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Additional file 1: Table 1a Pre-study questions on participants’ socio-demographic characteristics and social media use. Table 1b List of most popular social media platforms in Australia (July 2020) and answer categories on how often they are used in the past month. Table 2 Post-study questions on recognition and appreciation of social media food promotions. Table 3 Coding of composite food or beverages on social media into core and non-core classifications. Table 4 Participants’ duration of use, device used to access, and main reason for using their favourite social media platforms.

IntroductionHealth service use among the general public can decline during infectious disease outbreaks and has been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) implemented public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone, to mitigate impact of the pandemic.MethodsUsing data from the Health Management Information System (January 2018 - December 2020), we evaluated the impact of the pandemic on the use of essential health services (total visits, maternal health, vaccinations, visits for common infectious diseases, and diagnosis of non-communicable diseases) using interrupted time series with mixed effects segmented Poisson regression models during the first wave of the pandemic. Analyses were stratified by age, sex, health facility, and neighbourhood.ResultsHealth service use dropped rapidly following the start of the pandemic and ranged from 16% for hypertension diagnoses to 39% for diabetes diagnoses. However, reductions were highly concentrated in Gombe (81% decline in total visits) relative to health zones without lockdown. When the lockdown was lifted, total visits, visits for infectious diseases, and diagnoses for non-communicable diseases increased approximately two-fold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.ConclusionThe COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.Summary BoxWhat is already known about this subjectSubstantial declines in the use of health services among the general public have been well-documented during previous outbreaks of infectious diseases.Modelled studies predicted substantial increases in morbidity and mortality in many low- and middle-income countries (LMICs) mainly due to expected declines in the use of health services among the general public.Only a small number of studies have so far evaluated the impact of the COVID-19 pandemic on the use of health services in LMICs and none have also evaluated both the implementation and lifting of lockdown measures.What are the new findingsThis study found that overall use of health services declined in Kinshasa but was most pronounced in the Gombe health zone which was subject to strict lockdown measures.Some health services were more affected than others, most notably visits and tests for malaria and visits for new diagnoses of non-communicable diseases. Maternal and child health services were relatively unaffected.When the lockdown measures were lifted, health service utilization rebounded but remained at levels lower than those observed pre-pandemic.What do the new findings implyThe COVID-19 pandemic has likely had important effects on the use of health services among the general public throughout LMICs. However, evidence from Kinshasa suggests the effects may not be as widespread as previously assumed.The impact of strict social distancing measures needs on COVID-19 outcomes needs to be weighed off against the potential population-level health effects of these policies in various international contexts.

Een verkenning naar draagvlak, haalbaarheid, betaalbaarheid en impact De overheid stimuleert dat basisscholen kinderen helpen om gezond te leven. Een gezonde schoollunch en meer bewegen onder schooltijd kunnen hierbij helpen. Uit onderzoek blijkt dat hier draagvlak voor is onder ouders, kinderen en scholen. Ook is het haalbaar, mits al deze partijen worden betrokken bij de organisatie. Ouders zijn bereid om mee te betalen (1,75 euro per kind per dag), maar daarmee zijn de kosten (2,40 euro per kind per dag voor de zelfsmeerlunch en 4,50 euro voor de schoollunch met beweegactiviteiten) niet gedekt. Ondersteuning is dus nodig om minder draagkrachtige gezinnen financieel te steunen. Bij een zelfsmeerlunch maken kinderen zelf op school een gezonde lunch klaar. Ze eten dan meer fruit, groente en bruinbrood en drinken meer melk en water. Voor een zelfsmeerlunch is minimaal 30 minuten tijd nodig. Een cateraar kan de benodigdheden inkopen en leveren. De school kan dit ook zelf doen, maar dat vraagt om een goede coördinatie. Extra beweegmomenten zijn mogelijk door tijdens de lessen korte momenten daarvoor in te lassen. Pedagogisch medewerkers, zoals van de naschoolse opvang, en buurtsportcoaches van gemeenten, kunnen helpen bij sport- en spelactiviteiten. Door beweegactiviteiten en de zelfsmeerlunch hebben kinderen een gezonder gewicht. Het percentage kinderen van 4 tot 18 jaar met overgewicht zou kunnen dalen van 13,5 procent naar 10,2 procent in 2040, en met obesitas van 2,8 procent naar 2,3 procent. In de toekomst kan de daling eraan bijdragen dat minder volwassenen overgewicht, obesitas en diabetes hebben. Dan moeten de kinderen het veranderde gedrag wel blijven volhouden als ze volwassen zijn. Om kinderen hierbij te helpen kunnen schoollunches en beweegactiviteiten worden aangevuld met activiteiten op de middelbare school en in de wijk. Aanleiding voor deze verkenning zijn eerdere succesvolle projecten met gezonde schoollunches en meer bewegen in het basisonderwijs.

