Addressing medical resident mistreatment: A resident-centred approach.

INTRODUCTION: Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes. METHOD: We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645). RESULTS: When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach. CONCLUSION: Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.

What influences people's responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations.

BACKGROUND: Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond. OBJECTIVE: To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages. DESIGN: A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704. DATA SOURCES: Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020. STUDY SELECTION: All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded. SYNTHESIS: Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging. RESULTS: Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility. DISCUSSION: There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.

A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic.

Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.

Adult consumers of cranberry juice cocktail have lower C-reactive protein levels compared with nonconsumers.

Flavonoids are important bioactive plant constituents found in abundance in berries, including cranberries. Cranberry beverages have been shown to beneficially impact urinary and cardiovascular health in clinical and observational studies, but their association with anthropometric outcomes is unknown. We examined the association between cranberry juice cocktail (CJC) consumption with flavonoid intake, and cardiometabolic and anthropometric outcomes among adults in the US data for adults (≥19 years, n = 10334) were drawn from cross-sectional National Health and Nutrition Examination Survey combined 2005-2008 survey. We hypothesized that CJC consumers will have lower anthropometric measures and healthier cardiometabolic profiles, including lower cholesterol and C-reactive protein (CRP). A CJC consumer (n = 330) was defined as anyone consuming CJC for 2 nonconsecutive 24-hour dietary recalls. We used multivariate linear regression models to examine differences in anthropometric and cardiometabolic outcomes comparing CJC consumers to nonconsumers controlling for important confounders. Consumers drank an average 404 mL (14 fl oz) of CJC for 2 days and did not have higher total energy intakes compared with nonconsumers (mean [SD], 2259 [79] vs 2112 [24], respectively). In fully adjusted models, adult CJC consumers had significantly lower levels of CRP (mean [SD], -0.13 [0.05]; P = .015), results that were strengthened after further adjustment for body mass index (mean [SD], -0.98 [0.04]; P = .027). Trends toward lower weights and lower levels of cholesterol did not reach statistical significance. Intake of cranberry polyphenols may play a role in promoting anti-inflammatory markers among CJC consumers, specifically lowering CRP levels.

Adult cranberry beverage consumers have healthier macronutrient intakes and measures of body composition compared to non-consumers: National Health and Nutrition Examination Survey (NHANES) 2005-2008.

Flavonoids, present in high levels in cranberries, are potent bioactives known for their health-promoting benefits, but cranberry beverages (CB) are not typically recommended as part of a healthy diet. We examine the association between CB consumption with macronutrient intake and weight status. Data for US adults (≥19 years, n = 10,891) were taken from the National Health and Nutrition Examination Survey (NHANES) Survey 2005-2008. Total CB consumption was measured over two non-consecutive 24-h dietary recalls. Linear and logistic regression models adjusting for important covariates were used to examine predicted differences between CB consumers and non-consumers on macronutrient and anthropometric outcomes. Results are weighted to be nationally representative. CB consumers (n = 581) were older (>50 year) non-Hispanic black females. They consumed an average 221 mL (7.5 oz) CB per day. In fully adjusted models CB consumers (vs. non-consumers) had higher carbohydrates and total sugars and lower percent energy from protein and total fat (all p < 0.001), but no difference in total energy. A significantly higher proportion of CB consumers were predicted to be normal weight (BMI < 25 kg/m2; p = 0.001) and had to have lower waist circumferences (p = 0.001). Although there was not a significant trend across level of CB intake, low and middle level CB consumers compared to non-consumers were more likely to be normal weight (p < 0.001) and less likely to be overweight/obese (BMI ≥ 25 kg/m2, p < 0.001). Despite having slightly higher daily macronutrient intakes, CB consumers have more desirable anthropometric measures compared to non-consumers.

Giving the wrong impression: food and beverage brand impressions delivered to youth through popular movies.

BACKGROUND: Marketing on television showcases less-healthful options, with emerging research suggesting movies promote similar products. Given the obesity epidemic, understanding advertising to youth should be a public health imperative. The objective of this study was to estimate youth impressions to food and beverages delivered through movies. METHODS: Impressions were calculated by dividing US receipts annually into average movie ticket prices, then multiplying this by the number of brand appearances. Examination by ratings, product types and ages were conducted by Spearman rank correlation coefficient tests. RESULTS: Youth in the USA saw over 3 billion food, beverage or food-retail establishment (FRE) impressions on average, annually from 1996 to 2005. Those aged 12-18 viewed over half of all impressions, with PG-13-rated movies containing 61.5% of impressions. There were no significant trends in brand appearances by food, beverage or FRE impressions over the decade, although there was a decreasing trend in R-rated impressions for both foods (P< 0.01) and beverages (P< 0.01), but not FREs (P= 0.08). CONCLUSIONS: Movies promote billions of food and beverage impressions annually to youth. Given the public health crisis of obesity, future research should further investigate these trends, as well as the potential association of these unhealthy exposures in youth.

