Assisted-living elderly and the mealtime experience.

BACKGROUND: Although there is increasing evidence of barriers to nutritional health among elderly assisted-living residents, there has not been the same emphasis when examining the ways in which these individuals experience their mealtimes, as well as the factors that they perceive as contributing to their overall sense of health and well-being. Mealtimes may be disregarded as being particularly unimportant or hurried and overlooked, especially for those residents who may be lonely and have feelings of isolation, ultimately leading to a reduced food intake and poor nutrition. METHODS: A convenience sample of 38 men and women, aged ≥65 years, were selected from four assisted-living facilities in and around Montclair, NJ, USA, to participate in focus group discussions. Data were analysed using content analysis procedures. RESULTS: Participants described their experiences of mealtimes, and the factors contributing to an overall sense of well-being during these occasions. The ability to make healthy food choices, socialise, interact with staff, friends and family members, and enjoy a tasty meal in a warm and inviting dining environment, may provide a dignity that is unmatched by other services. CONCLUSIONS: The findings of the present study highlight the importance of maintaining the health of elderly assisted-living residents through strategies that enhance their mealtime experiences. Listening to the food voice of elderly through research such as that carried out in the present study will help policy makers develop a plan that will effectively deal with systemic barriers prevalent in these facilities, and incorporate strategies to motivate and encourage their residents to increase their food intake and improve their health and well-being.

The making of a nutrition professional: the Association for Nutrition register.

OBJECTIVE: Nutritionists in the UK are at the start of an exciting time of professional development. The establishment of the Association for Nutrition in 2010 has presented an opportunity to review, revitalize and expand the UK Voluntary Register of Nutritionists. In the UK and elsewhere, there is a need for a specialist register of nutritionists with title protection as a public safeguard. DESIGN: The new structure will base professional registration on demonstration of knowledge and application in five core competencies. Initially, there will be five specialist areas: animal; public health; nutritional scientist; food; sports and exercise. The wording and requirements linking the specialist areas to the competencies have been carefully defined by leading individuals currently on the existing register in these specialist areas. These have been evaluated by a random sample of existing registrants to check for accuracy of definitions and examples. Other work aims to establish a clear quality assurance framework in nutrition for workers in the health and social care sectors (UK Public Health Skills and Career Framework Levels 1-4) who contribute to nutrition activity, such as community food workers, nutrition assistants and pharmacists. Students, co-professional affiliates and senior fellows will also find a place in the new Association. The title 'nutritionist' is not currently legally protected in the UK and it is used freely to cover a range of unregulated practice. CONCLUSIONS: The establishment of a professional register to protect the public and to provide a clear identity for nutritionists is a vital step forward.

Surfing the net for public health resources.

OBJECTIVES: To identify public health open educational resources (OER) available online, map the identified OER to The Public Health Skills and Career Framework (PHSCF), and triangulate these findings with public health practitioners. STUDY DESIGN: Systematic online search for public health OER. METHODS: An online search was undertaken using a pre-defined set of search terms and inclusion/exclusion criteria. Public health OER were then mapped against the UK PHSCF. The findings of the search were discussed with public health specialists to determine whether or not they used these resources. RESULTS: A number of public health OER were identified, located on 42 websites from around the world. Mapping against the UK PHSCF demonstrated a lack of coverage in some areas of public health education. It was noted that many of the OER websites identified were not those generally used in practice, and those sites preferred by public health specialists were not identified by the online search. CONCLUSIONS: Public health OER are available from a number of providers, frequently universities and government organizations. However, these reflect a relatively small pool of original OER providers. Tagging of websites does not always identify their public health content. In addition, users of public health OER may not use search engines to identify resources but locate them using other means.

An emerging model for publishing and using open educational resources in public health.

INTRODUCTION: The open source revolution has enabled the development of open educational resources (OER) and the potential for sharing lessons learned. We present a potential model for publishing OER in public health to inform workforce development. METHODS: As part of the PHORUS (Public Health Open Resources for the University Sector) Project, a review of the literature relating to the development of OER was followed by an online search for OER resources relating specifically to public health. Furthermore, a Delphi study was conducted to identify and prioritize barriers and enablers to the production and use of public health OER. RESULTS: A wide array of OER literature was identified, although there were a limited number of public health-related papers. The key concepts influencing public health OER release found in the literature were identified as quality, ethics and values, rewards, risks and practical aspects, such as technological developments. These concepts were then further developed through the PHORUS project research findings to produce the basis of a potential model for OER development in public health. DISCUSSION/CONCLUSION: The synthesis of a literature review and Delphi study has produced a potential model to guide the development of OER in public health. The model provides a matrix where the questions about whether and how an academic can produce and publish OER are answered, according to various risks and benefits to them and their institution. We hope that this will provide practical assistance and encouragement for the academic public health community to create and share OER.

