Adaptation of the Patient Benefit Assessment Scale for Hospitalised Older Patients: development, reliability and validity of the P-BAS picture version

Background The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool developed to both identify the priorities of the individual patient and to measure the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI), indicating how much benefit the patient had experienced from the hospitalisation. The reliability and the validity of the P-BAS HOP appeared to be not yet satisfactory and therefore the aims of this study were to adapt the P-BAS HOP and transform it into a picture version, resulting in the P-BAS-P, and to evaluate its feasibility, reliability, validity, responsiveness and interpretability. Methods Process of instrument development and evaluation performed among hospitalised older patients including pilot tests using Three-Step Test-Interviews (TSTI), test-retest reliability on baseline and follow-up, comparing the PBI with Intraclass Correlation Coefficient (ICC), and hypothesis testing to evaluate the construct validity. Responsiveness of individual P-BAS-P scores and the PBI with two different weighing schemes were evaluated using anchor questions. Interpretability of the PBI was evaluated with the visual anchor-based minimal important change (MIC) distribution method and computation of smallest detectable change (SDC) based on ICC. Results Fourteen hospitalised older patients participated in TSTIs at baseline and 13 at follow-up after discharge. After several adaptations, the P-BAS-P appeared feasible with good interviewer’s instructions. The pictures were considered relevant and helpful by the participants. Reliability was tested with 41 participants at baseline and 50 at follow-up. ICC between PBI1 and PBI2 of baseline test and retest was 0.76, respectively 0.73. At follow-up 0.86, respectively 0.85. For the construct validity, tested in 169 participants, hypotheses regarding importance of goals were confirmed. Regarding status of goals, only the follow-up status was confirmed, baseline and change were not. The responsiveness of the individual scores and PBI were weak, resulting in poor interpretability with many misclassifications. The SDC was larger than the MIC. Conclusions The P-BAS-P appeared to be a feasible instrument, but there were methodological barriers for the evaluation of the reliability, validity, and responsiveness. We therefore recommend further research into the P-BAS-P.

Communicating Food Risk-Benefit Assessments: Edible Insects as Red Meat Replacers

Risk-benefit Assessment (RBA) is an emerging methodology in the area of Food and Nutrition that offers a simultaneous evaluation of both risks and benefits linked to dietary choices. Communication of such research to consumers may present a challenge due to the dual nature of RBA. We present a case study of a communication strategy developed for the NovRBA-project. The NovRBA-project (Novel foods as red meat replacers—an insight using Risk Benefit Assessment methods) performed a risk-benefit assessment to evaluate the overall health impact of substituting red meat (beef) by a novel food (house cricket), considering the microbial, toxicological and nutritional characteristics of the respective dietary choices. A literature review of risk perceptions and acceptance of beef and insects as food formed the basis of the communication strategy for the study's results, drawing on environmental and emotional as well as health-related motivations to consume or avoid either food and considering the sociodemographic characteristics of likely consumers. Challenges and future directions for consumer protection organizations communicating findings of risk-benefit analyses on food safety are discussed.

Quantitative risk-benefit assessment of Portuguese fish and other seafood species consumption scenarios

Portugal has high fish/seafood consumption, which may have both risks and benefits. This study aims to quantify the net health impact of hypothetical scenarios of fish/seafood consumption in the Portuguese population using a risk-benefit assessment methodology. Consumption data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n=5811) was used to estimate the mean exposure to methylmercury and EPA+DHA in the current and the alternative scenarios considered. Alternative scenarios (alt) were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (alt1: excluding predatory fishes; alt2: including only methylmercury low-level fishes) or in the frequency of weekly fish/seafood consumption (alt3 to alt6: 1,3,5 or 7 times a week, replacing fish/seafood meals with meat or others). The overall health impact of these scenarios was quantified using Disability-Adjusted Life Years (DALYs). In the Portuguese population, about 11450 DALYs could be prevented each year if the fish/seafood consumption increased to a daily basis. However, such a scenario would result in 1398 extra DALYs considering the consumption by pregnant women and the respective risk on foetal neurodevelopment. Our findings support a recommendation to increase fish/seafood consumption up to 7 times/week. However, for pregnant women and children, special considerations must be proposed to avoid potential risks on foetal neurodevelopment due to methylmercury exposure.

Essential nutrient element profiles in rice types: a risk–benefit assessment including inorganic arsenic

Rice is consumed by nearly half of the global population and a significant source of energy and nutrients. However, rice consumption can also be a significant pathway of inorganic arsenic (iAs) exposure, thus requiring a risk–benefit assessment. This study assessed nutrient element (NE) densities in fifty-five rice types (white, brown and wild rice) marketed in the UK. Densities of essential NE were used to rank rice types in meeting daily NE targets under different consumption scenarios through a newly developed optimisation approach. Using iAs data from these rice types, we assessed the margin of exposure (MOE) for low (the UK) and high (Bangladesh) rice intake scenarios. Our results showed that brown and wild rice are significantly higher in many NE and significantly contribute to dietary reference value (DRV). Our modelling showed that switching to brown or wild rice could increase the intake of several essential nutrients by up to eight times that of white rice. Using rice consumption data for mid-to-high-consumption countries, we estimate that brown rice could provide 100 % adult DRV for Fe, Mg, Cr, P and Mo, and substantial contributions for Zn, Se and K. Our results show that the amount of rice primarily determines risk from iAs consumed rather than the type of rice. Therefore, switching from white to brown or wild rice could be beneficial, provided iAs concentration in rice is within the recommended limits.

Children’s Cost-Benefit Assessment of Lies Across Three Cultures

We examined 4- to 11-year-old children’s evaluation of six types of lies arranged along a cost-benefit assessment model factoring both the lie-teller and the lie recipient. Children were from three distinct cultural environments: rural Samoa (n = 99), urban China (n = 49), and urban U.S. (n = 109). Following the simple script of six different stories involving a lie-teller and a lie recipient, children were asked to evaluate the character who lied and whether it deserved reward or punishment using a child-friendly Likert scale. From the time children produce both anti- and prosocial lies, our results show that their evaluation of lies rests on a cost-benefit analysis of both the lie-teller and the lie recipient. Such analysis varies depending on age, type of lie, and the child’s cultural environment. In general, Samoan children tended to rate lies more negatively, and they were less differential in their evaluation of the different types of lies compared to both Chinese and U.S. children. We interpret these results as reflecting the differences across cultures in explicit moral teaching and children’s relative experience in resource allocation.