Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.

Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.

Une alimentation malsaine compromet la santé et génère des coûts importants sur les plans individuels et sociaux ainsi qu’en services en santé. L’adoption d’une saine alimentation est tributaire de déterminants individuels et environnementaux liés aux caractéristiques des environnements physique, économique, politique et socioculturel. Cette étude transversale a pour objectif d’évaluer l'effet de l’environnement physique, plus précisément l’effet de l'accessibilité géographique de commerces alimentaires, sur l'alimentation. Pour répondre à cet objectif, un échantillon composé de 7783 adultes âgés de 40 à 70 ans résidant dans quatre villes du Québec (Canada) a été utilisé. Des indicateurs de proximité ainsi que des indicateurs absolus et relatifs de densité de commerces alimentaires, de restaurants-minute et de dépanneurs situés aux alentours du domicile des participants ont été associés à la consommation de fruits et légumes (F&L). Les données des analyses de régressions logistiques univariées suggèrent que la consommation du nombre de portions minimales de F&L (5 portions) était associée de façon significative aux sept mesures de l'environnement alimentaire (RC variant entre 0.76 et 1.27). Cependant, ces relations étaient pour la plupart non significatives lorsque des variables confondantes étaient prises en compte. En multivarié, les variables les plus significativement corrélées à la consommation de F&L étaient des variables individuelles du sexe, du revenu et de l'éducation. Notre modèle de régression n'explique que 12,4 % de la variance de consommation de F&L, même en tenant compte de tous les facteurs confondants significatifs. Ces résultats démontrent que des recherches supplémentaires sont nécessaires pour mieux cerner les facteurs d’influence de la consommation de F&L chez cette population. / Unhealthy eating habits can compromise one’s health and generate significant individual, social and health services costs. The adoption of healthy eating habits depends on individual and environmental determinants related to the characteristics of the physical, economic, political and socio-cultural environments. The objective of this cross-sectional study was to assess the effect of the physical environment, more precisely the effect of food outlet accessibility, on diet. To meet our objective, a subsample of the CARTaGENE database, composed of 7,783 adults aged 40 to 70 years old residing in four cities in Quebec (Canada) was used. Measures of proximity as well as absolute and relative measures of density of retail food outlets, fast-food outlets and convenience stores near participants’ residences were used to analyze fruit and vegetable (F&V) intake. Univariate logistic regression showed that the minimal recommended portions of F&V intake (5 or more portions) was significantly associated with all seven measures of the retail food environment (OR between 0.76 and 1.27). However, these relations were mostly non-significant when confounding variables were considered in the analysis. Variables most significantly correlated to F&V intake were individual-level confounding variables of sex, income and education. Women were 3.13 (CI 2.85 – 3.45) times more likely than men to eat the recommended number of F&V portions. Only 12.4% of the F&V variance was explained by our regression model when considering all significant confounding factors. These results show that more research is needed to understand factors explaining F&V intake in this population.

