An Approach for Integrating and Analyzing Sustainability in Food-Based Dietary Guidelines

International organizations, governments, researchers, and activists have proposed the need for deeper integration of sustainability considerations in national food-based dietary guidelines (FBDGs). Yet, as recent scholarship advances the conversation, questions remain around how to effectively frame and address the interconnectedness of multiple sustainability domains. Little systematic analysis has evaluated how current FBDGs have integrated complex messages about socially, environmentally, and economically sustainable consumption practices with nutrition and health messages. This study had two nested objectives: (i) to examine the validity of an existing sustainable diets framework by assessing how sustainability concepts have been framed and included in national FBDGs available from 2011 to 2019 and (ii) to describe a novel analysis approach that augments an existing framework which integrates sustainability domains and can be adapted for use by future FBDGs. A qualitative content analysis was used to examine sustainability concepts found in 12 FBDGs and supporting documents available in English that were developed for use in 16 countries across Europe, North and South America, and Asia as of 2019-from a global review of those published prior to 2016 and gray literature review of publications between 2016 and 2019. Health domains were the primary frame found across the FBDGs examined, but documents also commonly incorporated agricultural, sociocultural, and economic sustainability principles. Analyzed documents were used to adapt an existing policy analysis framework into a "Sustainability in FBDGs Framework." This proposed framework contributes a novel analysis approach and has five core domains that are interconnected: health and nutrition, food security and agriculture, markets and value chains, sociocultural and political, and environment and ecosystems. This study adds to the growing body of literature related to sustainable food systems and dietary guidelines by presenting how sustainability framing in FBDGs can be used to further develop a comprehensive framework for integrating sustainability domains. While this project helps to validate previous work, further analyses of FBDGs which have emerged since this study and those not available in English are needed to improve the guidance approach described here and for assessing the incorporation of sustainability domains in future FBDGs. This work is useful in informing processes for policy developers to integrate sustainability considerations into their national FBDGs.Peer reviewe

Exploring perspectives on chronic obstructive pulmonary disease in people who smoke heroin: a qualitative study

Background Smoking rather than injecting heroin has become more common over the last twenty years. Although there is an increasing body of evidence describing high levels of COPD in heroin smokers, there is limited evidence documenting the impact this has on this population group. Aim. We aimed to describe the experiences of heroin smokers with COPD in Liverpool, UK Design and Setting Participants were purposefully sampled for this qualitative study. Participants included were adults enrolled in an opioid replacement clinic run by Addaction in Liverpool, UK and whom had already engaged with spirometry testing for COPD as part of a previous study Methods. We preformed semi-structured interviews with participants with spirometrically-confirmed COPD in opioid replacement clinics in Liverpool, UK. Data were analysed using a framework analysis approach. Results. We invited 16 potential participants of whom 10 agreed to take part and were interviewed. Three themes common to all interviews were identified: functional measures of lung health that impacted on their activities of daily living, inhaler and medication perceptions with erratic use that was not concordant with their prescription, and the impact of difficulties accessing care. Conclusion. These findings, along with previous studies highlighting the prevalence of COPD in this population, warrant efforts to integrate community COPD and opioid replacement services to improve outcomes for this vulnerable population

Screening Heroin Smokers Attending Community Drug Clinics for Change in Lung Function:A Cohort Study

Background: Heroin smokers have high rates of COPD, respiratory morbidity, hospital admission, and mortality. We assessed the natural history of symptoms and lung function in this population over time. Methods: A cohort of heroin smokers with COPD was followed for 18 to 24 months. At baseline and follow-up, respiratory symptoms were measured by the Medical Research Council Dyspnea Scale (MRC) and the COPD Assessment Tool (CAT), and postbronchodilator spirometry was performed. Frequency of health-care-seeking episodes was extracted from routine health records. Parametric, nonparametric, and linear regression models were used to analyze the change in symptoms and lung function over time. Results: Of 372 participants originally recruited, 161 were assessed at follow-up (mean age, 51.0 ± 5.3 years; 74 women [46%]) and 106 participants completed postbronchodilator spirometry. All participants were current or previous heroin smokers, and 122 (75.8%) had smoked crack. Symptoms increased over time (MRC score increased by 0.48 points per year, P <.001; CAT score increased by 1.60 points per year, P <.001). FEV 1 declined annually by 90 ± 190 mL (P <.001). This deterioration was not associated with change in tobacco or heroin smoking status or use of inhaled medications. Conclusions: Heroin smokers experience a high and increasing burden of chronic respiratory symptoms and a decline in FEV 1 that exceeds the normal age-related decline observed among tobacco smokers with COPD and healthy nonsmokers. Targeted COPD diagnostic and treatment services hosted within opiate substitution services could benefit this vulnerable, relatively inaccessible, and underserved group of people

Fungal entomopathogens: new insights on their ecology

An important mechanism for insect pest control should be the use of fungal entomopathogens. Even though these organisms have been studied for more than 100 y, their effective use in the field remains elusive. Recently, however, it has been discovered that many of these entomopathogenic fungi play additional roles in nature. They are endophytes, antagonists of plant pathogens, associates with the rhizosphere, and possibly even plant growth promoting agents. These findings indicate that the ecological role of these fungi in the environment is not fully understood and limits our ability to employ them successfully for pest management. In this paper, we review the recently discovered roles played by many entomopathogenic fungi and propose new research strategies focused on alternate uses for these fungi. It seems likely that these agents can be used in multiple roles in protecting plants from pests and diseases and at the same time promoting plant growth

Government - Community Partnerships: Rhetoric or Reality?

This paper will explore a community development project involving a peer support and advocacy network, Young Mothers for Young Women, to determine the challenges and barriers in the management of government-community sector partnerships. Young Mothers for Young Women has identified models of practice and policies that can make a difference to how services and young women engage with society. However, passing this information through the chain of relationships both within the community and government sector has proven to be problematic. The impact of competitive tendering, the complexity of the way in which government-community sector relationships are constructed, the practices of government in terms of policy making processes, and the issues surrounding the ownership of intellectual property will be examined. This paper will share some of the experiences, the learnings and possible ways of improving relationships so as to achieve better community and individual outcomes through informed policy and practice in the government and community sectors for people seeking assistance. Government-community partnerships offer an opportunity for community development and shifting power relations between government and community groups to a power-sharing partnership. However, if these relations are managed poorly or fail to promote development and empowerment, they may further entrench existing inequalities

Critical health literacy: shifting textual–social practices in the health classroom

Special issue: critical health literacie