Supermarket receipts have the potential to provide prospective, objective information about the household food supply. The aim of this study was to develop an index to estimate population diet quality using food purchase data. Supermarket receipt data of 1 month were available for 836 adults from a corporate office of a large retail chain. Participants were aged 19-65 years (mean 37·6 (SD 9·3) years), 56 % were female and 63 % were overweight or obese. A scoring system (Healthy Trolley Index (HETI)) was developed to compare food expenditure with the Australian Guide to Healthy Eating. Monthly expenditure per food group, as a proportion of total food expenditure, was compared with food group recommendations, and a HETI score was calculated to estimate overall compliance with guidelines. Participants spent the greatest proportion on discretionary foods, which are high in fat/sugar (34·8 %), followed by meat including beef and chicken (17·0 %), fresh and frozen vegetables (13·5 %) and dairy foods (11·3 %). The average HETI score ranged from 22·6 to 93·1 (out of 100, mean 58·8 (SD 10·9)). There was a stepwise decrease in expenditure on discretionary foods by increasing HETI quintile, whereas expenditure on fruit and vegetables increased with HETI quintile (P < 0·001). The HETI score was lower in obese compared with normal-weight participants (55·9 v. 60·3; P < 0·01). Obese participants spent more on discretionary foods (38·3 v. 32·7 %; P < 0·01) and less on fruits and vegetables (19·3 v. 22·2 %; P < 0·01). The HETI may be a useful tool to describe supermarket purchasing patterns and quality of the household food supply with application for consumer feedback to assist improved quality of foods purchased.Key words: Diet quality: Supermarkets: Food supply Poor eating habits are one of the key drivers of overconsumption of energy, weight gain and obesity. Australians consume inadequate amounts of fruit, vegetables and whole grains and, on average, get about 35 % of their energy from energy-dense, nutrient-poor discretionary food and beverage items (1,2) . As a result, improving the food supply to support healthy food choices has been identified as a priority for Australian health promotion efforts and internationally (3,4) .About 60 % of Australian food retail expenditure is in the supermarket, indicating its potential as a key setting to influence the food supply (5) . Previously, supermarket purchases have been found to relate to dietary intakes, particularly at the household level (6,7) . For example, when compared with 4 d of weighed food record data, 1 month of shopping purchase information produced reasonable estimates about energy and fat intake (7) . Many nutrition interventions promoting the purchase of healthier foods have been trialled in the supermarket setting. Although the evidence is equivocal for the effectiveness of supermarket interventions focused on point-of-purchase dietary education and information provision (8,9) , the potential for success using an innovative approach in this setting has ...

Arohanui Hospice is a 12-bed specialist palliative care service based in Palmerston North, New Zealand. It serves a population of 180 000 people spread over a wide geographical area, both urban and rural. The Liverpool Care Pathway (LCP) was initially implemented at the hospice inpatient unit in January 2005. Following this, the 'LCP Pilot Project' was developed. This project involved the implementation of the LCP within three aged residential care facilities and two wards within the regional hospital. Included in the project was a research component to enable evaluation of the effectiveness of the LCP in each setting. This article will consider and demonstrate the use of process mapping (Buckman, 2003) as a quality improvement tool to enhance the effective implementation and sustained use of the LCP for the dying patient within aged residential care. Measures are considered that support the implementation of the LCP at an organisational level rather than at a purely clinical level. While this work has been completed within the New Zealand context, it is believed that the principles are transferable to similar settings internationally.

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Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child’s health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is ‘right’ or ‘just’ can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children’s voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.

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