The role of mentoring in public health nutrition workforce development. Perspectives of advanced-level practitioners

OBJECTIVE: To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists. DESIGN: Qualitative study using in-depth interviews. SUBJECTS AND SETTING: Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia. RESULTS: The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition. CONCLUSIONS: The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.     

Competencies for effective public health nutrition practice: a developing consensus

OBJECTIVES: To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice. DESIGN: A modified Delphi study involving three rounds of questionnaires. SUBJECTS: A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia. RESULTS: Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. CONCLUSIONS: There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.     

The Public Health Nutrition workforce and its future challenges: the US experience

OBJECTIVES: To describe the US public health nutrition workforce and its future social, biological and fiscal challenges. DESIGN: Literature review primarily for the four workforce surveys conducted since 1985 by the Association of State and Territorial Public Health Nutrition Directors. SETTING: The United States. SUBJECTS: Nutrition personnel working in governmental health agencies. The 1985 and 1987 subjects were personnel in full-time budgeted positions employed in governmental health agencies providing predominantly population-based services. In 1994 and 1999 subjects were both full-time and part-time, employed in or funded by governmental health agencies, and provided both direct-care and population-based services. RESULTS: The workforce primarily focuses on direct-care services for pregnant and breast-feeding women, infants and children. The US Department of Agriculture funds 81.7 % of full-time equivalent positions, primarily through the WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children). Of those personnel working in WIC, 45 % have at least 10 years of experience compared to over 65 % of the non-WIC workforce. Continuing education needs of the WIC and non-WIC workforces differ. The workforce is increasingly more racially/ethnically diverse and with 18.2 % speaking Spanish as a second language. CONCLUSIONS: The future workforce will need to focus on increasing its diversity and cultural competence, and likely will need to address retirement within leadership positions. Little is known about the workforce's capacity to address the needs of the elderly, emergency preparedness and behavioural interventions. Fiscal challenges will require evidence-based practice demonstrating both costs and impact. Little is known about the broader public health nutrition workforce beyond governmental health agencies.     

Food-based dietary guidelines and implementation: lessons from four countries--Chile, Germany, New Zealand and South Africa

OBJECTIVE: Food-based dietary guidelines (FBDGs) are globally promoted as an important part of national food and nutrition policies. They are presented within policy as key features of the strategy to educate the public and guide policy-makers and other stakeholders about a healthy diet. This paper examines the implementation of FBDGs in four countries: Chile, Germany, New Zealand and South Africa - diverse countries chosen to explore the realities of the FBDG within policy on public health nutrition. DESIGN: A literature review was carried out, followed by interviews with representatives from the governmental, academic and private sector in all four countries. RESULTS: In all four countries the FBDG is mainly implemented via written/electronic information provided to the public through the health and/or education sector. Data about the impact of FBDGs on policy and consumers' food choice or dietary habits are incomplete; nutrition surveys do not enable assessment of how effective FBDGs are as a factor in dietary or behavioural change. Despite limitations, FBDGs are seen as being valuable by key stakeholders. CONCLUSION: FBDGs are being implemented and there is experience which should be built upon. The policy focus needs to move beyond merely disseminating FBDGs. They should be part of a wider public health nutrition strategy involving multiple sectors and policy levels. Improvements in the implementation of FBDGs are crucial given the present epidemic of chronic, non-communicable diseases.     

Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger

BACKGROUND: In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services. OBJECTIVES: To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems. FINDINGS: The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. CONCLUSION: A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children 'covered' by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.     

Workforce development in South Africa with a focus on public health nutrition

OBJECTIVES: The present paper aims to review and report on the current and predicted future public health nutrition workforce in South Africa. Additionally, it examines ways in which the Department of Health (DOH) is striving to meet the increasing burden of nutrition-related diseases in South Africa. METHODS: The primary sources of data used for the review were reports from the Census office, South African health reviews, mortality and morbidity statistics, and documents from the Health Professions Council of South Africa. RESULTS: There are fewer than 2000 registered dietitians in South Africa and fewer than 600 of them work in the public health sector. Furthermore, professional nurses - who are the backbone of the primary health-care system and deliver the rudiments of basic nutritional care - are not being trained in sufficient numbers to meet population growth; in 2004 there was only one nurse per 4000 persons. This situation is aggravated by the growing burden of conditions associated with both overnutrition and undernutrition, as well as the enormous demands of the HIV/AIDS epidemic. The DOH is striving to meet these increasing needs by means of the Integrated Nutrition Programme as well as a National Human Resources Plan which includes numerous strategies to improve the quantity and quality of health professionals' training, including dietitians and nutritionists. This plan includes the objective of increasing the public health nutrition workforce to more than 250 newly trained dietitians and nutritionists per annum by 2010.     