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El trabajo de investigación se basa principalmente en el desarrollo de la marca Hilli alli, la cual consiste en la producción y comercialización vía online y en tiendas especializadas de kits de frutas y verduras congeladas con toppings personalizados. Esto en respuesta a la problemática de no encontrar un kit saludable y práctico de preparar que brinde los nutrientes necesarios para las actividades diarias a nuestro público objetivo, el cual está compuesto por hombres y mujeres entre 18 y 35 años de Lima Metropolitana de los niveles socioeconómicos A y B que consuman productos nutritivos y orgánicos. Los experimentos realizados nos permitieron validar la intención de los consumidores finales mediante sus comentarios en las publicaciones de redes sociales y mensajes directos. Asimismo, se validó el interés por parte de las tiendas especializadas de contar con nuestro producto como parte de su catálogo de bienes ofrecido al público objetivo que apuntamos. La estructura del trabajo se divide inicialmente en la descripción de la problemática a solucionar y el respectivo diseño del modelo del negocio. Todas las fases del trabajo llegan a un punto en común: justificar la viabilidad del negocio. Por último, se quiere demostrar si la inversión del proyecto puede ser recuperada en el tiempo trazado. La inversión inicial que se requiere para este proyecto es de un monto total de 59,000.00 soles, Esto nos permitirá iniciar nuestras operaciones y solventar los gastos que se requieren. Finalmente, nuestro VAN resultante es positivo, lo cual lo hace rentable nuestro negocio. / The research work is mainly based on the development of the Hilli alli brand, which consists of the production and marketing via online and in specialized stores of kits of frozen fruits and vegetables with personalized toppings. This in response to the problem of not finding a healthy and practical kit to prepare that provides the necessary nutrients for their daily activities to our target audience, which is made up of men and women between 18 and 35 years old from Metropolitan Lima of the levels socioeconomic A and B who consume nutritious and organic products. The experiments carried out allowed us to validate the intention of the final consumers through their comments in the social network publications and direct messages, likewise, the interest on the part of specialized stores to have our product as part of their catalog of offered goods was validated. the target audience we are targeting. The structure of the work is initially divided into the description of the problem to be solved and the respective design of the business model. All phases of the work reach a common point: justify the viability of the business. Finally, we want to show whether the investment in the project can be recovered in the time set. The initial investment required for this project is a total amount of 59,000.00 soles. This will allow us to start our operations and pay for the required expenses. Ultimately, our resulting NPV is positive, which makes our business profitable. / Trabajo de investigación

<p>Nesavesna upotreba antibiotika izazvala je razvoj antimikrobne rezistencije zabrinjavajućih razmera. Porast rezistencije prema konvencionalnim antimikrobicima nametnuo je potrebu pronalaska novih supstanci, koje će biti delotvorne protiv otpornih sojeva. U poslednje četiri decenije, dominira trend da se lekovi i lekovita sredstava prave na bazi prirodnih proizvoda, a naročito biljnog materijala. Hemijski sastav plodova porodice ruža (Rosaceae) upućuje na to da bi određene vrste ove porodice biljaka mogle ispoljavati antimikrobno dejstvo. Plodovi voća porodice Rosaceae istraživani u okviru ove disertacije su: malina (Rubus idaeus), kupina (Rubus fruticosus), tre&scaron;nja (Prunus avium), vi&scaron;nja (Prunus cerasus) i aronija (Aronia prunifolia). Predmet istraživanja ove doktorske disertacije je antimikrobno tj. antibakterijsko, antigljivično, antialgalno i antivirusno dejstvo sokova i ekstrakata plodova odabranog voća porodice Rosaceae gajenog i prikupljenog na teritoriji Srbije na &scaron;irok spektar humanih i animalnih patogenih mikroorganizama.Sokovi su dobijeni ceđenjem svežih plodova voća. Ekstrakti su dobijeni iz ostataka voća nakon ceđenja (tropa) metodom dvostruke etanolne ekstrakcije. Nakon ceđenja i ekstrakcije sprovođeno je uparavanje do suva sokova i ekstrakata. HPLC metodom je ispitano prisutstvo 23 hemijske komponente u svakom od sokova i ekstrakata. Antimikrobna analiza je sprovedena na 21 mikroorganizmu, od čega su 15 bile bakterije, 2 gljivice, 2 alge i 2 