Advancing research, policy and practice to promote resilient and sustainable food and health systems in the year of action on nutrition: Proceedings of the 7th annual International Summit on Nutrition and Health

In 2012, the World Health Assembly (WHA) endorsed global targets to reduce malnutrition in all its forms by 2025. The specific six nutrition targets aim to reduce low birth weight, stunting, wasting and anaemia in women of reproductive age;stop the rise of overweight in children under five years of age;and increase exclusive breastfeeding.1 In the following year, global targets for nutrition-related non-communicable diseases (NCDs) were further established, including halting the rise of diabetes and obesity in all age groups.2 Unfortunately, the world is off course to meet these targets with the exception of exclusive breastfeeding.3 On top of this, the Covid-19 pandemic has put enormous pressures on already strained food and healthcare systems contributing to increases in food insecurity and malnutrition worldwide.4 Malnutrition imposes high economic and social costs on individuals, families, and countries5;and effectively implementing preventative and curative actions to curb alarmingly high rates of malnutrition is still urgently needed.

Building capacity for integrated knowledge translation: a description of what we can learn from trainees' experiences during the COVID-19 pandemic.

The use of collaborative health research approaches, such as integrated knowledge translation (IKT), was challenged during the COVID-19 pandemic due to physical distancing measures and transition to virtual platforms. As IKT trainees (i.e. graduate students, postdoctoral scholars) within the Integrated Knowledge Translation Research Network (IKTRN), we experienced several changes and adaptations to our daily routine, work and research environments due to the rapid transition to virtual platforms. While there was an increased capacity to communicate at local, national and international levels, gaps in equitable access to training and partnership opportunities at universities and organizations have emerged. This essay explores the experiences and reflections of 16 IKTRN trainees during the first 2 years of the COVID-19 pandemic at the micro (individual), meso (organizational) and macro (system) levels. The micro level, or individual experiences, focuses on topics of self-care (taking care of oneself for physical and mental well-being), maintaining research activities and productivity, and leisure (social engagement and taking time for oneself), while conducting IKT research during the pandemic. At the meso level, the role of programmes and organizations explores whether and how institutions were able to adapt and continue research and/or partnerships during the pandemic. At the macro level, we discuss implications for policies to support IKT trainees and research, during and beyond emergency situations. Themes were identified that intersected across all levels, which included (i) equitable access to training and partnerships; (ii) capacity for reflexivity; (iii) embracing changing opportunities; and (iv) strengthening collaborative relationships. These intersecting themes represent ways of encouraging sustainable and equitable improvements towards establishing and maintaining collaborative health research approaches. This essay is a summary of our collective experiences and aims to provide suggestions on how organizations and universities can support future trainees conducting collaborative research. Thus, we hope to inform more equitable and sustainable collaborative health research approaches and training in the post-pandemic era.

A 2020 Evaluation of Global Knowledge Networks in the UN Decade of Action on Nutrition (2016-2025): Proceedings of the 6th International Summit on Medical and Public Health Nutrition Education and Research