Delivering multidisciplinary public health in action - the Cardiff food strategy case study

BACKGROUND: There is an increasing awareness that the provision of healthy food relies on the co-ordinated efforts of a number of diverse disciplines, not merely those traditionally linked with food. This paper documents the development of a food and health strategy, commissioned by the health alliance for the city of Cardiff, and focuses on the areas of sustainability, education and training as well as nutrition, food provision and food safety. OBJECTIVE: The aim of the strategy was to increase the uptake of a healthy, safe and sustainable diet for all those living in Cardiff. METHOD: The methodology included a rapid appraisal of food initiatives operating within the city, establishing a food and health strategy working group and the production of strategy documentation. Multi-agency collaboration and consultation were key components of the approach. RESULTS: As the strategy developed, seven action areas became apparent, including education and training, public sector procurement and rewarding excellence. These action areas were incorporated into seven 'action tables', which constitute the core of the strategy. The food and health strategy document was ratified by the Local Health Alliance board in August 2004. But, far greater benefits were realised as a consequence of setting up the strategy working group. Long before the document was written, the strategy process was operating as 'multidisciplinary public health in action'. CONCLUSION: The network that comprised the food and health strategy working group was already able to commence delivery of a more integrated approach to food and health within Cardiff.     

Tea or coffee? A case study on evidence for dietary advice

The present paper explores the level of evidence required to justify giving dietary advice to the public. There are important practical differences between the development of public health nutrition guidelines and guidelines for clinical practice. While the gold standard for evidence for clinical practice guidelines is a meta-analysis of a number of randomised controlled trials, this is often unrealistic and sometimes unethical for the evaluation of public health nutrition interventions. Hence, epidemiological studies make up the bulk of evidence for nutrition guidelines. Tea and coffee are an interesting case study in relation to this issue. They are two of the most commonly consumed beverages worldwide, yet there is little dietary advice on their use. The evidence for a relationship between coffee or tea consumption and several diseases is discussed. The available studies, predominantly epidemiological, together with animal and in vitro studies, indicate that coffee and tea are both safe beverages. However, tea is the healthier option because it has a possible role in the prevention of several cancers and CVD. While the evidence for such relationships is not strong, the public will continue to drink both tea and coffee, and will continue to ask nutritionists to make recommendations. It is therefore argued that advice should be given on the best available data, as waiting for complete data to become available could have severe consequences for public health.     

Are research priorities in Latin America in line with the nutritional problems of the population?

OBJECTIVE: Concordance of nutritional research priorities with the related burden of disease is essential to develop cost-effective interventions to address the nutritional problems of populations. The present study aimed to evaluate whether nutrition research priorities are in agreement with the population's nutritional problems in Latin America. DESIGN: The epidemiological profile was contrasted with the research priorities and research produced by academic institutions for each country. Qualitative analysis of research production by type of contribution to problem solving was also conducted. SETTINGS: Nine Latin American countries. RESULTS: Obesity (high body mass index (BMI)) and micronutrient deficiencies (anaemia) emerged as key problems, followed by stunting, breast-feeding/lactation and low birth weight. Wasting in children and women (low BMI) was uncommon. Concordance of ranked research priorities with the epidemiological profile of the country was generally good for nutrition-related chronic diseases, micronutrients and low birth weight, but not for undernutrition, stunting and breast-feeding. Studies on the efficacy and effectiveness of interventions were uncommon. CONCLUSIONS: The present research agenda insufficiently supports the goal of public health nutrition, which is to ensure the implementation of cost-effective nutrition programmes and policies. A more rational approach to define research priorities is needed.     

