School Food Programming across Canada during the COVID 19 Pandemic: Program Reach and Modalities

In 2020, after the COVID-19 pandemic resulted in widespread school closures and a consequent pause in school food programs (SFP), stakeholder groups soon found alternate methods for delivering meals and snacks to students. This paper examines the breadth of school food programming in Canada during the pandemic. SFPs collectively offered meals (breakfast was most frequent), food boxes, and gift cards and average weekly distributions were over 10,000 meals. In most cases, the programs provided enough food/coupons to feed multiple or all household members. Almost half the programs received funding from provincial/territorial governments and around two-thirds received charitable contributions.Copyright © 2022 Taylor & Francis Group, LLC.

Exploring the motivations to use online meal delivery platforms: Before and during quarantine

Online meal delivery platforms (OMDPs), like UberEats, have received more attention since quarantine was established to prevent the spread of COVID-19. The research into antecedents of satisfaction and continuous usage intention for OMDPs, in general, is under researched. The current study compared the antecedents of satisfaction before quarantine to the antecedents during quarantine through the lens of Expectation-Confirmation Theory. Through multiple regression analyses, the researchers found that before quarantine, sharing economy ethos, price-value, food quality, ease of use and confirmation of beliefs had a significant impact on satisfaction while during quarantine, food quality, service speed, ease of use, and confirmation of beliefs were significant. Practical and theoretical implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Customers' dining choice using meal ordering apps: insights from China and Indonesia

PurposeMeal ordering apps (MOAs) have transformed the customers' dining habits, particularly during mobility restrictions of the COVID-19 pandemic. Under the theoretical cover of the extended stimulus–organism–response (SOR) model, this paper attempts to explore the critical antecedents and outcomes of customer MOA engagement which predict the continuous purchase intentions using these apps. A multigroup analysis is conducted to investigate the difference between the hypothesized relationships between the Chinese and Indonesian consumers.Design/methodology/approachA mixed-method approach, including a systematic literature review, an open-ended essay (qualitative) with 139 MOA users and an online survey (quantitative) with 1,207 MOA users in total, was used for hypotheses testing.FindingsThe structural equation model results revealed that customer MOA experience factors such as mobile online reviews (MR), food quality (FQ), restaurant reputation (RR), service quality and system quality (SyQ) are the absolute positive factors that influence customer MOA cognitive, affective and behavioral engagement, which in turn affect continuous purchase intentions. The multigroup analysis results reveal that Chinese customers prioritized MR and FQ for customer MOA engagement (cognitive, affective and behavioral). Comparatively, Indonesian customers placed most importance on RR and SyQ.Originality/valueConsidering a market-specific setting and based on the extended SOR framework, this study is one of the first to take a comprehensive look at the critical antecedents and outcome of multidimensional customer MOA engagement in the developing countries' (China and Indonesia) online to offline meal delivery context. Further, this study investigates the customer continuous purchase intentions as an outcome of MOA engagement during the COVID-19 pandemic. The findings also reveal the differences in consumer behavior across the two developing but culturally diverse countries samples during the pandemic.

Partial replacement of maize with cassava root-moringa leaf and vegetable oil concentrates in broiler finisher diets

Context. Roots and leaves have potential as feed ingredients for poultry, but antinutritional factors (ANFs), high fibre and low energy may limit their efficient utilisation. There is need to improve processing methods and diet formulation for maximum utilisation of these readily available resources and reduce feed cost. Aim. To investigate the replacement of maize with cassava root, moringa leaf meal and vegetable oil blend in finisher broiler diets. Methods. In total, 160 male broiler chickens aged 30 days were weighed and allotted randomly to 20 deep litter pens containing eight birds of similar individual weight (1500 g +/- 16.11). Four broiler finisher iso-energetic and isonitrogenous diets were formulated for the experiment. Diet 1 was based on maize and in Diets 2, 3 and 4, 15%, 30% and 45% of maize was replaced respectively, by a concentrate of cassava root meal, moringa leaf meal and vegetable oil combination (CMOC). Each diet was given to five pens in a completely randomised design for a period of 12 days. Key results. There were no significant differences in the growth parameters of birds among treatments. Except for drumsticks of birds on the 30% CMOC diet, there were no significant effects of diet on carcass components or digestive organ weights (P > 0.05). Gizzard pH was higher in the control birds than in the test groups. Feed cost per kilogram of carcass weight was significantly (P < 0.05) lower with the dietary inclusion of CMOC. Conclusion. Replacing up to 30% of the maize with CMOC is beneficial and replacement up to 45% is not detrimental. However, the economic benefits of maize replacement with CMOC need to be re-evaluated with ingredient costings less affected by the present COVID-19 pandemic. Implications. Maximum utilisation of cassava root and moringa leaf meal in the diet will reduce cost and improve income of small-to medium-holder broiler producers.

