Survey of antimicrobial stewardship practices in public hospitals in New Zealand district health boards.

AIMS: To determine what antimicrobial stewardship (AMS) practices exist in New Zealand public hospitals. METHODS: A quantitative survey based on recommended components of hospital AMS programmes was sent to the 20 DHBs in June 2016. RESULTS: Ten of the 20 DHBs had an AMS committee, nine had dedicated AMS pharmacist full-time equivalents (FTEs) and eight had lead clinician FTEs. Only one DHB met FTE recommendations for AMS pharmacists and two for clinicians (0.3 and 0.1 FTEs per 100 acute beds, respectively). All DHBs had conducted at least one antimicrobial audit in the preceding 12 months, most had their own antimicrobial guidelines (19/20) and prescribing policies (18/20), and 12 reported on antimicrobial usage by at least one metric (eg, defined daily doses). Staff education on AMS had been given at most DHBs in the previous year, but only three reported having AMS ward rounds. All DHBs had surveillance programmes for resistant organisms and most produced antibiograms (16/20). All reported barriers to implementation of an AMS programme. CONCLUSIONS: Hospital AMS programmes are in their infancy in New Zealand, with wide variation in practices seen. National co-ordination is required to assist DHBs in developing effective programmes to improve antimicrobial use.

Who consumed 5 or more portions of fruit and vegetables per day in 1986-1987 and in 2000-2001?

OBJECTIVE: The aim of the study was to describe who ate 5 or more portions of fruit and vegetables per day ('compliers') in 1986-1987 and in 2000-2001. DESIGN: We used data from the Dietary and Nutritional Surveys of British Adults. Each is a nationally representative dietary survey using 7 d weighed food records for men and women, aged 16-64 years, living in private households in Great Britain in 1986-1987 and in 2000-2001. SETTING: Great Britain. SUBJECTS: Data were analysed for 2197 adults in 1986-1987 and 1724 adults in 2000-2001. RESULTS: In 1986-1987 12·7 % were classified as 'compliers' compared with 16·5 % in 2000-2001. Manual social classes, younger participants and people on benefits or outside paid employment were less likely to be 'compliers'. Being divorced, widowed or separated was negatively related to being a 'complier', as was being in a household with dependant children or a lone parent with dependant children. Between 1986-1987 and 2000-2001 improvements were seen across social class groups and differences between men and women and between regions were reduced. CONCLUSIONS: Only 12·7 % participants in the Dietary and Nutritional Surveys of British Adults were classified as 'compliers' in 1986-1987 compared with 16·5 % in 2000-2001. There have been some important changes in the distribution of 'compliers', but the low levels overall support the need for a reinvigorated policy drive to improve compliance with fruit and vegetable goals.

Dietary patterns among a national sample of British children aged 1 1/2-4 1/2 years.

OBJECTIVE: Using a nationally representative sample, to identify groups among British children aged 1 1/2-4 1/2 years who report similar patterns of diet. DESIGN: Nationally representative dietary survey, using 4 d weighed dietary records, of girls and boys aged 1 1/2-4 1/2 years living in private households in Great Britain in 1992-1993. Cluster analysis was used to aggregate individuals into diet groups. SETTING: Great Britain. PARTICIPANTS: Eight hundred and forty-eight boys and 827 girls. RESULTS: Three clusters were identified for girls and three for boys. Among boys the most prevalent cluster was 'Healthy Diet' (52.3%), the second was 'Convenience Diet' (38.3%) and the third was 'Traditional Diet' (9.3%). Among girls, the most prevalent dietary cluster was 'Healthy Diet' (58.7%), followed by a 'Convenience Diet' (36.6%) and 'Traditional Diet' (4.3%). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between clusters. CONCLUSIONS: Cluster analysis identified three groups among both girls and boys which differed not only in terms of reported dietary intake, but also with respect to nutrient intake, social and behavioural characteristics. The groups identified could provide a useful basis for the development, monitoring and targeting of public health nutrition policy for pre-school children in the UK. Further research is needed on the consequences for chronic disease in the future for these children.

Development and simulated validation of a food-frequency questionnaire for the Colombian population.

OBJECTIVE: To develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes. DESIGN: Subjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearman's rank correlation coefficients (rS) and Bland and Altman's limits of agreement (LOA). SETTING: Bucaramanga, Colombia. SUBJECTS: We studied 97 randomly selected 20-40-year-old subjects. RESULTS: Sixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. rS was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, rS varied from 0.46 (manganese) to 0.71 (vitamin B12). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake. CONCLUSIONS: According to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.

The epidemiology of good nutritional status among children from a population with a high prevalence of malnutrition.

