Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Skip to main content

    Rhona Hanning

    Nineteen children on CAPD have undergone short-term trials wherein amino acids have substituted for dextrose as osmotic agents in peritoneal dialysis fluid. Amino acid concentrations of 1.1% and 2.0% had osmolal concentrations comparable... more
    Nineteen children on CAPD have undergone short-term trials wherein amino acids have substituted for dextrose as osmotic agents in peritoneal dialysis fluid. Amino acid concentrations of 1.1% and 2.0% had osmolal concentrations comparable to 2.5% and 4.25% dextrose. Maximal absorption of amino acids and dextrose occurred within 1 hour after instillation. Fluid, urea, and creatinine removal were satisfactory with the modified dialysis solution and no adverse effects were noted. Long-term trials are recommended.
    Purpose: To conduct a qualitative evaluation of adjunct supports (brief motivational messaging regarding goals delivered by email/website, contact centre dietitian assistance) offered by EatRight Ontario (ERO) for users of a website-based... more
    Purpose: To conduct a qualitative evaluation of adjunct supports (brief motivational messaging regarding goals delivered by email/website, contact centre dietitian assistance) offered by EatRight Ontario (ERO) for users of a website-based nutrition/activity goal setting/tracking feature (eaTracker “My Goals”). Methods: One-on-one semi-structured interviews were conducted with My Goals users in Ontario (n = 18) and Alberta (n = 5) recruited via the eaTracker website and ERO contact centre dietitians (n = 5). Interview transcripts were analyzed using content analysis. Results: Participants had mixed experiences and perspectives with ERO motivational messaging. Messages targeted towards specific goals (e.g., tips, recipes) were generally well-liked, and generic messages (e.g., eaTracker login reminders) were less useful. No interviewed users had contacted ERO dietitians regarding goals, and dietitians reported encountering few callers asking for assistance while using My Goals. Limited user knowledge was one explanation for this finding. Participants provided suggestions to enhance these supports. Conclusion: Electronic motivational messaging and contact centre dietitian assistance have the potential to support achievement of goals set with website-based features. When considering using electronic messaging, researchers and practitioners should consider message content and delivery tailoring. Marketing that focuses on how contact centre dietitians can assist website users with their goals is needed when services are used in naturalistic settings.
    School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet... more
    School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as “common” or “inconsistent” across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.
    Weight bias and discrimination are highly pervasive and harmful to Canadians with higher weights. Researchers and practitioners who deliver, evaluate, and advise on dietary and weight-related interventions may inadvertently perpetuate... more
    Weight bias and discrimination are highly pervasive and harmful to Canadians with higher weights. Researchers and practitioners who deliver, evaluate, and advise on dietary and weight-related interventions may inadvertently perpetuate weight bias through their work; however, trainees in these fields rarely have access to weight bias education within their applied health programs. This study evaluated the acceptability of an online educational weight bias module developed for undergraduate students enrolled in health courses. The intervention included a pre-recorded 20-minute online module with prompts for reflection or discussion, a self-assessment quiz, as well as a separate module and range of resources for instructors. Overall, 211 students from applied health courses and 4 instructors completed an online survey querying the module’s delivery, impact, and relevance. Students agreed that the module provided useful information (82%), was easy to understand (97%), and was the right length (75%), but reported wanting more interactivity and engagement with the content. Instructors found the module engaging and useful and expressed interest in additional resources and support for weight bias education. Future research should explore the impact of weight bias education on students’ weight-related attitudes and perceptions as well as feasibility and relevance of online features such as multimedia tools.