Development and implementation of the guiding stars nutrition guidance program.

PURPOSE . To describe the collaborative process between a grocery retailer and a panel of nutrition experts used to develop a nutrition guidance system (Guiding Stars) that evaluates the nutrient profile of all edible products in the supermarket, and to report the results of the food and beverage ratings. DESIGN . A collaboration between a private retailer and members of the scientific community that led to the development of a scoring algorithm used to evaluate the nutritional quality of foods and beverages. SETTING/SUBJECTS . Northeast supermarkets (n  =  160). MEASURES . Food and beverage nutrition ratings and distribution of stars across different grocery categories. ANALYSIS . Descriptive statistics for rating distributions were computed. T-tests were conducted to assess differences in mean nutrient values between foods with zero versus three stars or a dichotomized variable representing all foods with one to three stars. RESULTS . All edible grocery items (n  =  27,466) were evaluated, with 23.6% earning at least one star. Items receiving at least one star had lower mean levels of sodium, saturated fat, and sugars and higher amounts of fiber than products not earning stars. CONCLUSION . The Guiding Stars system rates edible products without regard to brand or manufacturer, and provides consumers with a simple tool to quickly identify more nutritious choices while shopping. The low percentage of products qualifying for stars reflects poorly on the food choices available to Americans.

Tween sex differences in snacking preferences during television viewing.

Television viewing is associated with an increased risk in childhood obesity. Research surrounding food habits of tweens largely bypasses snacking preferences while watching television in the home. The aim of this cross-sectional study was to describe snacking prevalence by tween sex and to describe parental rules surrounding snacking while watching television at home. Survey data were obtained in 2008 from 4th- through 6th-grade students (n=1,557) who attended 12 New England schools. Complete self-reported measures (n=1,448) included demographics, household and bedroom television ownership, television watching frequency, snacking prevalence, snacking preferences, and parental rules regarding snacking while watching television. Comparisons were generated using χ(2) analyses. Overall, the majority of children (69.2%) snacked "sometimes" or "always" during television viewing, with the majority of responses (62.9%) categorized as foods. The most popular food snacks for both sexes in this sample were salty snacks (47.9%), with fruits and vegetables ranking a distant second (18.4%). Girls (22.6%) selected fruits and vegetables more frequently than boys (14.7%) (P=0.003). Of those drinking beverages (n=514), boys selected sugar-sweetened beverages more often than girls (43.5% vs 31.7%; P=0.006), and girls chose juice more often than boys (12.3% vs 6.1%; P=0.02). Overall, approximately half (53.2%) of the students consumed less-healthy snacks while watching television. Interventions for parents and both sexes of tweens focusing on healthy snacking choices may have long-term beneficial outcomes.

Adolescent weight status and receptivity to food TV advertisements.

OBJECTIVE: This study examined the relationship between adolescent weight status and food advertisement receptivity. DESIGN: Survey-based evaluation with data collected at baseline (initial and at 2 months), and at follow-up (11 months). SETTING: New Hampshire and Vermont. PARTICIPANTS: Students (n = 2,281) aged 10-13 in 2002-2005. MAIN OUTCOME MEASURE: Overweight. ANALYSIS: Generalized estimating equations to model the relationship between identifying a food advertisement as their favorite and being overweight. RESULTS: Overall, 35.9% of the adolescents were overweight. Less than one fifth named a food advertisement as their favorite (16.1%). Most of the food advertisements were for less-healthful food (89.6%). After controlling for school, age, sex, sociodemographics, physical activity, number of TV sessions watched, and having a TV in the bedroom, overweight adolescents were significantly less likely to be receptive to food advertisements (relative risk = 0.83, 95% confidence interval 0.70, 0.98) compared to non-overweight adolescents. CONCLUSIONS AND IMPLICATIONS: This study provides preliminary evidence that normal-weight adolescents are receptive to unhealthful food advertisements. Longitudinal studies are needed to evaluate whether consistent exposure to advertisements for unhealthful food, particularly if they are promoted with healthful behaviors such as being physically active, influence adolescents' food choices, and ultimately their body mass index, over the long term.

Guiding stars: the effect of a nutrition navigation program on consumer purchases at the supermarket.