OBJECTIVES: To identify socio-economic demographic and environmental factors that predict better height-for-age for children under 5 years of age in a Dhaka slum population. DESIGN: A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socio-economic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed. SETTING: Dhaka slums in Bangladesh. SUBJECTS: Three hundred and ninety-two children, surveyed in September-November 1996. MAIN OUTCOME MEASURES: Height-for-age Z-score (HAZ) above -2. RESULTS: Thirty-one per cent of children had HAZ >-2. Logistic regression adjusted for cluster sampling showed that better nourished children were more likely to have taller mothers, to be from female-headed households and from families with higher income, electricity in the home, better latrines, more floor space and living in Central Mohammadpur. Better nourished children were less likely to have fathers who have taken days off from work due to illness. CONCLUSIONS Interest in 'positive deviance' is motivated by the recognition that a focus on the malnourished only--the bottom tail of the distribution--provides indications of how families fail, but not of how they succeed in maintaining child nutrition in the face of adversity. Our analysis provides an alternative perspective on nutrition and vulnerability in an urban slum setting.

Factors affecting nutritional status in female adults in Dhaka slums, Bangladesh.

This study looks at women from the slums in Mohammadpur, Dhaka, Bangladesh, where 54 percent of women's BMI was less than 18.5. Fifty percent of the Dhaka slum population lived below the poverty line. Logistic regression showed that women with income above 1,500 taka per capita were 1.78 times more likely to have a higher BMI (odds ratio 1.7863; CI = 0.671-3.639). Women with their own savings were 1.89 times more likely to have higher BMI (odds ratio 1.879; CI = 0.01163-1.6431). Women were 4.5 times more likely to have a higher BMI when food expenditure per capita above 559 taka per month (odds ratio 4.55; CI = 1.0302-8.0799). Women were 1.82 times more likely to have higher BMI when there was a break even situation in financial status (odds ratio 1.8212; CI = -015709-3.6285). Female headed households were 3.3 times more likely to have a higher BMI compared to women living in male headed households (odds ratio 3.2966; CI = 0.33711-6.25620). Women who work 15-23 days per month were 2.3 times more likely to have a higher BMI (odds ratio 2.33; CI = 0.1133-4.5600). Women who are the budget manager are 1.12 times more likely to have a higher BMI (odds ratio 1.125; CI = 0.29296-2.0966). Where as a husband who beats his wife is 1.83 more likely to have a poorer BMI (odds ratio 1.8312; CI = -3.72596-0.17508). Women who have no marriage documents and women who take days off due to illness less than 11 days per month were more likely to have a poorer BMI (odds ratio 0.5567; CI = -0.049339-2.8379; odds ratio 0.7569; CI = 0.183167-2.0002). Women's nutritional status and well being can influence their ability to provide for themselves and their families and the demonstration of a relationship between measures of women's autonomy and control in the household and women's nutritional status is an important indication of the importance of these sociological constructs. Women's participation in work outside the home may be a factor increasing their autonomy. The identification of relationships between women's autonomy and control and their physical well being should provide further leverage for policy change that will enable women to escape some traditional roles and to contribute as more equal partners with men in the future of Bangladeshi society.

Livelihoods, nutrition and health in Dhaka slums.

OBJECTIVES: To identify groups within Dhaka slums that report similar patterns of livelihood, and to explore nutritional and health status. DESIGN: A random sample of households participated in a longitudinal study in 1995-1997. Socio-economic and morbidity data were collected monthly by questionnaire and nutritional status was assessed. Cluster analysis was used to aggregate households into livelihood groups. SETTING: Dhaka slums, Bangladesh. SUBJECTS: Five-hundred and fifty-nine households. MAIN OUTCOME MEASURES: Socio-economic and demographic variables, nutritional status, morbidity. RESULTS: Four livelihood groups were identified. Cluster 1 was the richest cluster with land, animals, business assets and savings. Loans as well as income were higher, which shows that this group was credit-worthy. The group was mainly self-employed and worked more days per month than the other clusters. The cluster had the second highest body mass index (BMI) score, and the highest children's nutrition status. Cluster 2 was a poor cluster and was mainly dependent self-employed. Savings and loans were lower. Cluster 3 was the most vulnerable cluster. Members of this group were mainly casual unskilled, and 40% were female-headed households. Total income and expenditure were lowest amongst the clusters. BMI and children's nutritional status were lowest in the slum. Cluster 4 was the second richest cluster. This group comprised skilled workers. BMI was the highest in this cluster and children's nutritional status was second highest. CONCLUSIONS: Cluster analysis has identified four groups that differed in terms of socio-economic, demographic and nutritional status and morbidity. The technique could be a practically useful tool of relevance to the development, monitoring and targeting of vulnerable households by public policy in Bangladesh.