    ABSTRACT Locally harvested food consumption is declining among Canadian First Nations (FN) youth. The objective of this study was to investigate, among youth in 2 FN communities, the frequency of lesser snow goose (Chen caerulescens... more
    ABSTRACT Locally harvested food consumption is declining among Canadian First Nations (FN) youth. The objective of this study was to investigate, among youth in 2 FN communities, the frequency of lesser snow goose (Chen caerulescens caerulescens) consumption, its contribution to nutritional intake, and the nutritional outcomes of a harvest sharing program. A cross-sectional survey and pre–posttest design was used. Food intakes were assessed via 24-hour recall and food frequency questionnaire. At baseline (n = 84, 12.38 ± 1.07 years, 49% male) 48% of participants consumed snow goose. Consumption frequency was associated with meat and alternatives (P = .019), protein (P = .004), vitamin B12 (P = .004), iron (P = .011), and zinc (P = .006). At postprogram (n = 73, 12.34 ± .99 years, 44% male), consumption prevalence increased, significantly for girls (P = .015). Harvest sharing supports snow goose consumption, which imparts nutritional benefits.
    Children with chronic renal failure (CRP) grow poorly and are frequently malnourished. Inadequate dietary intake is only one of several factors which have been implicated in the etiology of the growth failure [1–3], yet its relevance may... more
    Children with chronic renal failure (CRP) grow poorly and are frequently malnourished. Inadequate dietary intake is only one of several factors which have been implicated in the etiology of the growth failure [1–3], yet its relevance may be significant. Nutritional management of CRF usually involves the restriction of protein, phosphate, sodium, and potassium, which severely limits nutrition and food selection for these often anorectic patients. With the introduction of continuous ambulatory peritoneal dialysis (CAPD), more liberal diets may be prescribed.
    Purpose: The purpose of this work was to assess Arab Muslim immigrant mothers’ acculturation level, to explore apparent links between acculturation level and experiences of dietary changes, and to gather information on factors affecting... more
    Purpose: The purpose of this work was to assess Arab Muslim immigrant mothers’ acculturation level, to explore apparent links between acculturation level and experiences of dietary changes, and to gather information on factors affecting dietary acculturation. Methods: Semi-structured individual interviews focusing on food choices were conducted with 24 mothers who had been in Canada 5 years or more. An adapted version of an existing acculturation scale was used to assess participants’ perception of their own acculturation. Results: Arab Muslim mothers retain traditional food preparation. However, several factors led to changes in their daily food consumption such as children’s preferences, time concerns, and availability of Arabic food. No significant relation was found between measured levels of acculturation and the adoption of Canadian food behaviour or the retention of preparation and consumption of traditional foods (dietary acculturation); however, a greater length of stay in Canada was somewhat associated with limitations on preparing traditional food. The findings indicated that many of the Arab Muslim mothers interviewed retain important aspects of their traditional cuisine. Conclusions: Dietary acculturation for Arab Muslim immigrants to Canada involved a balance between carrying forward food-related traditions and adapting to Canadian culture, including Canada’s food culture.
    This study explored perceived barriers and facilitators to healthful eating in schools and communities among overweight teens who completed an E-health intervention. Twenty-two teens were recruited to a photovoice study and asked to take... more
    This study explored perceived barriers and facilitators to healthful eating in schools and communities among overweight teens who completed an E-health intervention. Twenty-two teens were recruited to a photovoice study and asked to take pictures of things that made it easier or harder to make healthful food choices at school and in their community. Digital photographs were reviewed using semi-structured interviews. Transcribed audio-recordings were analyzed using constant comparative analysis. Similar themes emerged from the school and community environments with food/beverage availability emerging most frequently, followed by peer influence, convenience, price, school practices, marketing and the online world. Teens described an obesity-promoting environment and perceived very limited healthful options. Policy-driven environmental changes as well as strategies that help teens navigate food choices in their schools and communities are needed to support healthful eating.
    Absolute total body (TB) and regional spine (RS) bone mineral content (BMC) measured by dual photon absorptiometry were lower (p... more
    Absolute total body (TB) and regional spine (RS) bone mineral content (BMC) measured by dual photon absorptiometry were lower (p < .05) in Turner syndrome (TS) girls compared to a cohort of younger (by 2 years) but taller and heavier prepubertal girls. Maximal voluntary strength (MVC) of the elbow flexors, knee extensors, and plantar flexors were also consistently and, in most cases, significantly lower in TS girls. Differences between groups in absolute bone mineral and muscle strength disappeared, however, when normalized for skeletal cross-sectional area (areal density) and for the product of muscle cross-sectional area and estimated moment arm, respectively. Maximal voluntary strength and body mass correlated moderately strongly with the bone mineral measures, but only body mass contributed significantly to the variance in total body and regional spine bone mineral measures. Bone mineral and muscle strength appear appropriate for body size and for skeletal and muscle morphology in young TS girls.