virusi. Od navedenih mikroorganizama 14 je bilo autohtonih izolata, a 7 referentnih sojeva. Ispitivanje antibakterijskog, antifungalnog i antialgalnog dejstva plodova odabranog voća je sprovedeno difuzionom i mikrodilucionom metodom. Analiza antivirusne aktivnosti plodova odabranog voća je sprovedena posmatranjem inhibicije citopatogenog efekta (CPE) virusnih čestica na ćelijsku kulturu. Sve studije su sprovedene u triplikatu. Rezultati hemijske analize su obrađeni statistikom metodom srednje vrednosti, uz računanje standardne devijacije. Eksperimentalno dobijeni podaci u okviru ispitivanja antibakterijskog, antigljivičnog i antialgalnog dejstva su uvr&scaron;teni u statističku analizu. Metodom aproksimacije je utvrđena tačna koncentracija soka ili ekstrakta koja daje željeni efekat na ispitivani mikroorganizam. Rezultati analize antivirusnog dejstva su statistički obrađeni metodom srednje vrednosti. Kako bi se utvrdio stepen povezanosti rezultata dobijenih u okviru antimikrobnih analiza sa hemijskim supstancama prisutnim u plodovima odabranog voća sprovedena je regresiona analiza za vaki pojedinačni slučaj. Antibakterisjko, antiungalno i antialgalno dejstvo sokova i ekstrakata je upoređeno sa istim dejstvima konvencionalnih antimikrobnih lekova. Najveću ukupnu količinu ispitivanih supstanci je sadržao ekstrakt kupine (3965,56 mg/ml), a najmanju ekstrakt tre&scaron;nje (161,44 mg/ml). Od svih ispitivanih hemijskih supstanci, samo su: antocijani, katehin, galna kiselina i vitamin C, prisutni u svim ispitivanim sokovima i ekstraktima. Sve ispitivane biljke sadrže veću količinu supstanci u ekstraktu, osim kod tre&scaron;nje, kod koje se veća količina supstanci nalazi u soku. U najvećoj meri su u sokovima i ekstraktima plodova biljaka prisutni antocijani i to najvi&scaron;e kod kupine od ekstrakata, a kod maline od sokova. Antimikrobno (antibakterijsko, antifungalno, antialgalno i antivirusno) dejstvo je dokazano za svaki od sokova i/ili ekstrakata plodova odabranog voća. Po prosečnim vrednostima rezultata dilucione analize antimikrobnog i dejstva na MDBK ćelije, protiv najvećeg broja mikroorganizama najdelotvorniji je bio ekstrakt kupine, a neaktivan ili najslabije aktivan (aktivan u najvećoj koncentraciji) sok tre&scaron;nje. Prosečne vrednosti antimikrobnog i dejstva na MDBK ćelije su bile u opsegu od 0,71 mg/ml do 100 mg/ml. Sve ispitivane supstance su pokazale antibakterijsku aktivnost u ispitivanim koncentracijama na sve ispitivane bakterije, osim soka maline na Escherichia-u coli i soka aronije na Klebsiella-u pneumoniae. Ekstrakti su bolje delovali u većini slučajeva, uz nekoliko izuzetaka. Sve ispitivane supstance su pokazale antfiungalnu aktivnost na Candida-u albicans ATCC 24433, osim soka aronije. Na autohtoni soj Candida-e albicans su delovali samo ekstrakti kupine i tre&scaron;nje. Ekstrakti su bolje delovali u većini slučajeva, osim kupine na Candida-u albicans ATCC 24433, u kojem je dejstvo soka bilo jednako sa dejstvom ekstrakta. Iako su skoro svi ispitivani sokvi i ekstrakti ispoljili antialgalno dejstvo, na Prototheca-u wickerhamii nisu delovali vi&scaron;nja i sok maline, dok sok aronije nije delovao antialgalno ni na jednu od ispitivanih Prototheca. Ekstrakti su bolje delovali u većini slučajeva, osim maline kod koje je, u oba slučaja, bolje delovao sok. Sve ispitivane supstance su pokazale antivirusnu aktivnost na Bovine herpesvirus i Bovine viral diarrhea virus, kao i toksičnost na MDBK ćelije, osim sokova maline i tre&scaron;nje, koji su bili neaktivni protiv Bovine herpesvirus-a. Ekstrakti su bolje delovali u većini slučajeva, osim tre&scaron;nje na MDBK ćelije i Bovine viral diarrhea virus, na koje je jače delovao sok. U potpunosti jednako delovanje soka i ekstrakta je uočeno kod aronije za sva tri dejstva i maline za toksičnost na MDBK ćelije. Pri ispitivanju difuzionom metodom antibiotik je ispoljio jače dejstvo u odnosu na sokove i ekstrakte, osim ekstrakata kupine, maline i vi&scaron;nje na Trueperella-u pyogenes. Pri ispitivanju dilucionom metodom, dejstvo ekstrakata i sokova na Gram pozitivne bakterije je bilo uporedivo sa dejstvom Streptomicina, dok je dejstvo antibiotika na Gram negativne bakterije bilo jače u odnosu na sokove i ekstrakte, izuzetev jačeg dejstva ekstrakta maline protiv Escherichia-e coli. Nistatin je sve antifungalne i antialgalne efekte na gljivice i alge obuhvaćene istraživanjem ispoljio u manjim koncentracijama u odnosu na ispitivane sokove i ekstrakte.Najpovezanije sa antibakterijskim dejstvom sokova i ekstrakata na odgovarajuće mikroorganizme su bile: kumarinska, ferulna i galna kiselina, katehin. Najveći procenat povezanosti sa