Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial.

BACKGROUND: To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city London boroughs. METHODS: Women attending baby clinics with their infants (312) were randomised to receive monthly home visits from trained volunteers over a 9-month period (intervention group) or standard professional care only (control group). The primary outcome was vitamin C intakes from fruit. Secondary outcomes included selected macro and micro-nutrients, infant feeding habits, supine length and weight. Data were collected at baseline when infants were aged approximately 10 weeks, and subsequently when the child was 12 and 18 months old. RESULTS: Two-hundred and twelve women (68%) completed the trial. At both follow-up points no significant differences were found between the groups for vitamin C intakes from fruit or other nutrients. At first follow-up, however, infants in the intervention group were significantly less likely to be given goats' or soya milks, and were more likely to have three solid meals per day. At the second follow-up, intervention group children were significantly less likely to be still using a bottle. At both follow-up points, intervention group children also consumed significantly more specific fruit and vegetables. CONCLUSIONS: Home visits from trained volunteers had no significant effect on nutrient intakes but did promote some other recommended infant feeding practices. TRIAL REGISTRATION: Current Controlled Trials ISRCTN55500035.

The process of establishing, implementing and maintaining a social support infant feeding programme.

OBJECTIVE: To describe the process of establishing and implementing a social support infant feeding intervention. DESIGN: This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample. SETTING: Camden and Islington, London, UK. RESULTS: Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and self-confidence. The evaluation of the training programme demonstrated that it improved volunteers' knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers' interest and enthusiasm. The retention of volunteers is, however, a key challenge. CONCLUSIONS: The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention.

Inequalities in diet and physical activity in Europe.

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding socio-demographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined.

A minimum income for healthy living

There is overwhelming evidence of the role of food and nutrition in the maintenance and promotion of good health, from the avoidance of classic deficiency diseases to the role of antioxidants in the prevention of coronary heart disease and cancer. Hopefully, the man will be active and enjoy a lot of walking, in comfortable shoes and away from traffic. Such exercise is rewarding in mental refreshment, in sociality, and weight regulation with its multiple short and long-term metabolic benefits. Society, including social welfare, has been slow in coming to terms with the new health knowledge.

Effects of neutral posture on muscle tension during computer use.

This study focused on developing a new approach to seated work positions was conducted on 67 office workers who use a Visual Display Terminal (VDT) as a major function of their working day. Muscle tension was measured by surface electromyography (sEMG) while participants were asked to adopt 4 selected working postures. Pain was measured before and after ergonomic intervention on the Nordic scale, which was modified for this study. Adjustable workstations were used to place participants in desired positions during the clinical testing sessions and the extended intervention period. Results indicate the effects of this ergonomic intervention may have positive effects on muscle tension and pain, significant enough to encourage employers to implement training and workstation modifications following these guidelines.

A minimum income for healthy living.

BACKGROUND: Half a century of research has provided consensual evidence of major personal requisites of adult health in nutrition, physical activity and psychosocial relations. Their minimal money costs, together with those of a home and other basic necessities, indicate disposable income that is now essential for health. METHODS: In a first application we identified such representative minimal costs for healthy, single, working men aged 18-30, in the UK. Costs were derived from ad hoc survey, relevant figures in the national Family Expenditure Survey, and by pragmatic decision for the few minor items where survey data were not available. RESULTS: Minimum costs were assessed at 131.86 pound sterling per week (UK April 1999 prices). Component costs, especially those of housing (which represents around 40% of this total), depend on region and on several assumptions. By varying these a range of totals from 106.47 pound sterling to 163.86 pound sterling per week was detailed. These figures compare, 1999, with the new UK national minimum wage, after statutory deductions, of pound 105.84 at 18-21 years and 121.12 pound sterling at 22+ years for a 38 hour working week. Corresponding basic social security rates are 40.70 pound sterling to 51.40 pound sterling per week. INTERPRETATION: Accumulating science means that absolute standards of living, "poverty", minimal official incomes and the like, can now be assessed by objective measurement of the personal capacity to meet the costs of major requisites of healthy living. A realistic assessment of these costs is presented as an impetus to public discussion. It is a historical role of public health as social medicine to lead in public advocacy of such a national agenda.

Mapping access to food in a deprived area: the development of price and availability indices.

OBJECTIVE: To develop and map indices to illustrate variation in the cost and availability of healthy food. DESIGN: Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software. RESULTS: Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown. CONCLUSIONS: Data can be collected and indices developed which indicate geographic variation in shop 'expensiveness', and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.

Nutritional status indicators: interpretation and policy making role.

PIP: Anthropometric measurements, usually based on the growth of children, and considered to be reflective of the degree and state of nutritional status, have long been the measurement of choice in assessing the health and welfare of a community. However, it must be borne in mind that any such measure serves only as an indicator of the functioning of a very complex system. As such it is subject to error when applied according to rigid and predetermined numeral scales reflecting social valuations, and really cannot be considered to be a technical description of a physiological state. The limitations to the application of such inferred nutritional data, from a systems viewpoint, are many and should be recognized. Nonetheless, measures of nutritional status can provide valuable information on the effects of the health, social and food environment of individuals and communities. Bearing in mind the limitations of their usefulness, such measurements can serve as useful tools in policy making and can be integrated with information from other sectors of government for this purpose.^ieng