    Summary As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect... more
    Summary As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified “inside out” socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings.
    Purpose: Self-reported coronavirus 2019 (COVID-19) pandemic effects on dietetic job search, employment, and practice of recent graduates were explored within a national workforce survey. Methods: Graduates (2015–2020) who were... more
    Purpose: Self-reported coronavirus 2019 (COVID-19) pandemic effects on dietetic job search, employment, and practice of recent graduates were explored within a national workforce survey. Methods: Graduates (2015–2020) who were registered/licensed dietitians or eligible to write the Canadian Dietetic Registration Exam were recruited through dietetic programmes, Dietitians of Canada’s communication channels, and social media. The online survey, available in English and French from August through October 2020, included questions about pandemic experiences. Descriptive statistics and thematic analysis were applied to closed and open-ended responses, respectively. Results: Thirty-four percent of survey respondents (n = 524) indicated pandemic effects on job search and described delayed entry into dietetics, fewer job opportunities, and challenges including restricted work between sites. The pandemic affected employment for 44% of respondents; of these, 45% indicated working from home, 45...
    Background: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health... more
    Background: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research and program development with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning from key learnings and successes on scaling-up the Learning Circle (LC) vertically in Haida Nation, British Columbia (BC) and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. Application of these principles is discussed in the cont...
    Youth health, long-term food sovereignty and the reclamation of traditional food-related knowledge are areas of concern within Indigenous communities in Canada. Learning Circles: Local Healthy Food to School (LC:LHF2S) built on an... more
    Youth health, long-term food sovereignty and the reclamation of traditional food-related knowledge are areas of concern within Indigenous communities in Canada. Learning Circles: Local Healthy Food to School (LC:LHF2S) built on an exemplar program in four predominantly Indigenous communities. In each, the initiative worked with interested community members to plan, implement and evaluate a range of activities aimed at enhancing access to local, healthy and traditional foods for schools and youth. This case study describes the context, process, outcomes and perceptions of implementation in one of the communities, Hazelton/Upper Skeena, located in northern British Columbia. Data were collected between 2016–2019 and included semi-directed interviews with community members and LCEF (n = 18), process reporting (e.g., LCEF reports, emails, conference calls and tracking data), photographs and video footage, and photovoice. Data were analyzed thematically. Hazelton/Upper Skeena has an activ...
    Integrated knowledge translation (IKT) and community-based participatory research (CBPR) are recognized as effective approaches when Indigenous and non-Indigenous partners work together to focus on a common goal. The “Learning Circles:... more
    Integrated knowledge translation (IKT) and community-based participatory research (CBPR) are recognized as effective approaches when Indigenous and non-Indigenous partners work together to focus on a common goal. The “Learning Circles: Local Healthy Food to School” (LC:LHF2S) study supported the development and implementation of Learning Circles (LC) in 4 Canadian Indigenous communities with the goal of improving local, community-based healthy food systems. Critical to the research process were annual gatherings (AG) where diverse stakeholders (researchers, Indigenous community members, and partners) visited each community to share knowledge, experiences, and provide support in the research process. Using a qualitative, descriptive method, this paper explores how the AG supported IKT across partners. Yearly interviews involving 19 total participants (with some participating multiple times across the 4 gatherings) elicited their AG experiences in supporting local LC:LHF2S. Three them...