Sublingual allergen immunotherapy: Safety, adherence, efficacy in adolescents during COVID-19 pandemic

Background: Allergic rhinitis, one of the most common chronic allergic diseases, commonly associated with asthma, has a disease modifying therapy, allergen-specific immunotherapy (AIT). AIT can play a significant role in the reduction of clinical and immunological reaction to the culprit allergen, decreasing the onset of new sensitizations, preventing the onset of asthma, and reducing use of pharmacological treatments. This latter aspect is highly relevant for adolescents, a category of patients that frequently prefer to use "as few drugs as possible". AIT continuation may be difficult in some situations, such as the COVID-19 pandemic. Difficulty in accessing hospitals was experienced by many leading to a discontinuation of therapies for chronic conditions, such as allergic rhinitis. Method(s): We report our experience on the management, safety and adherence to sublingual immunotherapy (SLIT) prescribed to 25 adolescents affected by allergic rhinitis (house dust mite (HDM) -8 patients, SLIT grass pollen -12 patients, SLIT parietaria -5 patients), during the COVID-19 pandemic, following EAACI recommendations. The first administration of SLIT was carried out under medical supervision. We used a personalized monitoring approach according to the type of SLIT prescribed and according to the needs presented by each patient, advising them how to recognize and manage a possible reaction. Result(s): No immediate severe adverse reactions were reported by patients. Between the 2nd and 5th day of SLIT, 4 patients in therapy with HDM SLIT, experienced an exacerbation of rhinitis symptoms, with resolution after the use of oral antihistamine and topical cortisone+antihistamine before taking the daily dose of SLIT (for 30 days). Two patients on grass pollen SLIT and 2 patients on HDM SLIT, with gastric upset after taking SLIT daily while fasting, presented a resolution of the symptom after we advised them to take the daily dose in the morning after breakfast. Five patients interrupted SLIT for COVID-19 infection, until complete resolution. To date, all 25 patients are continuing SLIT, with good tolerability, with an improvement of rhinitis symptoms. Conclusion(s): We have reported real-life SLIT adherence and safety in adolescents that started SLIT during the COVID-19 pandemic to confirm how SLIT is a winning strategy and the only modifying treatment for allergic conditions.

Evaluation of a Low-Fat Low-Calorie Meal on the Relative Bioavailability of Trametinib and Dabrafenib: Results From a Randomized, Open-Label, 2-Part Study in Healthy Participants.

In this randomized, open-label, 2-part, 2 × 2 crossover, phase 1 study, the effect of a low-fat low-calorie (LFLC) meal on the relative bioavailability of a trametinib 2-mg tablet or dabrafenib 150-mg capsule was evaluated in healthy participants. Trametinib adjusted geometric mean ratios (90%CI) of fed : fasted for area under the concentration-time curve (AUC) from time 0 to the last quantifiable concentration and AUC from time 0 extrapolated to infinity were 0.76 (0.71-0.82) and 0.82 (0.77-0.88), respectively. For dabrafenib, the adjusted geometric mean ratios of AUC from time 0 to the last quantifiable concentration and AUC from time 0 extrapolated to infinity (90%CI) for fed:fasted were 0.85 (0.79-0.91) and 0.86 (0.80-0.92), respectively. Consumption of an LFLC meal delayed trametinib and dabrafenib absorption, with an increase in time to maximum concentration of ≈15 and ≈30 minutes, respectively, compared to the fasted state. These findings indicate that consumption of an LFLC meal reduced the bioavailability and delayed the absorption of trametinib and dabrafenib, supporting current recommendations to administer both drugs in the fasting state; however, an occasional LFLC meal is unlikely to affect the pharmacokinetics of the drugs once steady state is reached and, by consequence, not likely to alter the overall intended efficacy.

