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Renewed focus on public health has brought about considerable interest in workforce development among public health nutrition professionals in Canada. The present article describes a situational assessment of public health nutrition practice in Canada that will be used to guide future workforce development efforts.
A situational assessment is a planning approach that considers strengths and opportunities as well as needs and challenges, and emphasizes stakeholder participation. This situational assessment consisted of four components: a systematic review of literature on public health nutrition workforce issues; key informant interviews; a PEEST (political, economic, environmental, social, technological) factor analysis; and a consensus meeting.
Information gathered from these sources identified key nutrition and health concerns of the population; the need to define public health nutrition practice, roles and functions; demand for increased training, education and leadership opportunities; inconsistent qualification requirements across the country; and the desire for a common vision among practitioners.
Findings of the situational assessment were used to create a three-year public health nutrition workforce development strategy. Specific objectives of the strategy are to define public health nutrition practice in Canada, develop competencies, collaborate with other disciplines, and begin to establish a new professional group or leadership structure to promote and enhance public health nutrition practice. The process of conducting the situational assessment not only provided valuable information for planning purposes, but also served as an effective mechanism for engaging stakeholders and building consensus.
To describe the US public health nutrition workforce and its future social, biological and fiscal challenges.
Literature review primarily for the four workforce surveys conducted since 1985 by the Association of State and Territorial Public Health Nutrition Directors.
The United States.
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.
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.
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.
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.
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.
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.
To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists.
Qualitative study using in-depth interviews.
Subjects and setting
Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia.
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.
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.
To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women.
Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand.
Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available.
Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.
Observational studies and clinical trials have shown conclusive evidence that periconceptional folic acid supplementation prevents up to 70 % of neural tube defects (NTD). The Honduran government wanted to implement a supplementation programme of folic acid but needed to assess the relative effects of two dosages of folic acid.
To determine the effect of two dosages of folic acid on blood folate levels in Honduran female factory workers aged 18 to 49 years.
This was a randomized, double-blind control supplementation trial conducted in Choloma, Honduras. A total of 140 eligible women were randomly assigned to two dosage groups and followed up for 12 weeks. One group received a daily dosage of 1 mg folic acid and the other a once weekly dosage of 5 mg. Serum folate and red blood cell folate levels were determined by radioassay at baseline, 6 weeks and 12 weeks.
Serum folate levels increased from 6·3 (se 0·2) to 14·9 (se 0·6) ng/ml (P < 0·0001) in women assigned to the 1 mg/d group and from 6·9 (se 0·3) to 10·1 (se 0·4) ng/ml (P < 0·0001) in those assigned to the 5 mg/week group. Red blood cell folate concentrations also increased significantly in both groups, albeit more slowly. Educational level, age and BMI were not associated with the changes in serum and red blood cell folate levels during the supplementation period. However, a differential effect on serum folate levels by dosage group and time was observed.
Although both folate supplementation regimens increased serum and red blood cell folate levels significantly among the women studied, blood folate levels that are considered to be protective of NTD were reached faster with the daily dosage of 1 mg folic acid.
To characterise the diet of First Nations in north-western Ontario, highlight
foods for a lifestyle intervention and develop a quantitative food-frequency
Cross-sectional survey using single 24 h dietary recalls.
Eight remote and semi-remote First Nations reserves in north-western
129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80
The greatest contributors to energy were breads, pasta dishes and chips
(contributing over 20 % to total energy intake). ‘Added
fats’ such as butter and margarine added to breads and vegetables
made up the single largest source of total fat intake (8·4 %).
The largest contributors to sugar were sugar itself, soda and other
sweetened beverages (contributing over 45 % combined). The mean number of
servings consumed of fruits, vegetables and dairy products were much lower
than recommended. The mean daily meat intake was more than twice that
recommended. A 119-item QFFQ was developed including seven bread items, five
soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes,
nine fruits and 14 vegetables. Frequency of consumption was assessed by
eight categories ranging from ‘Never or less than one time in one
month’ to ‘two or more times a day’.
We were able to highlight foods for intervention to improve dietary intake
based on the major sources of energy, fat and sugar and the low consumption
of fruit and vegetable items. The QFFQ is being used to evaluate a diet and
lifestyle intervention in First Nations in north-western Ontario.
To describe the relationship between dietary intake and different levels and
types of physical activity (PA).
