Objective: The present study aimed to (i) describe the availability of nutrition information in major chain restaurants, (ii) document the energy and nutrient levels of menu items, (iii) evaluate relationships with restaurant characteristics, menu labelling and trans fat laws, and nutrition information accessibility, and (iv) compare energy and nutrient levels against industry-sponsored and government-issued nutrition criteria. Design: Descriptive statistics and multivariate regression analysis of the energy, total fat, saturated fat, trans fat, sodium, carbohydrate and protein levels of 28 433 regular and 1833 children's menu items. Setting: Energy and nutrition information provided on restaurant websites or upon request, and secondary databases on restaurant characteristics. Subjects: The top 400 US chain restaurants by sales, based on the 2009 list of the Restaurants & Institutions magazine. Results: Complete nutrition information was reported for 245 (61 %) restaurants. Appetizers had more energy, fat and sodium than all other item types. Children's menu specialty beverages had more fat, saturated fat and carbohydrates than comparable regular menu beverages. The majority of main entrées fell below one-third of the US Department of Agriculture's estimated daily energy needs, but as few as 3 % were also within limits for sodium, fat and saturated fat. Main entrées had significantly more energy, fat and saturated fat in family-style restaurants than in fast-food restaurants. Restaurants that made nutrition information easily accessible on websites had significantly lower energy, fat and sodium contents across menu offerings than those providing information only upon request. Conclusions: The paper provides a comprehensive view of chain restaurant menu nutrition prior to nationwide labelling laws. It offers baseline data to evaluate how restaurants respond after laws are implemented.

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Objective Apply and compare two methods that identify signals for the need to update systematic reviews, using three Evidence-based Practice Center reports on omega-3 fatty acids as test cases. Study Design and Setting We applied the RAND method, which uses domain (subject matter) expert guidance, and a modified Ottawa method, which uses quantitative and qualitative signals. For both methods, we conducted focused electronic literature searches of recent studies using the key terms from the original reports. We assessed the agreement between the methods and qualitatively assessed the merits of each system. Results Agreement between the two methods was “substantial” or better (kappa > 0.62) in three of the four systematic reviews. Overall agreement between the methods was “substantial” (kappa = 0.64, 95% confidence interval [CI] 0.45–0.83). Conclusion The RAND and modified Ottawa methods appear to provide similar signals for the possible need to update systematic reviews in this pilot study. Future evaluation with a broader range of clinical topics and eventual comparisons between signals to update reports and the results of full evidence review updates will be needed. We propose a hybrid approach combining the best features of both methods, which should allow efficient review and assessment of the need to update.

We report the results of a study designed to assess and evaluate how the law shapes the public health system's preparedness activities. Based on 144 qualitative interviews conducted in nine states, we used a model that compared the objective legal environment with how practitioners perceived the laws. Most local public health and emergency management professionals relied on what they perceived the legal environment to be rather than on an adequate understanding of the objective legal requirements. Major reasons for the gap include the lack of legal training for local practitioners and the difficulty of obtaining clarification and consistent legal advice regarding public health preparedness. Narrowing the gap would most likely improve preparedness outcomes. We conclude that there are serious deficiencies in legal preparedness that can undermine effective responses to public health emergencies. Correcting the lack of legal knowledge, coupled with eliminating delays in resolving legal issues and questions during public health emergencies, could have measurable consequences on reducing morbidity and mortality.

Distinct interpretations of preparedness law impede effective collaboration for PH preparedness. Clarification of legal authority mandates, designation within laws of scope of preparedness activities and guidance on interpretation of current federal and state laws are needed.