Rebuilding a Team in 2022

Introduction The COVID-19 pandemic resulted in a rapid change in the delivery of education with remote working, people required to stay home, and maintaining social distance when at work, all of which had an impact on teamwork and team relationships. Aim/Method As a newly appointed Lead Practice Educator I was responsible for re-establishing the team, with the aim to prioritise developing the relationships with each other to increase their sense of team and belonging, to enable the continued provision of high-quality training. Results With feedback from the educators a variety of activities was planned such as formal and social catch ups utilising the outdoor spaces around the trust. We celebrated team members and wins in the team, both virtually and face to face and via email making use of feedback from #feedbackfriday on Twitter to share with the wider team. One of the activities that was particularly successful was a team breakfast, staff commented how much they enjoyed spending time together engaging in spontaneous conversations, something that is challenging to replicate in the virtual environment. New staff were buddied up with more established members of the team, and the educators were encouraged to work together providing a more joined up approach. In addition, a Friday email was implemented to streamline communication within the team. Discussion/Conclusion During and after the activities team relationships have flourished-by working apart they became stronger individual educators and now their combined efforts have resulted in a more cohesive and adaptive team. They collaborate to deliver more comprehensive local inductions, highlight patient safety problems, and provide solutions by pooling their resources to elicit a more joined up approach across our 3 directorates.

The association among circadian rhythm, circadian genes and chrononutrition, its effect on obesity: a review of current evidence

Circadian rhythms, also known as circadian clocks, are cyclic endogenous biological patterns of an approximately 24-hour cycle which regulate the timing of physiology, metabolism, and behavior. Recent research in the field of circadian science has suggested that the timing of food intake may also play a role in markers of health, in addition to food choice and food quantity. There is emerging evidence suggesting that the timing of dietary intake, so-called chrono-nutrition, may be influenced by an individual<apos;>s chronotype. For example, the evening type has been linked to unhealthy diet, which could indicate a higher possibility of obesity. On the other hand, the continuum of chronotype diversity is largely mediated by genes. The presence of single nucleotide polymorphisms (SNP) of clock genes have been associated with obesity, chronotype, metabolic disturbances, and dietary habits (e.g., breakfast skipping, meal timing, energy/macronutrient intake). In this review, we outline the current knowledge of the interactions between clock genes, chronotype, dietary intake and chrono-nutrition.Additionally, it is emphasized that the COVID-19 pandemichas had a significant impact on the circadian system, dietary choices and meal timing. For this reason, the current review aims to focus on how chronotype/sleep and chrono-nutrition are affected during the COVID-19 pandemic.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

The Effects of COVID-19 Restrictions on Dietary Behaviors, Supplement, and Physical Activity Habits of Children with Autism Spectrum Disorder

Study Objectives: Limited studies show that adverse behavioral outcomes such as physical activity (PA), Dietary Behaviors (DB) are increasing among children with autism spectrum disorder (ASD) because of COVID 19. However, the effects of the pandemic on children with ASD are little known. This study aimed to evaluate the factors that may affect the PA, DS, and DB of individuals with ASD before and during the curfew brought by the COVID-19 epidemic. Method(s): A total of 64 ASD participants (40 boys and 24) girls aged 6-18 years, were included in the study. The mean age of the participants was (13.75 +/- 1.67). An online questionnaire consisting of sociodemographic data, PA, DS, and DS habits was applied to the participants. Result(s): BMI (kg/m2) increased compared to pre-COVID-19 (< 0.001). It was determined that the physical activity levels of the participants with ASD were greatly reduced compared to pre-COVID-19 (<0.001). Duration of PA conducted 1 time a week, 3 times a week, and >7 days/week were found to be <30 minutes (< 0.001). Compared to pre-COVID-19, breakfast habits were changed (71.9%;< 0.001). Eating and snacking although not feeling hungry increased, (< 0.310;< 0.120 respectively). Vitamin C (53.1%), vitamin D (70.3%), vitamin B12 (50.0%), Calcium (75.0) and Magnesium (67.1%) use was determined to increase significantly (< 0.001) in participants with ASD during COVID-19. Conclusion(s): It was determined that individuals with ASD have significant decreases in physical activity, and nutritional behavior and significant increases in supplement use during the COVID-19 epidemic.Copyright © 2022 Mattioli 1885. All rights reserved.

