Implications of a food system approach for policy agenda-setting design

A call to governments to enact a strategy for a sustainable food system is high on the global agenda. A sustainable food system presupposes a need to go beyond a view of the food system as linear and narrow, to comprehend the food system as dynamic and interlinked, which involves understanding social, economic and ecological outcomes and feedbacks of the system. As such, it should be accompanied by strategic, collaborative, transparent, inclusive, and reflexive agenda-setting process. The concepts of, directionality relating to an agreed vision for a future sustainable food system, and, reflexivity which describes the capacity for critical deliberation and responsiveness, are particularly important. Based on those concepts, this paper proposes an evaluative framework to assess tools and instruments applied during the agenda-setting stage. We apply the evaluative framework to recent food policy processes in Finland and Sweden, revealing that their agenda-setting design cannot be assessed as fully addressing both directionality and reflexivity, thus possibly falling short of the policy design needed for enable more transformative policy approaches

Demand-Side Food Policies for Public and Planetary Health

Background: The current food system has major consequences for the environment and for human health. Alignment of the food policy areas of mitigating climate change and public health will ensure coherent and effective policy interventions for sustaining human health and the environment. Thispaperexploresliteratureondemand-sidepoliciesthataimtoreduceconsumptionof animal-basedfoods,increaseplant-basedfoods,andreduceoverconsumption. Methods:Wesearched for publications, published between January 2000 and December 2019, considering the above policy domains. Articles were distinguished for type of policy instrument, for topic via keywords and examples were given. Results: The majority of demand-side policies focus on preventing overweight and obesity, using all types of policy instruments including more forceful market-based policies. Hardly any examples of public policies explicitly aiming to lower animal-based foods consumption were found. Policies combining health and sustainability objectives are few and mainly of the information type. Discussion: Moving towards environmentally sustainable and healthy diets is challenging as the implemented demand-side policies focus largely on human health, and not yet on environmental outcomes, or on win-wins. Policies targeting foods from the health perspective can contribute to lower environmental impacts, by indicating suitable animal-based food replacers, and aiming at avoiding overconsumption of energy dense-nutrient poor foods. Preferred policies include a variety of instruments, including strong measures. Conclusions: Working solutions are available to ensure coherent and effective demand side food policies aligning public health and environmental aims. Implementation of aligned and effective policy packages is urgent and needed.© 2020 by the authorspublishedVersio

Enantioselective pharmacokinetics of tramadol and its three main metabolites; impact of CYP2D6, CYP2B6, and CYP3A4 genotype

Tramadol is a complex drug, being metabolized by polymorphic enzymes and administered as a racemate with the (+)- and (−)-enantiomers of the parent compound and metabolites showing different pharmacological effects. The study aimed to simultaneously determine the enantiomer concentrations of tramadol, O-desmethyltramadol, N-desmethyltramadol, and N,O-didesmethyltramadol following a single dose, and elucidate if enantioselective pharmacokinetics is associated with the time following drug intake and if interindividual differences may be genetically explained. Nineteen healthy volunteers were orally administered either 50 or 100 mg tramadol, whereupon blood samples were drawn at 17 occasions. Enantiomer concentrations in whole blood were measured by LC-MS/MS and the CYP2D6, CYP2B6 and CYP3A4 genotype were determined, using the xTAG CYP2D6 Kit, pyrosequencing and real-time PCR, respectively. A positive correlation between the (+)/(−)-enantiomer ratio and time following drug administration was shown for all four enantiomer pairs. The largest increase in enantiomer ratio was observed for N-desmethyltramadol in CYP2D6 extensive and intermediate metabolizers, rising from about two to almost seven during 24 hours following drug intake. CYP2D6 poor metabolizers showed metabolic profiles markedly different from the ones of intermediate and extensive metabolizers, with large area under the concentration curves (AUCs) of the N-desmethyltramadol enantiomers and low corresponding values of the O-desmethyltramadol and N,O-didesmethyltramadol enantiomers, especially of the (+)-enantiomers. Homozygosity of CYP2B6 *5 and *6 indicated a reduced enzyme function, although further studies are required to confirm it. In conclusion, the increase in enantiomer ratios over time might possibly be used to distinguish a recent tramadol intake from a past one. It also implies that, even though (+)-O-desmethyltramadol is regarded the enantiomer most potent in causing adverse effects, one should not investigate the (+)/(−)-enantiomer ratio of O-desmethyltramadol in relation to side effects without consideration for the time that has passed since drug intake

Sense of entitlement to support for the reconciliation of employment and family life

This article explores young European women and men’s expectations of support - from the state and employers - for reconciling paid employment and family life. It is based on a qualitative study employing focus groups with young women and men in Norway, Sweden, Portugal, Ireland and the UK. Drawing on the concept of sense of entitlement, derived from social justice theory, it was expected that the type of welfare state and ‘gender contract’ that young adults have experienced will influence their sense of entitlement to support for work and family life. Findings indicate that participants perceived their entitlement to state and employer support differently across national context. However this is moderated by gender, parental and occupational status, and particularly by awareness of provisions in other countries in the case of state support, while perceived entitlement to employer support varies according to the specific policy considered, gender and perception of benefits to employers. Some implications for public policy makers and employers are discussed

Workforce capacity to address obesity: a Western Australian cross-sectional study identifies the gap between health priority and human resources needed