Cross-sectional evaluation of the EPIPorto study. Energy expenditure
(metabolic energy equivalent tasks) and dietary intake during the past year
were assessed using a PA questionnaire and a semi-quantitative
food-frequency questionnaire, respectively.
Representative sample of adults in Porto, Portugal.
Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and
For total PA, males who were active had significantly higher mean intake of
energy (10·76 (2570·7) vs. 9·78
(2336·9) MJ/d (kcal/d), P
< 0·001) and lower level of protein consumption
(16·9 vs. 17·6 % of energy, P < 0·001) compared with sedentary males.
In males, the association between total PA and energy intake remained after
adjustment for age, education and body mass index. Similar results were
observed when occupational activity was analysed. Concerning the energy
expended in leisure time, in both genders, after adjustment for the
previously described variables, a significant positive association was found
between PA and intake of vitamin C (g/d): β = 0·12, 99 % confidence interval
(CI) 0·02, 0·21 for females and β = 0·13, 99 % CI
0·03, 0·22 for males. Leisure-time activity in females
was also positively associated with intakes of fibre, vitamin E, folate,
calcium and magnesium, and negatively associated with saturated fat.
Higher levels of PA in leisure time were associated with higher intakes of
micronutrients and lower intakes of saturated fat, particularly in females.
For total and occupational PA, similar nutrient intake was observed between
active and sedentary individuals.
The aim of the present study was to pilot-test a school-based intervention
designed to increase consumption of whole grains by 4th and 5th grade
This multi-component school-based pilot intervention utilised a
quasi-experimental study design (intervention and comparison schools) that
consisted of a five-lesson classroom curriculum based on Social Cognitive
Theory, school cafeteria menu modifications to increase the availability of
whole-grain foods and family-oriented activities. Meal observations of
children estimated intake of whole grains at lunch. Children and parents
completed questionnaires to assess changes in knowledge, availability,
self-efficacy, usual food choice and role modelling.
Parent/child pairs from two schools in the Minneapolis metropolitan area; 67
in the intervention and 83 in the comparison school.
Whole-grain consumption at the lunch meal increased by 1 serving (P < 0·0001) and
refined-grain consumption decreased by 1 serving for children in the
intervention school compared with the comparison school post-intervention
(P < 0·001).
Whole-grain foods were more available in the lunches served to children in
the intervention school compared with the comparison school
post-intervention (P <
0·0001). The ability to identify whole-grain foods by children in
both schools increased, with a trend towards a greater increase in the
intervention school (P =
0·06). Parenting scores for scales for role modelling (P < 0·001) and enabling
behaviours (P <
0·05) were significantly greater for parents in the intervention
school compared with the comparison school post-intervention.
The multi-component school-based programme implemented in the current study
successfully increased the intake of whole-grain foods by children.
Investigate the relationship between body mass index (BMI) and intake of
sugars and fat in New Zealand adults and children.
Secondary analyses of National Nutrition Survey (1997) and
Children’s Nutrition Survey (2002) data for the New Zealand
population. BMI calculated from height and weight; fat, sugars and sucrose
(used as a surrogate for added sugars) intakes estimated from 24-hour diet
recall. Ethnic-specific analyses of children’s data.
Relationships (using linear regression) between BMI and sugars/sucrose
intakes; per cent total energy from fat; mean total energy intake from
sucrose. Subjects classified into diet-type groups by levels of intake of
fat and sucrose; relative proportions of overweight/obese children in each
group compared with that of normal weight subjects using design-adjusted
New Zealand homes and schools.
4379 adults (15+ years); 3049 children (5–14 years).
Sugars (but not sucrose) intake was significantly lower among obese compared
to normal weight children. In adults and children, those with the lowest
intake of sugars from foods were significantly more likely to be
overweight/obese. Sucrose came predominantly from beverages; in children,
45% of this was from powdered drinks. Sucrose intake from sugary beverages
was not related to BMI. Per cent total energy (%E) from sucrose was
significantly inversely related to %E from fat among adults and children.
Proportions of overweight/obese adults or children in each diet-type group
did not differ from that of normal weight individuals.
Current sugars or sucrose intake is not associated with body weight status in
the New Zealand population.
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.
A literature review was carried out, followed by interviews with
representatives from the governmental, academic and private sector in all
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
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