Washing the great unwashed: a history of British public hand hygiene

British and European public attitudes towards hand hygiene have evolved over time. Early examples of soap-like products date from Babylon around 5000 years ago, later probably passing along the silk route to Europe. A mixture of fats boiled with ashes were found in clay cylinders. In the fourth century BC, Hippocrates propagated ancient Chinese and Greek theories that epidemics spread via noxious 'miasma' particles. In the Roman Empire, Galen advocated health by balancing four humours (blood, yellow bile, black bile and phlegm). The Romans brought public bathhouses to Britain after invading in 55BC adding a social aspect to cleanliness, also bringing fresh water in aqueducts. Emily Cockayne's book Hubbub: Filth, Noise & Stench in England documents daily life in England from 1600 to 1770. Diarist Samuel Pepys reportedly rubbed himself 'clean' using a cloth. King Louis XIV of France reportedly took two baths during his reign, the first during his recovery from a convulsive episode. In the Middle Ages, 'cleanliness' focused on keeping up appearances. It was believed that white linen garments absorbed the body's impurities and cleaned the skin. People wore visible starched white collars and cuffs, to signal cleanliness and social superiority. British public attitudes changed during the nineteenth century, driven by discoveries showing a relationship between hygiene and health. Bulwer- Lytton disparagingly referred to the 'great unwashed' lower classes in his 1830 novel Paul Clifford. However, in 1837, Buckingham Palace did not have a bathroom. Bathing was mostly inaccessible, labourers would usually bath in sweat and were cleaned only on admission to hospitals or poor houses. In 1845, English dermatologist Sir Erasmus Wilson published a lay handbook called Healthy Skin. This was wildly popular and disseminated the health benefits of sanitation and clean skin. Public washhouses proliferated. By the 1920s handwashing was common practice in Western countries. Soap manufactures Lever Brothers launched a 'clean hands' campaign advising children to wash their hands 'before breakfast, before dinner and after school'. After the Second World War, bathrooms became widespread and home plumbing made village washhouses redundant and unappealing. Handwashing practices among healthcare workers have remained low, averaging 39%. Hand hygiene was at the forefront in tackling the COVID-19 pandemic. The public were advised to wash their hands frequently, for at least 20 s each time. Will this be a landmark in handwashing history.

Detection of Social Isolation Based on Meal-Taking Activity and Mobility of Elderly People Living Alone

Objectives Background Social isolation is probably one of the most affected health outcomes in the elderly people, particularly those living alone, due to the COVID-19 pandemic. Therefore, we try to identify it by detecting changes in the elderly such as malnutrition and lack of mobility. Material and methods The system consists of two types of sensors installed at various locations in the user's home: Passive infrared (PIR) sensors and reed switch sensors. It was implemented for 15 days in the home of a 26-year-old student living alone, as a first step to later be deployed in the home of elderly people. Results Our study showed strong similarities between the activities detected by the algorithm and the real activity pattern of the interviewed individual. In addition, the system was able to identify two daily patterns (weekday and weekend) of the person as he is a student and is present in class during the week. Conclusion A system composed of low-cost, unobtrusive, non-intrusive and miniaturized sensors is able to detect meal-taking activity and mobility. These results are an intermediate step in assessing the potential risk of social isolation in older people living alone based on these ADLs.Copyright © 2023 AGBM

Can we imagine the meal-sharing economy without service providers? The impact of COVID-19

The meal-sharing economy has taken significant scholarly attention recently;however, no study examines the impact of the current health crisis on meal-sharing economy platforms. This research attempts to bridge this gap by investigating the effect of the COVID-19 on the meal-sharing economy based on the service providers' perspective. For this purpose, thirteen interviews with meal-sharing service providers in Istanbul were conducted, and the data were examined through conventional content analysis. Findings showed that meal-sharing service providers have been facing unprecedented challenges since the outbreak. The findings also reveal a common consensus on the disruptive role of the coronavirus measures in terms of limiting meal-sharing activities. Moreover, it was indicated that the current health crisis has compelled service providers to redesign their events as online virtual activities. The results provide favorable theoretical and practical insights to guide the meal-sharing platforms for a health crisis adoption and revival of such platforms. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of COVID-19 on foodservice operations within urban Kansas childcare centers

