percentage of fat on average. The presence of body dissatisfaction (40.4%) was associated with practitioners of physical exercise who were classified as overweight/obesity by BMI (p=0.035). Most practitioners reported using hyperprotein food supplements (84.2%) and more than half of them without nutritional guidance (61.9%). For 95.7% of the sample, the main objective of physical exercise is physical fitness. Conclusion: A high percentage of body dissatisfaction was significantly associated with overweight / obesity. In addition, there was a high consumption of dietary supplements without adequate guidance, which can cause serious damage to the health of practitioners of physical exercise in gyms.O objetivo do estudo foi avaliar a insatisfação corporal, o uso de suplementos alimentares associando com o estado nutricional de praticantes de exercício físico de uma academia. Materiais e Métodos: Dados sociodemográficos, utilização de suplementos alimentares e percepção do próprio corpo e insatisfação corporal foram coletados através de questionários estruturados. Peso, estatura e dobras cutâneas foram aferidos e calculou-se o Ãndice de Massa Corporal (IMC) e o % de gordura corporal. Resultados: Em relação ao estado nutricional, 57,4% dos indivíduos da amostra apresentavam eutrofia e 41,5% excesso de peso/obesidade; e apenas 17% o percentual de gordura na média. A presença de insatisfação corporal (40,4%) foi associada a praticantes de exercício físico que foram classificados com sobrepeso/obesidade pelo IMC (p=0,035). A maioria dos praticantes referiu utilizar suplementos alimentares hiperproteicos (84,2%) e mais da metade destes sem orientação nutricional (61,9%). Para 95,7% da amostra o principal objetivo da prática de exercício físico é a forma física. Conclusão: Foi observado elevado percentual de insatisfação corporal associado significativamente ao sobrepeso/obesidade. Além disso, observou-se elevado consumo de suplementos alimentares sem orientação adequada o que pode acarretar graves prejuízo à saúde dos praticantes de exercício físico em academias