森林生态系统健康评估方法的现状与前景

森林是林业的主体,作为森林可持续经营的组成部分和重要措施,森林健康问题引起了国内外许多学者的关注,成为当前林业研究的重要领域之一。从森林健康的发展历程和内涵入手,对森林健康评估指标体系法、生态指示者法和健康距离法3种主要方法进行综述,并分析各种方法的优缺点。快速诊断和评估将是森林健康研究的重要方向,需要加强以下几方面:1)界定森林生态系统健康内涵;2)形成森林生态系统健康快速诊断和评估的简化指标体系;3)建立森林健康快速诊断和评估方法;4)森林健康快速诊断和评估的应用技术;5)森林健康快速诊断和评估多技术、多方法、多尺度的研究。     

A risk analysis methodology for assessing natural resources degradation

Risk analysis has been employed, amongst other things, both to estimate the probability of future water demand emergencies in reservoir systems (using simulation modelling), and to estimate environmental and public health risks (using empirical data). We assert that this framework, when coupled with simulation modelling, can be applied to examine and compare the impacts of resource exploitation, land use and production strategies which may cause land degradation. Our representation of risk analysis relies on the assumption that each land use strategy is associated with a risk of the system (i.e., social system, production system, ecosystem) attaining a subjectively unacceptable environmental condition (e.g. poor human nutrition, crop failure, degradation of a natural resource) sometime during a management planning period. The research methodology entails: (1) the identification of critical variables in the social and biological environment that are affected by exploitation and management of resources; (2) the identification through interviews, surveys, and research of regions of unacceptability in these variables that determine the dynamics of local environmental degradation; (3) the translation of resource policy and practice into a computer model of impact on the resource system; (4) many iterations of simulation of the system to determine the ‘risk of failing’ in each of the critical variables. The presentation of risk probabilities to decision-makers represents a reduction of many simulations into an understandable estimate of environmental impact. More importantly, risk analysis is potentially a learning tool for human system studies, and an interface for applied social science and ecological research.     

Evaluation of health, nutrition and food security programmes in a complex emergency: the case of Congo as an example of a chronic post-conflict situation

OBJECTIVE: To describe the case of Congo as an example of the assessment and appropriateness of donor operational and sectoral strategies in a complex emergency. DESIGN AND SETTING: The paper reports the findings of an external evaluation of operations financed by the European Commission Humanitarian Office in the Democratic Republic of Congo (DRC). RESULTS: The Congolese health system is suffering from severe deterioration. What is functioning in the public health context is donor-dependent with high costs and limited coverage. Despite a relatively favourable agro-climatic situation, food shortage and famine severely affect the nutritional status of large population groups. In this context, humanitarian programmes have generally improved access to health care and the nutritional status of beneficiaries. The reduction of malnutrition in project areas is often demonstrated even though the context did not permit consolidation of these results. Malnutrition continues to claim a massive cost of lives owing to the effect of widespread food insecurity that follows a circular cause-and-effect pattern of very low food production and extreme poverty. CONCLUSIONS: The current context in DRC does not correspond yet to 'post-crisis': neither at population level with regard to indicators of poverty, malnutrition, disease and death, nor at institutional level, with regard to state support to institutions. In these situations, the international community is often called upon to replace the state as service provider. Integrated humanitarian actions should be the future of relief projects in DRC. Health, nutrition and food security components should be considered a standard public health intervention strategy representing the most sensible approach to address the needs of the affected population.     

Defining protected area boundaries based on vascular-plant species richness using hydrological information derived from archived satellite imagery

Surface and near-surface hydrological conditions are not generally considered in the selection of protected-area boundaries; however, these hydrological conditions may be critical in the maintenance of hydrologically driven biodiversity areas and should factor heavily in systematic conservation planning and impact-mitigation efforts. Here we demonstrate the use of Synthetic Aperture Radar (SAR) satellite imagery to model surface and near-surface hydrological dynamics and related vascular-plant species richness surrounding Sundance Provincial Park, Alberta, Canada. Based on a relationship established between field-sampled soil moisture and remote-sensed SAR backscatter coefficient, we generated landscape-scale maps of surface hydrological condition and related vascular-plant species richness surrounding the protected area. After processing, SAR data were classified into three hydrological classes: unsaturated, saturated and inundated. By assembling a multi-year series of SAR images acquired across the natural range of hydrological conditions, the probability of surface saturation and inundation was developed. Using the resulting probability map to select sites for biodiversity assessment, we found relatively strong relationships between total vascular plants (species richness, especially ferns and herbs), and the probability of wet area (both saturated and inundated areas) occurrence. Using this relationship, we mapped vascular-plant species richness across the study region revealing opportunities to mitigate impacts from adjacent developments and to expand the park to increase its ecological value. This study presents an important approach for assessing biodiversity of existing parks and generating valuable input layers that help to define ecologically relevant protected-area boundaries.     