    Abstract: Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo... more
    Abstract: Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo Region (Ontario, Canada) as a case study for “what works ” with respect to facilitating access to healthy, local food through regional food system policy making. Policy and planning approaches were explored through multi-sectoral perspectives of: (a) the development and adoption of food policies as part of the comprehensive planning process; (b) barriers to food system planning; and (c) the role and motivation of the Region’s public health and planning departments in food system policy making. Forty-seven in-depth interviews with decision makers, experts in public health and planning, and local food system stakeholders provided rich insight into strategic government actions, as well as the local and historical context within which food system policies ...
    Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively.  While these sectors are often siloed within public health organizations, the... more
    Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively.  While these sectors are often siloed within public health organizations, the actions of the two sectors often interact and conflict at the program level despite their common goal of improving population health.  The objective of the present study was to identify determinants that influenced the success of collaboration between practitioners of the two sectors in British Columbia, to inform Canadian food policy.  We inductively analyzed 14 interviews with practitioners working in the two sectors who had experience with successful collaboration. Data were interpreted in consultation with an inter-professional collaboration framework.  Participants identified determinants at the systemic level, including the cultural, professional, educational, legislative, and political systems, which were often considered barriers to collabora...
    ObjectiveUnhealthy dietary behaviours are prevalent among adolescents. This might relate, in part, to obesogenic environments, including recreation food facilities. The REFRESH Study (Recreation Environment and Food Research: Experiences... more
    ObjectiveUnhealthy dietary behaviours are prevalent among adolescents. This might relate, in part, to obesogenic environments, including recreation food facilities. The REFRESH Study (Recreation Environment and Food Research: Experiences from Hockey) aimed to explore, from the perspectives of adolescent ice hockey players and parents, broad social and physical environmental influences on adolescent food behaviours associated with hockey participation.DesignPlayers used photovoice to describe their food experiences in relation to ice hockey. The approach included photos, individual interviews and focus groups. Exemplar photographs were exhibited for stakeholders, including five parents who were interviewed. Interview and focus group transcripts were thematically analysed.SettingRecreational ice hockey environment, Ontario, Canada, 2015–16.SubjectsIce hockey players (n24) aged 11–15 years recruited from five leagues.ResultsDominant influences among players included: their perceived im...
    Continuous Ambulatory Pertioneal Dialysis (CAPD) has encouraged nephrologists around the world to reassess peritoneal dialysis as an acceptable replacement of renal function. Since CAPD is so applicable to children, especially infants,... more
    Continuous Ambulatory Pertioneal Dialysis (CAPD) has encouraged nephrologists around the world to reassess peritoneal dialysis as an acceptable replacement of renal function. Since CAPD is so applicable to children, especially infants, there is an added incentive for pediatric nephrologists to assess the dialytic characteristics of the child’s peritoneal membrane. Anecdotally, pediatric nephrologists have found peritoneal dialysis difficult to perform on very young infants. The most apparent and troublesome difficulty is a perceived reduction in ultrafiltration characteristics. One of the reasons for this impression is that infants, after cardiac surgery, may develop acute renal failure, and acute peritoneal dialysis is often the type of dialysis used. The reasons for the difficulty in removing fluid by ultrafiltration are multiple. Often, SVCH children have very reduced left ventricular function and therefore, a sluggish mesenteric circulation. Therefore, this impression concerning peritoneal dialysis in infants and young children may be incorrect and in fact may be the results of a number of other causes which do not necessarily involve the peritoneal membrane. We have previously reported that the glucose and protein concentration in “spent” or “used” dialysate from CAPD patients is different with respect to age [1]. Using 6 years of age as the dividing age, younger patients have a lower glucose and higher protein concentration in the dialysate compared to older children. Therefore, it would appear that with the loss of the glucose osmotic concentration gradient in the dialysate, there would be a decreased ultrafiltration capacity in younger children. There have been no reports comparing the effect of a child’s age on peritoneal membrane morphology. Esperanca et al. [2] reported that the infant’s peritoneal membrane is relatively larger than the adult’s: 383 cm2 as compared with 177 cm2/kg body weight.