BACKGROUND: To improve diet quality and overall population health, the need to develop nutritional rating systems that are comprehensive in scope and easy for the consumer to understand and use at the point-of-purchase has emerged. OBJECTIVE: Our aim was to examine the effect of a comprehensive storewide supermarket point-of-purchase nutrition navigation intervention by using a shelf-label 3-tiered star icon on consumer food and beverage choices and their associated nutritional quality. DESIGN: By using a natural experiment design, purchasing data from 2006 to 2008 were obtained from a Northeast supermarket chain with 168 stores located in northern New England and New York and examined at preimplementation and at 1- and 2-y follow-up periods. RESULTS: The nutrition navigation system studied showed significant changes in food purchasing immediately after implementation, and these changes continued to be significant 1 and 2 y later. When the same 8-mo period (January-August) each year was compared, in 2006, 24.50% of items purchased earned a star rating; this proportion increased to 24.98% (P < 0.001) and 25.89% (P < 0.0001) at the 1- and 2-y follow-up periods, respectively. For a 4-wk period, 1 y after program implementation, consumers purchased significantly more ready-to-eat cereals with stars (eg, less added sugars and more dietary fiber) and fewer no-star, high-sugar, low-fiber cereals. CONCLUSION: Increasing rates of obesity and declining diet quality for Americans strongly support the need for effective supermarket point-of-purchase programs, such as the Guiding Stars nutrition navigation program, that provide clear, concise, and simplified nutrition information to guide consumer food and beverage choices.

Prevalence of food and beverage brands in movies: 1996-2005.

OBJECTIVE: The objective of this study was to describe food and beverage brand placements in a large representative sample of popular movies. METHODS: We identified and coded brand placements for foods, beverages, and food retail establishments in the top 20 US box office movie hits for each year from 1996 to 2005. We also coded general movie characteristics (Motion Picture Association of America rating, run time, genre, and information about major characters). We summarized the number and types of food, beverage, and food retail establishment brands by movie characteristics and also identified manufacturers that are associated with each of the brands. RESULTS: Of the 200 movies coded, 138 (69%) contained at least 1 food, beverage, or food retail establishment brand. Movies rated PG-13 and R were significantly more likely to have brand placements compared with movies in other rating categories. Comedies, action/adventures, and horror films had more brand placements than other genres. We did not detect a significant difference in the number of movies with brand placements or mean number of placements per movie by year of movie release. A total of 1180 brand placements were identified and verified, including 427 food, 425 beverage, and 328 food retail establishment brand placements. Candy/confections (26%) and salty snacks (21%) were the most prevalent food brands, sugar-sweetened beverages (76%) were the most prevalent beverage brands, and fast food composed two thirds of the food retail establishment brand placements. CONCLUSIONS: Food, beverage, and food retail establishment brands are frequently portrayed in movies, and most of the brand placements are for energy-dense, nutrient-poor foods or product lines. Movies are a potent source of advertising to children, which has been largely overlooked.

Modeling expert opinions on food healthfulness: a nutrition metric.

Research during the last several decades indicates the failure of existing nutritional labels to substantially improve the healthfulness of consumers' food/beverage choices. The present study aims to fill this void by developing a nutrition metric that is more comprehensible to the average shopper. The healthfulness ratings of 205 sample foods/beverages by leading nutrition experts formed the basis for a linear regression that places weights on 12 nutritional components (ie, total fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron) to predict the average healthfulness rating that experts would give to any food/beverage. Major benefits of the model include its basis in expert judgment, its straightforward application, the flexibility of transforming its output ratings to any linear scale, and its ease of interpretation. This metric serves the purpose of distilling expert knowledge into a form usable by consumers so that they are empowered to make more healthful decisions.

Like parent, like child: child food and beverage choices during role playing.

OBJECTIVE: To examine food and beverage choices of preschool-aged children. DESIGN: Semistructured observational study. While pretending to be adults during a role-play scenario, children selected food and beverage items from a miniature grocery store stocked with 73 different products, of which 47 foods and beverages were examined in this analysis. Parents self-reported how frequently they purchased specific grocery items. SETTING: A behavioral laboratory. PARTICIPANTS: One hundred twenty children, aged 2 to 6 years, and 1 parent for each child. Main Outcome Measure Children's total purchases were classified according to the number of healthier and less healthy products they selected as least healthy, somewhat healthy, and most healthy choices. The same categories were used to classify parents' self-reported purchases. RESULTS: Most of the children (70.8%) purchased foods that were categorized as least healthy choices. Only 13 children (10.8%) had shopping baskets consisting of the healthiest choices. On average, children in the group with the least healthy choices purchased the same number of healthier and less healthy products, whereas children in the group with most healthy choices purchased 5 healthier products for each less healthy product selected. The healthfulness of children's total purchases were significantly (P = .02) predicted by their parents' purchasing categorization. CONCLUSIONS: When presented with a wide array of food products, young children chose combinations of healthier and less healthy foods and beverages. The data suggest that children begin to assimilate and mimic their parents' food choices at a very young age, even before they are able to fully appreciate the implications of these choices.