PURPOSE/OBJECTIVES: The purpose of this study was to identify the ways in which the COVID-19 pandemic affected foodservice operations within urban Kansas childcare centers. METHODS: Three COVID-19-related questions were added to an online survey of Child and Adult Care Food Program (CACFP) participating childcare centers located throughout Kansas. Responses were collected from July through August, 2020. Descriptive statistics and thematic analysis of open-ended responses were used to identify common concerns. RESULTS: Seventy-nine of the 138 childcare centers invited to complete the COVID-19-related questions responded (57.2% participation rate). The majority (n=56, 70.1%) reported decreased enrollment, whereas a small number (n=9, 11.4%) reported an increase. Approximately twothirds of the centers (n=49, 62.0%) reported foodservice operation modifications owing to COVID-19-related challenges. Three overarching themes were discovered within the centers' responses: (a) procurement challenges including decreased availability and increased cost of foods, (b) changes in meal service including shifting to disposable tableware and ceasing familystyle meal service, and (c) menu and production changes in response to enrollment changes and product availability issues. APPLICATION TO CHILD NUTRITION PROFESSIONALS: Future consideration for CACFP participants include shifting to more shelf-stable foods when faced with food availability issues and utilizing more cost-effective food purchasing options, which might be attained through group purchasing organizations. Well-developed emergency plans such as emergency menus should include plans for procurement challenges. Resources and training to increase understanding and knowledge of CACFP meal pattern guidelines may make menu changes based on availability easier or less challenging. Best practice guidelines, such as family-style meals, may have to take health and safety measures into consideration. As centers continue to experience COVID-19-related issues and plan for a "return to normal", child nutrition professionals can fulfill an important role in helping centers adapt their foodservice operations to meet the challenge.

Meal-timing patterns and chronic disease prevalence in two representative Austrian studies.

PURPOSE: This study aimed at describing meal-timing patterns using cluster analysis and explore their association with sleep and chronic diseases, before and during COVID-19 mitigation measures in Austria. METHODS: Information was collected in two surveys in 2017 (N = 1004) and 2020 (N = 1010) in representative samples of the Austrian population. Timing of main meals, nighttime fasting interval, last-meal-to-bed time, breakfast skipping and eating midpoint were calculated using self-reported information. Cluster analysis was applied to identify meal-timing clusters. Multivariable-adjusted logistic regression models were used to study the association of meal-timing clusters with prevalence of chronic insomnia, depression, diabetes, hypertension, obesity and self-rated bad health status. RESULTS: In both surveys, median breakfast, lunch and dinner times on weekdays were 7:30, 12:30 and 18:30. One out of four participants skipped breakfast and the median number of eating occasions was 3 in both samples. We observed correlation between the different meal-timing variables. Cluster analysis resulted in the definition of two clusters in each sample (A17 and B17 in 2017, and A20 and B20 in 2020). Clusters A comprised most respondents, with fasting duration of 12-13 h and median eating midpoint between 13:00 and 13:30. Clusters B comprised participants reporting longer fasting intervals and later mealtimes, and a high proportion of breakfast skippers. Chronic insomnia, depression, obesity and self-rated bad health-status were more prevalent in clusters B. CONCLUSIONS: Austrians reported long fasting intervals and low eating frequency. Meal-timing habits were similar before and during the COVID-19-pandemic. Besides individual characteristics of meal-timing, behavioural patterns need to be evaluated in chrono-nutrition epidemiological studies.

Long-term support referrals to enhance food security and well-being in older adults: Texas physicians and nurses on what works.

Aim: Senior participation in the congregate meal programs (CMPs) has alarmingly declined over the past decade in Texas as elsewhere in the nation. The purpose of this survey study was to identify the possible reasons for this decline from the viewpoint of the Texas physicians and nurses who are key in coordinating care and ensuring food security for the vulnerable older Texans by referring them to community-based long-term support services (LTSS). Subject and methods: The methodology adopted was an online panel survey of physicians and nurses from rural and urban Texas counties. Structured multiple-choice and open-ended questions primarily focused on provider referral processes, reasons for connecting older clients to CMPs, perceptions about various aspects of these programs, possible reasons for the decline in participation, suggestions to make the programs an integral part of the community-based LTSS referral system, and how to address the COVID-19 pandemic constraints on the programs. Results: As a majority of the healthcare providers surveyed were unaware of the CMPs in their communities, the study spotlighted an urgent need for a better-coordinated referral process centered on strategic marketing and awareness-building about the CMPs, including an extensive healthcare provider education component as well as an overall improvement in meal quality and variety. Conclusion: The study highlights a need for additional research so decision-makers better understand how to best disseminate information to healthcare providers to improve the referral mechanisms, increase the referrals, and enhance the overall CMP program quality to benefit the vulnerable food-insecure older adults.

"That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children.

BACKGROUND: Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children. METHODS: Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm. RESULTS: Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations. CONCLUSIONS: This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.