De consumptie van voldoende vezels is een belangrijke factor inhet voorkomen van welvaartsaandoeningen, zoals obesitas, diabetesII, hart- en vaatziekten en bepaalde vormen van kanker.Per dag wordt geadviseerd 30 tot 40 gram vezels te eten. De huidigeinname is gemiddeld echter slechts 18-23 gram per dag (1,2).Het lijkt daarom een goede zaak de consumptie van bijvoorbeeldvolkorenbrood te stimuleren. Nudging blijkt echter niet steeds degewenste resultaten te hebben.

While the current food environment of large serving sizes, high calorie density, and plentiful and inexpensive options makes it difficult for parents to properly feed their kids, practical tools are emerging that support portion size management for children.

BACKGROUND: The burden of healthcare-associated infections, such as healthcare-acquired Clostridium difficile (HA-CDI), can be expressed in terms of additional length of stay (LOS) and mortality. However, previous estimates have varied widely. Although some have considered time of infection onset (time-dependent bias), none considered the impact of severity of HA-CDI; this was the primary aim of this study. METHODS: The daily risk of in-hospital death or discharge was modelled using a Cox proportional hazards model, fitted to data on patients discharged in 2012 from a large English teaching hospital. We treated HA-CDI status as a time-dependent variable and adjusted for confounders. In addition, a multi-state model was developed to provide a clinically intuitive metric of delayed discharge associated with non-severe and severe HA-CDI respectively. FINDINGS: Data comprised 157 (including 48 severe) HA-CDI cases among 42,618 patients. HA-CDI reduced the daily discharge rate by nearly one-quarter [hazard ratio (HR): 0.72; 95% confidence interval (CI): 0.61-0.84] and increased the in-hospital death rate by 75% compared with non-HA-CDI patients (HR: 1.75; 95% CI: 1.16-2.62). Whereas overall HA-CDI resulted in a mean excess LOS of about seven days (95% CI: 3.5-10.9), severe cases had an average excess LOS which was twice (∼11.6 days; 95% CI: 3.6-19.6) that of the non-severe cases (about five days; 95% CI: 1.1-9.5). CONCLUSION: HA-CDI contributes to patients' expected LOS and risk of mortality. However, when quantifying the health and economic burden of hospital-onset of HA-CDI, the heterogeneity in the impact of HA-CDI should be accounted for.

Objective: What predicts whether a child will be at risk for obesity? Whereas past research has focused on foods, eating habits, feeding styles, and family meal patterns, this study departs from a food-centric approach to examine how various dinner rituals might influence the BMIs of children and adults. Methods: In this study of 190 parents (BMI529.167.2) and 148 children (BMI520.364.4), the relationship between their BMIs and everyday family dinner rituals was examined using both correlation and regression analysis (controlled for educational level of parents). Results: Families who frequently ate dinner in the kitchen or dining room had significantly lower BMIs for both adults (r520.31) and children (r520.24) compared to families who ate elsewhere. Additionally, helping cook dinner was associated with higher BMI for girls (r50.26), and remaining at the table until everyone is finished with eating was associated with lower BMI for boys (r520.31). Conclusions: Dinner tables may be one place where social support and family involvement meet—both of which relate to the BMI of children as well as parents. Family meals and their rituals might be an underappreciated battleground to fight obesity.

It is beneficial for both the public health community and the food industry to meet nutritional needs of elderly consumers through product formats that they want. The heterogeneity of the elderly market poses a challenge, however, and calls for market segmentation. Although many researchers have proposed ways to segment the elderly consumer population, the elderly food market has received surprisingly little attention in this respect. Therefore, the present paper reviewed eight potential segmentation bases on their appropriateness in the context of functional foods aimed at the elderly: cognitive age, life course, time perspective, demographics, general food beliefs, food choice motives, product attributes and benefits sought, and past purchase. Each of the segmentation bases had strengths as well as weaknesses regarding seven evaluation criteria. Given that both product design and communication are useful tools to increase the appeal of functional foods, we argue that elderly consumers in this market may best be segmented using a preference-based segmentation base that is predictive of behaviour (for example, attributes and benefits sought), combined with a characteristics-based segmentation base that describes consumer characteristics (for example, demographics). In the end, the effectiveness of (combinations of) segmentation bases for elderly consumers in the functional food market remains an empirical matter. We hope that the present review stimulates further empirical research that substantiates the ideas presented in this paper.

Gezondheidslogo’s op eten hebben het laatste decennium een flinke opmars gemaakt in het supermarktschap. Was de voedingsboodschap in de jaren tachtig en negentig nog gericht op welke groepen voedingsmid- delen je meer of minder moest eten, de periode daarna richtte zich op het verschaffen van intuïtieve informatie op de verpakking.

Objective: To determine how common serving bowls containing food for multiple persons influence serving behavior and consumption and whether they do so independently of satiation and food evaluation. Methods: In this between-subjects experiment, 68 participants were randomly assigned to either a group serving pasta from a large-sized bowl (6.9-L capacity) or a medium-sized bowl (3.8-L capacity). Results: Analysis of covariance showed that when given a large-sized bowl, diners served 77% more pasta (364.0 versus 205.5 g; P .32). Conclusions and Implications: In contrast to those in studies involving larger-sized plates and spoons, people serving from larger bowls felt more satiated. These findings again highlight the role that external cues play in food consumption and show the importance of considering serving bowl size in nutrition education.

Research in developed countries showed that many citizens perceive that radio signals transmitted by mobile phones and base stations represent potential health risks. Less research has been conducted in developing countries focused on citizen perceptions of risks and benefits, despite the recent and rapid introduction of mobile communication technologies. This study aims to identify factors that are influential in determining the tradeoffs that Bangladeshi citizens make between risks and benefits in terms of mobile phone technology acceptance and health concerns associated with the technology. Bangladesh was selected as representative of\ many developing countries inasmuch as terrestrial telephone infrastructure is insubstantial, and mobile phone use has expanded rapidly over the last decade, even among the poor. Issues of importance were identified in a small-scale qualitative study among Bangladeshi citizens (n = 13), followed by a survey within a sample of Bangladeshi citizens (n = 500). The results demonstrate that, in general, the perceived benefits of mobile phone technology outweigh the risks. The perceived benefits are primarily related to the social and personal advantages of mobile phone use, including the ability to receive emergency news about floods, cyclones, and other natural disasters. Base stations were seen as a symbol of societal advance. The results furthermore suggest that overall risk perceptions are relatively low, in particular health risks, and are primarily driven by perceptions that related to crime and social inconvenience. Perceived health risks are relatively small. These findings show that risk communication and management may be particularly effective when contextual factors of the society where the system is implemented are taken into consideration

Zowel hun recente en resolute opkomst in de voedingsmarkt als de toegedichte positieve invloed op het gezondheidsvraagstuk geven aanleiding gezondheidlogo's, zoals "Ik Kies Bewust" en het "Gezonde Keuze Klavertje", nader onder de loep te nemen. De verkenningen in dit boek stellen zich vragen bij wijze van routebeschrijving. Bereikt de aangeboden informatie de consument? Leiden logo's naar gezond voedingskeuzegedrag? Worden consumenten op het verkeerde been gezet door gezondheidslogo's op de verpakking van frisdrank of mayonaise? Zetten gezondheidslogo's bedrijven aan tot innovatie in de richting van gezondere voedingsmiddelen? Dragen gezondheidslogo's bij aan de verbetering van de volksgezondheid? In Gezondheidslogo's op eten wordt het terrein van gezondheidslogo's op diverse manieren bewandeld en belicht.