Background: The disease burden due to poor nutrition, physical inactivity and obesity is high and increasing. An adequately sized and skilled workforce is required to respond to this issue. This study describes the public health nutrition and physical activity (NAPA) practice priorities and explores health managers and practitioner’s beliefs regarding workforce capacity to deliver on these priorities. Methods: A workforce audit was conducted including a telephone survey of all managers and a postal survey of practitioners working in the area of NAPA promotion in Western Australia in 2004. Managers gave their perspective on workforce priorities, current competencies and future needs, with a 70 % response rate. Practitioners reported on public health workforce priorities, qualifications and needs, with a 56 % response rate. Results: The top practice priorities for managers were diabetes (35 %), alcohol and other drugs (33 %), and cardiovascular disease (27 %). Obesity (19 %), poor nutrition (15 %) and inadequate physical activity (10 %) were of lower priority. For nutrition, managers identified lack of staff (60.4 %), organisational and management factors (39.5 %) and insufficient financial resources (30.2 %) as the major barriers to adequate service delivery. For physical activity services, insufficient financial resources (41.7 %) and staffing (35.4 %) and a lack of specific physical activity service specifications (25.0 %) were the main barriers. Practitioners identified inadequate staffing as the main barrier to service delivery for nutrition (42.3 %) and physical activity (23.3 %). Ideally, managers said they required 152 % more specialist nutritionists in the workforce and 131 % specialists for physical activity services to meet health outcomes in addition to other generalist staff. Conclusion: Human and financial resources and organisational factors were the main barriers to meeting obesity, and public health nutrition and physical activity outcomes. Services were being delivered by generalists rather than specialists, which may reduce service effectiveness. Although conclusions from this research need to take into account the fact that the audit was conducted in 2004, the findings suggest that there was a need to equip health services with an adequately skilled workforce of sufficient capacity to deliver an effective public health response to the obesity epidemic, particularly addressing poor nutrition and physical inactivity

Antibacterial and dermal toxicological profiles of ethyl acetate extract from Crassocephalum bauchiense (Hutch.) Milne-Redh (Asteraceae)

<p>Abstract</p> <p>Background</p> <p>The emergence in recent years of numerous resistant strains of pathogenic bacteria to a range of formerly efficient antibiotics constitutes a serious threat to public health. <it>Crassocephalum bauchiense</it>, a medicinal herb found in the West Region of Cameroon is used to treat gastrointestinal infections as well as liver disorders. The ethyl acetate extract from the leaves of <it>C. bauchiense </it>was evaluated for its antibacterial activity as well as acute and sub-acute toxicities.</p> <p>Methods</p> <p>The plant extract was prepared by maceration in ethyl acetate. Its phytochemical screening was done by standard methods. The broth microdilution method was used to evaluate the <it>in vitro </it>antibacterial activity. The <it>in vivo </it>antibacterial activity of a gel formulation (0.05, 1 and 2% w/v) of this extract was evaluated using a <it>Staphylococcus aureus</it>-induced dermatitis in a murine model. Selected haematological and biochemical parameters were used to evaluate the dermal sub-acute toxicity of the extract in rats.</p> <p>Results</p> <p>Phytochemical screening of the <it>C. bauchiense </it>extract revealed the presence of alkaloids, phenols, tannins and sterols. <it>In vitro </it>antibacterial activities were observed against all the tested microorganisms (MIC = 0.04-6.25 mg/ml). Formulated extract-gel (2% w/v) and gentamycin (reference drug) eradicated the microbial infection after five days of treatment. A single dermal dose of this extract up to 32 g/kg body weight (bw) did not produce any visible sign of toxicity. Also, daily dermal application of the <it>C. bauchiense </it>extract gel formulation for 28 days did not show any negative effect, instead some biochemical parameters such as alanine aminotransferase (ALT and AST), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides were significantly (p < 0.05) affected positively.</p> <p>Conclusion</p> <p>These results indicate that the <it>C. bauchiense </it>ethyl acetate extract can be used safely for the treatment of some bacterial infections.</p

Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four- to six-year-old children's steps per day: The ToyBox-study

Background: The ToyBox-intervention is a theory- and evidence-based intervention delivered in kindergartens to improve four- to six-year-old children''s energy balance-related behaviours and prevent obesity. The current study aimed to (1) examine the effect of the ToyBox-intervention on increasing European four- to six-year-old children'' steps per day, and (2) examine if a higher process evaluation score from teachers and parents was related to a more favourable effect on steps per day. Methods: A sample of 2438 four- to six-year-old children (51.9% boys, mean age 4.75±0.43years) from 6 European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) wore a motion sensor (pedometer or accelerometer) for a minimum of two weekdays and one weekend day both at baseline and follow-up to objectively measure their steps per day. Kindergarten teachers implemented the physical activity component of the ToyBox-intervention for 6 weeks in total, with a focus on (1) environmental changes in the classroom, (2) the child performing the actual behaviour and (3) classroom activities. Children''s parents received newsletters, tip cards and posters. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and the six intervention countries separately. In addition, process evaluation questionnaires were used to calculate a total process evaluation score (with implementation and satisfaction as a part of the overall score) for teachers and parents which was then linked with the physical activity outcomes. Results: No significant intervention effects on four- to six-year-old children'' steps per weekday, steps per weekend day and steps per average day were found, both in the total sample and in the country-specific samples (all p>0.05). In general, the intervention effects on steps per day were least favourable in four- to six-year-old children with a low teachers process evaluation score and most favourable in four- to six-year-old children with a high teachers process evaluation score. No differences in intervention effects were found for a low, medium or high parents'' process evaluation score. Conclusion: The physical activity component of the ToyBox-intervention had no overall effect on four- to six-year-old children'' steps per day. However, the process evaluation scores showed that kindergarten teachers that implemented the physical activity component of the ToyBox-intervention as planned and were satisfied with the physical activity component led to favourable effects on children''s steps per day. Strategies to motivate, actively involve and engage the kindergarten teachers and parents/caregivers are needed to induce larger effects