    Background Indigenous communities in Canada are concerned about long-term food sovereignty and the reclamation of traditional food-related skills among their people. Learning Circles: Local Food to School (LF2S) was an innovative... more
    Background Indigenous communities in Canada are concerned about long-term food sovereignty and the reclamation of traditional food-related skills among their people. Learning Circles: Local Food to School (LF2S) was an innovative community-based project that worked to promote multisectoral partnerships, focused on food. Guided by a facilitator, the Learning Circle (LC) brought together interested community members to plan and implement activities aimed at enhancing access to local, healthy, and traditional foods for school communities. Objectives The article describes the context, process, and food-related outcomes of the LC in Haida Gwaii (HG), British Columbia, Canada and evaluates perceptions of the transition in local food systems, food literacy, and community capacity associated with the LC. Methods The sources that were gathered between 2016 and 2018 included annual semidirected interviews with community members and the Learning Circle Coordinator (LCC) (n = 24), process repor...
    In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities... more
    In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability; and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that...
    Indigenous communities in Canada are concerned about the health of their youth and the reclamation of traditional food-related skills amongst their people. Food sovereignty has an integral role in food and nutrition security, and the path... more
    Indigenous communities in Canada are concerned about the health of their youth and the reclamation of traditional food-related skills amongst their people. Food sovereignty has an integral role in food and nutrition security, and the path to Indigenous self-determination. Learning Circles: Local Healthy Food to School (LC:LHF2S) was a community engagement model that aimed to enhance access to local, healthy, and traditional foods for youth. In each of four First Nations communities, a Learning Circle Evaluation Facilitator worked to plan and implement activities, build on community strengths, and promote partnerships. This paper describes how the model was perceived to support food sovereignty. Data included interviews, process reporting, and school surveys, and was analyzed according to pillars effective for the development of food sovereignty in Indigenous communities. Goals set by two communities incorporated food sovereignty principles, and in each community capacity-building wo...
    Odds ratios from multivariate binary logistic regression analysis assessing the association between eaTrackerÂŽ My Goals feature user demographics and types of goals set with the My Goals feature. (PDF 260 kb)
    Search results â Targeted web searches. This table depicts the ten unique searches applied to Google search engine and the number of records identified from each search.
    Figure S1. Organigram of the decision making for biological follow up during the Human Biomonitoring in the Dehcho Region of the Northwest Territories (2016â 2017). (JPG 324 kb)
    Objective: Canadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers ’ selection of products low v.... more
    Objective: Canadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers ’ selection of products low v. high in sodium. Design: Participants were randomly assigned to one of five experimental conditions: (i) control condition with no FOP label; (ii) basic numeric FOP label; (iii) numeric FOP label with ‘high ’ and ‘low ’ sodium content descriptors; (iv) detailed Traffic Light (TL) label with colour coding, content descriptors and numeric information; and (v) simple TL label with no numeric information. Participants were shown pairs of grocery products that varied in sodium content and told they could choose a free sample. Selection of the low-sodium v. the high-sodium product was the primary behavioural outcome, in addition to ratings of effectiveness, understanding, liking and believability. Setting: Waterloo, Ontario, Canada. Subjects: Adults (n 430) ...
    There is tremendous need for feasible and acceptable community-based interventions to address poor nutrition and health among teen mothers in rural Eastern Uganda. To inform such interventions, we identified facilitators/opportunities and... more
    There is tremendous need for feasible and acceptable community-based interventions to address poor nutrition and health among teen mothers in rural Eastern Uganda. To inform such interventions, we identified facilitators/opportunities and challenges for maternal/child nutrition and health at community level, as perceived by those closest to the problem. In-depth interviews were conducted among 101 teens, family and community members in Budondo sub-county using questions based on social cognitive theory constructs related to nutrition/health. Data were analyzed thematically using Atlas-ti7.5.4. Facilitators included family support for positive teen decision-making regarding healthcare and practices and opportunities included income generation training and availability of healthcare services. Challenges included poor attitude of parents towards community workers, harsh treatment, inability to obtain income generation materials, insufficient land, food or medical supplies and medical u...

    And 157 more