Food‐related risk‐reduction strategies: purchasing and consumption processes

Confronted with an alarming social discourse favouring the perception of food risk, modern consumers find themselves in a situation of psychological discomfort caused by consumption of foodstuffs coming from the agricultural and foodstuff industry. To eliminate this discomfort the consumer may change their purchasing and consumption habits (constraining hypothesis) or introduce some measures for the reduction of risk. The aim of this paper is to present a new classification of risk reducers taking into account the diversity of buying and consumption practices. Copyright © 2004 Henry Stewart Publications.     

FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function‐based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.     

Infant feeding and HIV in Sub-Saharan Africa: what lies beneath the dilemma?

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities.

Decreasing expulsions by a child with a feeding disorder: using a brush to present and re-present food

Previous research has demonstrated that extinction in the form of re-presentation of expelled bites is an effective intervention for treating food expulsion. The current study compared the effectiveness of re-presenting expulsions with a spoon to re-presenting with a Nuk brush for a 4-year-old boy with a feeding disorder. Fewer expulsions were observed when using the brush for re-presentation, and further reductions were observed when the brush was also used for initial presentations.     

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.     

Sham surgery: An ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Use of the high-probability instructional sequence and escape extinction in a child with food refusal

We used the high-probability (high-p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high-p sequence in the treatment of food refusal.     

‘Please don’t put the whole dang thing out there!’: A discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on ‘choices’ and ‘barriers to breastfeeding’. It is our argument, however, that women's cultural context plays a key role in infant feeding ‘choices’. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of ‘good’ or ‘bad’ motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding ‘choices’, considering the cultural context within which British mothers ‘choose’ how to feed their babies.     

Escape as reinforcement and escape extinction in the treatment of feeding problems

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.