Great expectations and hard times: developing community indicators in a healthy communities initiative in Canada.

This paper reports on expectations for and community members' experience in the development of community indicators in a healthy communities initiative (HCI) in Alberta, Canada. The HCI process involved community visioning, the creation of action plans to further the vision by addressing key health priorities and/or community capacity building activities and the development of indicators to monitor and report on progress towards goals. Nineteen semi-structured interviews were conducted with community participants to discuss definitions of success in the HCI and participant experience in developing indicators. Three themes emerged: the formal indicators lacked relevance to community members; the community did not own the HCI indicators and participants instead drew upon measures of success which were largely experiential in nature. The study provides a critically reflective, candid account of on-the-ground work with communities. The findings reveal limitations in the process of developing community indicators in this HCI, which we attribute in part to skills and discontinuities on the staffing side of the health authority and in part to failure to recognize and fully appreciate 'different ways of knowing' between communities and agencies.

Parents' and caregivers' concerns about obesity in young children: a qualitative study.

To address the childhood obesity epidemic, it is necessary to understand parents' and caregivers' concerns and beliefs regarding their children's weight problems and best practices for addressing those concerns. Formative research methods were used to identify obesity-related concerns of Hispanic, Black, and White parents of young children (5-8 years old) in North Carolina. Participants identified challenges at multiple levels of influence. In all groups, participants reported that they had trouble finding enough time to help their children develop healthy lifestyles. Conflicting family priorities and needs often made it difficult to ensure that their children had healthy diets. Children's own diet and activity preferences and their parent or caregiver's inability to adequately guide their choices also contributed to obesigenic behaviors. In addition, many thought that physician and community support for their efforts to manage their children's eating habits was inadequate. Findings from these focus groups suggest that participants would be receptive to positive, multilevel prevention approaches to help their children attain and maintain healthy weights.

Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice.

BACKGROUND: Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening. METHODS: We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50-75 years old recruited from an academic internal medicine practice. RESULTS: Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask) before viewing the decision aid to 3.2 afterwards (difference, 0.4; p < 0.0001, paired t-test). Most found the aid useful and reported that it improved their knowledge about screening. Sixty percent said they were ready to be tested, 18% needed more information, and 22% were not ready to be screened. Within 6 months of viewing, 43% of patients had completed screening tests. CONCLUSION: We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening. PRACTICE IMPLICATIONS: This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels.

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites.

OBJECTIVE: To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN: Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS: Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Student's t tests. RESULTS: Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS: Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.

The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life.

BACKGROUND: Obesity is now one of our major public health problems. Effective and acceptable treatment options are needed. The Lap-Band system is placed laparoscopically and allows adjustment of the level of gastric restriction. METHODS: A prospective study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center. After extensive preoperative evaluation, patients with a body mass index > 35 were treated by Lap-Band placement. Close follow-up with progressive adjustment of gastric restriction continued permanently. Medical co-morbidities were monitored as part of comprehensive prospective data collection. RESULTS: There have been no deaths perioperatively or during follow-up. Significant perioperative adverse events occurred in 1.2% only. Reoperation has been needed for prolapse (slippage) in 12.5%, erosion of the band into the stomach in 2.8% and for tubing breaks in 3.6%. A steady progression of weight loss has occurred through the duration of the study with 52 +/- 19% EWL at 24 months (n = 333), 53 +/- 22% EWL at 36 months (n = 264), 52 +/- 24% EWL at 48 months (n = 108), 54 +/- 24% EWL at 60 months (n = 30), and 57 +/- 15% EWL at 72 months (n = 10). Major improvements have occurred in diabetes, asthma, gastroesophageal reflux, dyslipidemia, sleep apnea and depression. Quality of life as measured by Rand SF-36 shows highly significant improvement. CONCLUSIONS: Placement of the Lap-Band system provides safe and effective control of severe obesity. The effect on weight loss is durable and is associated with major improvement in health and quality of life. It has the potential to provide a broadly acceptable option for this common and serious disease.