Changes in food neophobia and dietary habits of international students.

BACKGROUND: International study is becoming more prevalent, yet aspects such as food neophobia often militate against visiting students consuming a nutritionally balanced diet. The present study aimed to evaluate the extent to which international post-graduate students experience food neophobia, how this might vary by nationality and other demographic characteristics, and how acculturation might manifest itself in students' dietary behaviour. METHODS: International students (n = 228) attending a Masters course were invited to complete a validated food neophobia and dietary habits questionnaire during their first week at university. The questionnaire was subsequently re-administered to the same students approximately 4 and 8 months later. RESULTS: In total, 226 usable responses were analysed (124, 58 and 44, respectively) for the first, second and final data collection. Perhaps surprisingly, the overall food neophobia scores increased from an mean (SD) initial value of 27.95 (16.95) to 33.67 (33.67) after 3 months, although, when comparing European and Asian students, only the former were significantly different (P < 0.05). Both Asian and European students reported small but not significant changes in their eating habits, although, after 3 months, significantly (P = <0.05) fewer changes were reported. No significant changes were reported in students' perceived healthiness of their diets either by nationality or over time. CONCLUSIONS: Understanding the complexities of food neophobia, other aspects of dietary change and at what point these changes might take place in the acculturation process when students arrive in the UK needs to be fully understood if a climate for positive learning is to be established.

Hospital food service: a comparative analysis of systems and introducing the 'Steamplicity' concept.

BACKGROUND: Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; 'stakeholders' (i.e. patients, staff, etc.) satisfaction with both systems; and patients' acceptability of the food provided. METHOD: The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors. RESULTS: Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g. CONCLUSIONS: The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.

A comparison of energy intake between eating positions in a NHS hospital--a pilot study.

Malnutrition and the under-consumption of food in hospitals is prevalent and in UK hospitals, the consumption of meals is mainly a solitude event, despite evidence to show that eating in the presence of others can actually increase food intake. Dietary data were collected for three consecutive 24 h periods (n=13) from patients who consumed their meals either in bed, at the side of the bed or in the presence of others. Results show a significant increase (p<0.05) in the mean daily energy intake for those sitting around a table in the presence of others. Although a small pilot study, the results confirm the value of social facilitation in improving the under-consumption of food when in hospital.

Fruit and vegetables--attitudes and knowledge of primary school children.

OBJECTIVES: To evaluate whether children, aged 8-11 years could correctly identify commonly available fruit and vegetables; to assess the acceptability of these; and to gain a broad understanding of children's perceptions of 'healthy eating'. METHODS: Fruit and vegetables used were those readily available in retail outlets in the UK. Data were collected from three year-groups (n = 221) using a questionnaire supported by semistructured interviews and discussions. RESULTS: Overall, fruit was more popular than vegetables and recognition of fruit better; melons being the least well identified. Recognition of vegetables increased with age; the least well identified being cabbage which was confused with lettuce by 32, 16 and 17% of pupils in their respective age groups. Most children (75%) were familiar with the term healthy eating, citing school (46%) as the most common source of information. Pupils showed an awareness and understanding of current recommendations for a balanced diet, although the message has become confused. CONCLUSIONS: If fresh fruit and vegetables are to form part of a balanced diet, the 'health message' needs to be clear. Fruit is well liked; vegetables are less acceptable with many being poorly recognized, factors which need to be addressed.

A preliminary assessment of two hospital food service systems using parameters of food safety and consumer opinion.

The goal of any hospital caterer should be to provide food that meets nutritional requirements, satisfies the patient, improves morale and is microbiologically safe. Food distribution to hospital wards plays a critical role. The aim of this study was to compare two hospital food service systems using parameters of food safety and consumer opinion. An NHS hospital was selected where food delivery was due to change from a plated system to a cafeteria trolley system. Samples (50 g) of dishes (n = 27) considered to be high-risk were collected for three consecutive days from breakfast, lunch and supper meals. The samples were taken from a pre-ordered tray (similar to that of a patient) in the plated system and from the trolley on the ward in the cafeteria system of meal delivery (approximately six months after its introduction). Consumer opinions cards (n = 180) were distributed and interviews also conducted. Microbiologically, the quality of food items delivered by both systems was satisfactory. However, concern was raised with the plated system, not for hot foods cooling down but for chilled foods warming up and being sustained in ambient conditions. Overall consumer satisfaction and experience was enhanced with the trolley system. Food was hotter and generally perceived to be of a better quality. Satisfaction with cold desserts was not dependent on the delivery system.