antimikrobnom aktivnosti ploda imali su antocijani na Enterococcus faecalis (71,94%). Najmanje povezani sa antimikrobnom aktivnosti na odgovarajuće mikroorganizme su bili: hlorogenska kiselina, kempferol, kumarinska i siringinska kiselina, vitamin C, vanilinska kiselina, epikatehin, katehin, rutin, krisin, elaginska i p-hidroksibenzoeva kiselina. Saznanja dobijena u okviru ove disertacije pro&scaron;iruju obim znanja o antimikrobnom dejtvu voća i predstavljaju osnovicu za svrsishodniju primenu voća kako u ishrani tako i u terapiji. Međutim, dalja istraživanja u smislu pro&scaron;irenja spektra ispitivanih mikroorganizama, antimikrobnih studija pojedinačnih komponenti iz plodova i mehanizama dejstva su potrebna.</p> / <p>Nonconscientious use of antibiotics has caused the development of antimicrobial resistance of worrying proportions. The increase in resistance to conventional antimicrobials has imposed a need to find new substances that will be effective against resistant strains. Over the last four decades, the trend is to medicines and medicinal products be made on the basis of natural products, and especially plant material. The chemical composition of the Rose family (Rosaceae) fruits suggests that certain species of this family of plants may exhibit an antimicrobial effect. The fruits of the Rosaceae family studied in the framework of this dissertation are: Raspberry (Rubus idaeus), Blackberry (Rubus fruticosus), Cherry (Prunus avium), Cherry (Prunus cerasus) and Aronia (Aronia prunifolia). The subject of the research of this doctoral dissertation is antimicrobial ie. antibacterial, antifungal, antialgal and antiviral effects of juices and fruit extracts, of the selected fruit of the Rosaceae family collected on the territory of Serbia, on a wide range of human and animal pathogenic microorganisms. Juices were obtained by the process of squeezing fresh fruits. The extracts were obtained from residues of fruits after extraction (pomace) by the double ethanol extraction method. After squeezing and extraction, evaporation to dryness of juices and extracts was carried out. The presence of 23 chemical components in each of the juices and extracts was examined by the HPLC method. Antimicrobial analysis was carried out on 21 microorganisms, of which 15 were bacteria, 2 fungi, 2 algae and 2 viruses. 14 of these microorganisms were autochthonous isolates and 7 reference strains. The antibacterial, antifungal and antialgal effect of the selected fruit was tested by the diffusion and microdilution method. The analysis of the fruits antiviral activity was carried out by observing the inhibition of cytopathogenic effect (CPE) of viral particles per cell culture. All studies were conducted in triplicate. The results of the chemical analysis were processed by means of a mean value method, with calculation of the standard deviation. The experimentally obtained data within the antibacterial, antifungal and antialgal examination were included in the statistical analysis. The method of approximation was used in order to determine the exact concentration of the juice or extract, which gives the desired effect on the examined microorganisms. The results of the antiviral analysis were statistically processed using the mean value method. In order to determine the degree of correlation of the results obtained in the framework of antimicrobial analysis with the chemical substances present in the fruits of the selected fruit, regression analysis was carried out for each individual case. Antibacterial, antifungal and antialgic effects of juices and extracts are compared with he same effects of conventional antimicrobial drugs, Streptomycin and Nystatin. The largest total amount of test substances was contained by blackberry extract (3965.56 mg/ ml), and the smallest by extract of sweet cherry (161.44 mg/ ml). Of all the investigated chemicals, only: anthocyanins, catechins, gallic acids and vitamin C were present in all examined juices and extracts. All investigated plants contain a higher amount of substances in the extract, except for sweet cherries, in which a greater amount of substances is present in the juice. In the juices and extracts of fruits anthocyanins are present to the greatest extent, mostly in the blackberry extract, and in raspberry juices. According to the average values of the results of the dilution analysis of the antimicrobial and the effect on the MDBK cell, the most effective was the blackberry extract and the most active inactive (active in the highest concentration) cherry juice against the most numerous microorganisms. The average antimicrobial values and effects on the