Duodenal Stricture as a Rare, Possible Complication of Eosinophilic Gastrointestinal Disease (Egid)

EGID is a recently described condition with an unknown etiology and pathogenesis. There are three case reports of duodenal stricture associated with EGID: one in an adult requiring pancreaticoduodenectomy due to the suspicion of malignancy and 2 cases in a child and a young adult, who responded to oral steroids. We report the case of a 10-year-old who presented to A&E with a 9-month history of epigastric abdominal pain and 1 episode of haematemesis, on a background of asthma. He was treated for Helicobacter pylori, based on a positive stool antigen. Abdominal pain and vomiting persisted, therefore an oesophago-gastro-duodenoscopy (OGD) was performed. This identified widespread white plaques throughout the oesophagus, erythema and nodularity of the gastric antrum and white nodules in the first part of the duodenum. Histology revealed changes of EGID and eosinophilic oesophagitis (EOE) and patient was commenced on Montelukast, oral viscous Budesonide (OVB), Cetirizine and continued proton pump inhibitor (PPI). After the allergy workup identified house dust mites, cat sensitisation and fish allergy, a 6-food elimination diet was initiated. During the next 2 years, symptoms subsided, and endoscopy changes improved, with only mild signs of active EOE while on OVB, PPI and diary/egg/fish free diet. However, the patient relapsed due to poor compliance to treatment. He became more unwell during the Covid pandemic with recurrent vomiting and static weight. A trial of dupilumab was considered, however his reassessment OGD had to be delayed due to restricted access to theatre. He was treated empirically with a reducing course of oral prednisolone, with temporary response. The endoscopic assessment performed subsequently showed erythema, erosions and white plaques in the distal oesophagus and gastric antrum with narrowing between the first and the second part of the duodenum (D2), that could not be entered. Histology identified mild upper oesophagitis (4 eosinophils (eos)/HPF), active middle and lower oesophagitis (20 eos/HPF and 12 eos/HPF, respectively), chronic gastritis (80 eos/HPF) and nonspecific reactive changes of the proximal duodenum. A barium meal confirmed a duodenal stricture. At this stage, we recommended a sloppy diet and a second weaning course of oral prednisolone, along with Montelukast. He was subsequently commenced on azathioprine for maintenance of remission. A repeat barium study and small bowel MRI performed post course of steroids and on azathioprine revealed stable appearances of the proximal duodenal stricture, excluding the presence of further strictures. While the patient has responded to the course of oral steroids and azathioprine, a repeat upper GI endoscopy is currently planned to dilate the duodenal stricture. The challenges posed by this case were the rarity of the condition, limited treatment options and access to endoscopy during the Covid pandemic and the fact that unlike previous case reports a sustained remission could not be obtained on steroids, and a maintenance immunosuppressive medication was required. We can conclude that this subgroup of patients should be monitored closely for signs of bowel obstruction and will require more intense treatment, including immunomodulators, endoscopic dilatation and or surgery.

Change in Diet Quality and Meal Sources during the COVID-19 Pandemic in a Diverse Subset of Men and Women in the Cancer Prevention Study-3.

The COVID-19 pandemic resulted in restrictive measures that caused disruptions in behaviors that may have long-term consequences on diet, health, and chronic disease risk. The aim of this study was to assess longitudinal changes in diet quality from before to during the pandemic among 2335 adult participants (816 males and 1519 females; aged 36-78) of the Cancer Prevention Study-3 cohort. We compared dietary screeners conducted in 2018 and 2020 and calculated a diet quality score, which assigned higher points for recommended foods. Overall diet quality slightly improved among all participants from before to during the pandemic, particularly among males (+0.45 points, p < 0.001), White participants (+0.24 points, p < 0.001), and participants reporting weight loss (+0.66 points, p < 0.001 for 2.25 -< 4.5 kg loss; +1.04 points, p < 0.001 for ≥4.5 kg loss); change in diet quality did not differ by other sociodemographic factors. Reported consumption of most food groups decreased, especially whole grains (-0.17 servings/day, p < 0.001) and vegetables (-0.21 servings/day, p < 0.001), primarily among females, Black participants, and participants who gained ≥2.25 kg. The frequency of meals from outside the home decreased, especially in full-service restaurants (-0.47 times/week, p < 0.001) and for ready-to-eat meals (-0.37 times/week, p < 0.001). Declines in whole grain and vegetable consumption raise concerns for weight gain in these populations and increased risk of poor metabolic health and chronic disease.

Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study.

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (padjusted = 0.0124 and padjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (padjusted = 0.027 and padjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Online on-demand delivery services of food and alcohol: A scoping review of public health impacts.

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy.