Justin McNab

From Denmark to Delhi: the multisectoral challenge of regulating trans fats in India.

OBJECTIVE India has proposed legislating an upper limit of trans fat in partially hydrogenated vegetable oils and mandating trans fat labelling in an effort to reduce intakes. The objective of the present study was to examine the complexities of regulating trans fat in India by examining the policy processes involved and the perceived implementation challenges. DESIGN Semi-structured interviews (n 18) were conducted with key informants from various sectors. Interviewees were asked about sources of trans fat in the food supply, existing policies that may influence trans fats and perceived challenges related to the proposed trans fat regulation, in addition to questions tailored to their area of expertise. Interview data were organised based on common themes. SETTING Interviews were conducted in India. SUBJECTS Interviewees were key informants from various sectors including agriculture, trade, industry and health. RESULTS Several themes were identified related to the complexity of regulating trans fat in India. A lack of trans fat awareness, the large unorganised retail sector, a need for suitable alternative products that are both acceptable to consumers and affordable, and a need to build capacity were crucial factors affecting Indias ability to successfully regulate trans fat. The limited number of food inspectors will create an additional challenge in terms of enforcement of trans fat regulation. CONCLUSIONS Although India will face challenges in regulating trans fat, legislating an upper limit of trans fat in partially hydrogenated vegetable oils will likely be the most effective approach to reducing it in the food supply. Ongoing engagement with industry, agriculture, trade and processing sectors will prove essential in terms of product reformulation.

It hinges on the door: Time, spaces and identity in Australian Aboriginal Health Services

Abstract This paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented ‘person as illness’ design features of Australia’s current mainstream health system.

Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial

Objective: To determine whether Care Navigation (CN), a nurse‐led hospital‐based coordinated care intervention, reduced the use of hospital services and improved quality of life for patients with chronic illness.

Non-communicable diseases and implications for medical practice in Australia: a framework for analysis

Non‐communicable diseases (NCDs) have become leading causes of mortality and morbidity as part of historical epidemiological, demographic and nutritional transitions. There has been considerable historical analysis of the immediate and underlying causes of this change in the impacts of communicable diseases and NCDs, but far less historical analysis of how this transition has shaped medical practice. We lay out a framework for future historical analysis by proposing four domains of inquiry into key areas of change: changes in the concept of disease; evolution of medical technology; changes in workforce, including variation in roles and emerging areas of specialisation; and changes in health care structures including models of care, government responses and transitioning health systems. Our aim is to encourage analysis that takes into account key features in each of the four domains, thus enabling a more complete understanding of why, how and under what circumstances NCDs have had an effect on medical practice.