Banning front-of-package food labels: first Amendment constraints on public health policy

In recent months, the FDA has begun a crackdown on misleading nutrition and health claims on the front of food packages by issuing warning letters to manufacturers and promising to develop stricter regulatory standards. Leading nutrition policy experts Marion Nestle and David Ludwig have called for an even tougher approach: a ban on all nutrition and health claims on the front of food packages. Nestle and Ludwig argue that most of these claims are scientifically unsound and misleading to consumers and that eliminating them would 'aid educational efforts to encourage the public to eat whole or minimally processed foods and to read the ingredients list on processed foods'. Nestle and Ludwig are right to raise concerns about consumer protection and public health when it comes to front-of-package food labels, but an outright ban on front-of-package nutrition and health claims would violate the First Amendment. As nutrition policy experts develop efforts to regulate front-of-package nutrition and health claims, they should be mindful of First Amendment constraints on government regulation of commercial speech.     

我国乡村生态系统的功能、问题及对策

当前,全国上下正在全力实施乡村振兴战略,积极推进乡村生态系统向前发展。本文从生态学、农业生态学角度,对我国乡村生态系统的主要功能、当前面临的突出问题,以及应采取的对策和措施进行探讨,以期为助力实施乡村振兴战略、推进乡村生态系统的可持续发展提供参考。我国乡村生态系统具有承载人口、改善环境、提供产品、增加收入、扩大就业、观光旅游、传承文化、科普教育、培养人才,以及为城市居民养老提供场所等多方面的作用与功能。当前,我国乡村生态系统尚存在多方面的问题与挑战,如：生态破坏、资源浪费、环境污染、自然灾害、经济贫困、科教文卫落后、公共服务缺失、社会风气不良、村民流失和村庄消失。为促进乡村振兴战略的实施,推进我国乡村生态系统可持续发展,应遵循"三效"并举原则、循序渐进原则、综合治理原则、因地制宜原则和久久为功原则,并采取以下措施：增强认识、搞好规划、整治环境、优化结构、提升功能、改善条件、强化公共服务、完善法律法规、加大投入力度和加速人才培养。     

Nutrimetabolomic strategies to develop new biomarkers of intake and health effects

Correctly assessing the metabolic status of subjects after consumption of specific diets is an important challenge for modern nutrition. Recently, metabolomics has been proposed as a powerful tool for exploring the complex relationship between nutrition and health. Nutritional metabolomics, through investigating the role that dietary components play in the maintenance of health and development of risk disease, aims to identify new biomarkers that allow the intake of these compounds to be monitored and related to their expected biological effects. This review offers an overview of the application of nutrimetabolomic strategies in the discovery of new biomarkers in human nutritional research, suggesting three main categories: (1) assessment of nutritional and dietary interventions; (2) diet exposure and food consumption monitoring; and (3) health phenotype and metabolic impact of diet. For this purpose, several examples of these applications will be used to provide evidence and to discuss the advantages and drawbacks of these nutrimetabolomic strategies.     

基于DSR模型的煤矿废弃工业广场再开发时序评价体系

为提高煤矿废弃工业广场再开发效率,从"城市双修"视角出发,基于驱动力-状态-响应(driving force-state-response,DSR)模型框架,建立由3个一级指标、7个二级指标、16个三级指标组成的煤矿废弃工业广场再开发时序评价体系。以北京京西煤矿为例,采用赋值法进行指标量化分级,利用四象限法对驱动力D、状态S和响应R结果进行耦合处理。结果表明:长沟峪(D=3.818,S=3.848)、大台(D=3.732,S=4.603)和木城涧(D=2.646,S=4.522)划属近期开发;王平(D=4.240,S=3.187)、千军台(D=2.248,S=3.887)和大安山(D=1.792,S=4.39)划属中期开发;安家滩(D=2.118,S=1.464)和花坡根(D=2.798,S=1.907)划属远期开发。该时序评价体系将煤矿废弃工业广场再开发与城市发展紧密结合,以更全面的视角进行时序评价,准确性更高、适宜性更强,为同类型废弃工业广场再开发时序评价提供借鉴参考。     

全面推进新世纪的城市水土保持工作

随着城市化步伐加快 ,城市水土流失问题日益突出。自然流失是城市水土流失的次要方面 ,城市建设产生的人为水土流失是城市水土流失的主体。优美的生态环境是现代化文明城市的重要标志。提高各级领导的认识是搞好此项工作的关键因素。推进城市水保工作的具体措施是进一步强化领导 ,搞好规划 ,广泛宣传 ,继续搞好示范建设工作。