The six key action areas, outlined in the Work Programme of the UN Decade of Action on Nutrition, provide a blueprint for sustained nutrition action and are positioned within the 2030 Agenda for Sustainable Development, particularly Target 2.2, ending all forms of malnutrition by 2030.5 Five years on from when the Nutrition Decade was proclaimed, hunger and malnutrition remain problems of huge scale with diet-related health costs linked to mortality and non-communicable diseases projected to exceed USD 1.3 trillion per year.2 Although the change to date has been modest, the remaining years of the Nutrition Decade present an unprecedented opportunity for accelerated efforts. The NNEdPro Global Centre is an award-winning interdisciplinary think-tank, training academy and knowledge network anchored in Cambridge, UK.6 The work of NNEdPro focuses on developing adaptable and scalable models for nutrition education and combining clinical and public health knowledge with leadership training to aid and evaluate implementation in education, health care and community settings globally. [...]the unaffordability of eating well is exacerbated by the pandemic and highlights the need to revitalize nutrition commitments and strengthen accountability for such action.2 There is also a need to consider the impact of trade and investment policies on food systems and maximise action to improve food security and nutrition, and invest responsibly into agriculture and food systems.22 In Action Area 5, Safe and supportive environments for nutrition at all ages, there remains scope to scale-up and further strengthen country level action by improving food offered in public institutions (e.g., school, prison, and hospital settings), considering regulatory approaches to shape food price and availability, and subsequently food choice, and supporting the use of the Voluntary Guidelines on Food Systems and Nutrition of the Committee of World Food Security,23 as discussed at the Summit. The food system accounts for more than one-third of global greenhouse gas emissions, and conversely, the present environmental crisis also places additional strain on the food and healthcare systems.18 Diet-related greenhouse gas emissions are estimated to exceed USD 1.7 trillion per year by 2030 based on current food consumption patterns.18 The resources required to sustain current food systems are vast;food production consumes over 50% of the planets habitable land surface and 70% of freshwater.19 Health care systems constitute a large sector which requires considerable amounts of energy and resources and produces substantial emissions and waste.20 For example, in 2012 alone, the European health system produced 24.7 million tonnes of carbon dioxide emissions, the equivalent of the total greenhouse gas emissions of the entire country of Croatia that same year.21 In the context of the Nutrition Decade, we need increased recognition of the role of agriculture and food systems to promote crop diversification, to create healthy food environments, and to implement measures to ensure food safety standards.

Trainee-led research using an integrated knowledge translation or other research partnership approaches: a scoping reviews.

BACKGROUND: There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work. METHODS: We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research. CONCLUSION: Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.

Correction: Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program.

[This corrects the article DOI: 10.2196/25507.].

Adoption, feasibility and safety of a family medicine-led remote monitoring program for patients with COVID-19: a descriptive study.

BACKGROUND: Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine-led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community. METHODS: COVIDCare@Home is a multifaceted, interprofessional team-based remote monitoring program developed at an ambulatory academic centre, the Women's College Hospital in Toronto. A descriptive analysis of the first cohort of patients admitted from Apr. 8 to May 11, 2020, was conducted. Lessons from the implementation of the program are described, focusing on measure of adoption (number of visits per patient total, with a physician or with a nurse; length of follow-up), feasibility (received an oximeter or thermometer; consultation with general internal medicine, social work or mental health, pharmacy or acute ambulatory care unit) and safety (hospitalizations, mortality and emergency department visits). RESULTS: The COVIDCare@Home program cared for a first cohort of 97 patients (median age 41 yr, 67% female) with 415 recorded virtual visits. Patients had a median time from positive testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to first appointment of 3 (interquartile range [IQR] 2-4) days, with a median virtual follow-up time of 8 (IQR 5-10) days. A total of 4 (4%) had an emergency department visit, with no patients requiring hospitalization and no deaths; 16 (16%) of patients required support with mental and social health needs. INTERPRETATION: A family medicine-led, team-based remote monitoring program can safely manage the care of outpatients diagnosed with COVID-19. Virtual care approaches, particularly those that support patients with more complex health and social needs, may be an important part of ongoing health system efforts to manage subsequent waves of COVID-19 and other diseases.

Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program.

Adaptive leadership has become an essential skill for leaders in health systems to respond to the COVID-19 pandemic as new knowledge emerges and case counts rise, fall, and rise again. This leadership approach has been described as an iterative process of taking a wide view of the situation, interpreting the meaning of incoming data from multiple directions, and taking real-time action. This process is also common in start-ups, which attempt to create new products or services of uncertain value for consumer markets that may not yet exist. Start-ups manage uncertainty through "pivots," which can include changes in the target group, need, features, or intended benefit of a product or service. Pivots are large changes that account for the high likelihood of getting something wrong during development, and they are distinct from the "tweaks" or small tests of change that define quality improvement methodology. This case study describes three pivots in the launch of a remote monitoring program for COVID-19. Adaptive leadership helped inform strategic decisions, with pivots providing a framework for internal and external stakeholders to articulate options for changes to address shifting needs. There is considerable uncertainty in the appropriate design and implementation of health services, and although this case example focuses on the use of adaptive leadership and pivots during a pandemic, these strategies are relevant for health care leaders at any time.