MDBK cells were in the range of 0.71 mg/ ml to 100 mg/ ml. All investigated substances showed antibacterial activity in the tested concentrations on all examined bacteria, except raspberry juice on Escherichia coli and aronia juice on Klebsiella pneumoniae. Extracts acted better in most cases, with few exceptions. All investigated substances showed antifungal activity on Candida albicans ATCC 24433, except aronia juice. On the autochthonous Candida albicans, only blackberry and sweet cherry extracts were active. Extracts worked better in most cases, except for blackberry on Candida albicans ATCC 24433, in which the effect of the juice was equally efficient as the extract. Although almost all of the examined juices and extracts exhibited an antialgal effect, the sour cherry and raspberry juice did not work on the Prototheca wickerhamii, while the aronia juice did not express antialgal activity to any of tested Prototheca isolates. Extracts worked better in most cases, apart from raspberries, wich juice was stronger in both cases. All investigated substances showed antiviral activity on Bovine herpesvirus and Bovine viral diarrhea virus, as well as the toxicity to MDBK cells, except for raspberry and cherry juices, that were inactive against Bovine herpesvirus. The extracts worked better in most cases, except sweet cherries on MDBK cells and Bovine viral diarrhea virus, whose juice had stronger effect. The equally effective action of juice and extract was observed in aronia for all three effects and raspberries for toxicity to MDBK cells. In the diffusion test, antibiotic showed a stronger effect than juices and extracts, except for extracts of blackberry, raspberry and sour cherries on Trueperella pyogenes. In a dilution study, the effect of extracts and juices on Gram-positive bacteria was comparable to that of Streptomycin, while the effect of the antibiotic on Gram negative bacteria was stronger than juices and extracts, with exception of the stronger effect of raspberry extract against Escherichia coli. Nystatin has expressed its all antifungal and antialgal effects on fungi and algae included in the study in smaller concentrations compared to the examined juices and extracts. The most consistent with the antibacterial effect of juices and extracts on the appropriate microorganisms were: coumarin, ferulan and gallic acid, catechin. The highest percentage of association with antimicrobial activity of the fruits was given by anthocyanins to Enterococcus faecalis (71.94%). The least related to the antimicrobial activity on the appropriate microorganisms were: chlorogenic acid, champferol, coumarin and saringic acid, vitamin C, vanillic acid, epicatechin, catechin, rutin, chrysin, elaginic and p-hydroxybenzoic acid. The knowledge gained through this dissertation expands the scope of knowledge on antimicrobial activity of fruits and forms the basis for more effective use of fruits in both therapy and nutrition. However, further research in terms of extending the range of examined microorganisms, antimicrobial studies of individual fruits components and mechanisms of action are required.</p>

With obesity in adolescents becoming a major health problem in the United States, there has been an expansion in the use of nutritional education programs as intervention. Effective nutrition education can decrease the incidence of obesity and other diet-related chronic diseases, type-2 diabetes, cardiovascular disease, and hypertension. This dissertation in practice proposes to design a nutrition education program, integrating farm and culinary activities into a nutrition education curriculum. The program is designed as a stand-alone program, but for this practice, implementation integrates the nutrition education program into the Film @ 6 after-school program – a STEM-focused program designed to assist sixth graders in their first year of middle school – at Southeast Middle School in Salisbury, Rowan County, North Carolina (NC). This experiential nutrition education program will provide instruction and activities in order to increase nutritional knowledge, improve culinary techniques, and increase consumption of fruits, vegetables, and minimally processed foods of sixth grade students as a means to address the overweight and obesity risks of middle school children. Children and adolescents are considered the priority population for intervention strategies because 70% of obese adolescents become obese adults and it is difficult to reduce excessive weight once established (Dehghan, Akhtar-Danesh, & Merchant, 2005).

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No description available.