An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index in Japan

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI)

BACKGROUND

Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA.

METHODS

This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps.

RESULTS

Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed.

CONCLUSIONS

This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

Nutritional and health status of Afghan refugee women living in Punjab: A cross-sectional study

Afghan refugees are the world's densely populated community, with 2.6 million registered Afghan refugees living globally, of whom about 2.2 million are in Iran and Pakistan. Pakistan is a densely populated country, and due to its low socioeconomic status, food insecurity, unhygienic conditions, and inadequate access to health care, the Afghan refugees have high chances of being malnourished; the chances of death for these Afghans are 25 times more every year from undernourishment and poverty than those from violence. This study aimed to assess anthropometric and biochemical analyses, their health complications, and the socioeconomic status of Afghan refugee women living in Islamabad Punjab as women are the most vulnerable and highly malnourished group in any community. This cross-sectional study involved 150 Afghan women aged 15-30 years; they were assessed for their nutritional status using Anthropometric, Biochemical, Clinical and Diet (ABCD). The results indicate the prevalence of underweight, normal weight, and overweight at 74.7%, 16.7%, and 8.7%, respectively. Majority of the women have extremely low hemoglobin (Hb) level, which indicates iron deficiency as well as low body mass index for their age. As the results indicate that there are high chances of severe malnutrition among this most vulnerable segment of the population, this situation must be addressed immediately; the main aim of this study is to highlight the current situation of these Afghan refugees in Pakistan. More research is needed to determine how normal body weight women with low hemoglobin levels are compared to women with ideal body mass index ratios.

Intraoperative Assessment of Margin Accuracy in Early Oral Squamous Cell Carcinoma (cT1, T2, N0): Clinical Versus Frozen Section Analysis

Background The incidence of oral cavity cancer is increasing. During oral carcinoma surgery, to achieve a tumor-free margin, intraoperative margin assessment includes two primary methods, namely, clinical examination and frozen section analysis. With extensive preoperative imaging investigations and intraoperative clinical margin assessment, the need for further cost and resource-intensive frozen section analysis has recently come under question. This study aimed to assess whether frozen section analysis can be safely omitted in most cases of early oral squamous cell carcinoma surgeries for cost-effectiveness. Methodology A hospital-based, observational study including 30 admitted cases of early oral squamous cell carcinoma was conducted at the Department of General Surgery, Pradyumna Bal Memorial Hospital, Bhubaneswar. All consecutive confirmed cases of early oral squamous cell carcinoma of all age groups and both genders after considering the inclusion and exclusion criteria were involved in the study. A comparative assessment of the free margins after tumor excision was done by the surgeon followed by frozen section analysis. Results The mean age was 53.03 ± 13.72 years, with a male-to-female ratio of 6.5:1. Carcinoma of the lower alveolus with gingivobuccal sulcus was the most common presentation of the study (33.33%). In our study, clinically assessed margins had a sensitivity of 75.39%, a specificity of 94.43%, and an accuracy of 92.77%. Frozen section assessed margins had a sensitivity of 66.5%, a specificity of 96.94%, and an accuracy of 92.77%. Conclusions Based on the accuracy of clinically assessed and frozen section assessed margins, this study concluded that surgically resected/excised specimen by the surgeon plays a vital role in assessing the adequacy of resected/excised margins in early oral squamous cell carcinoma (cT1, T2, N0) cases, which can possibly replace the costly frozen section analysis.

The Healthy Food Environment Policy Index in Poland: Implementation Gaps and Actions for Improvement

Background: Poland is facing the growing problem of overweight and obesity in the population, which makes it necessary to conduct a thorough assessment of the existing food environment policies. The aims of the study were: (1) to depict the strength of healthy food environment policies in Poland and identify implementation policies and infrastructure support gaps; (2) to identify and prioritise improvement policies, taking into account their importance, achievability and equity. Methods: We used the Healthy Food Environment Policy Index (Food-EPI). An experts’ panel rated Polish policies and infrastructure compared to international best practices and developed a list of recommended improvement actions addressing both components. Results: eight of the twenty-two policy and four of the twenty-two infrastructure indicators achieved the “no/very weak policy” result. Another four policy and five infrastructure indicators were considered “weak”. Another seven and eight indicators, respectively, were assessed as “moderate”. Among the identified actions, the highest priority was given to a food labelling system and training for persons involved in nutrition in schools. Conclusions: The Polish healthy food environment has been assessed as very weak or weak in most aspects. The infrastructure was assessed as slightly better compared to the policies domain, with more indicators receiving the “moderate” score.