Nutrition & Dietetics最新文献

Aim: Nutritional requirements are increased in young people to support growth, and this is particularly critical when pregnancy occurs within young age groups. The aim was to describe nutritional intakes (with particular emphasis on iron and calcium) and selected pregnancy outcomes, in a young antenatal population aged 14-24 years.

Method: A retrospective audit was conducted using 404 records from a young parents' antenatal clinic which included prepregnancy body mass index (BMI), pregnancy weight gain, baby birth weight, nutritional biochemistry, and dietitian assessment of iron and calcium intakes and supplement use. Age groups were compared (adolescents aged 14-18 years versus older 19-24 years clients), and regression analysis was used to explore potential predictors of birth outcomes.

Results: There was no difference in prepregnancy body mass index for age, pregnancy weight gain, baby birth weight or outcomes, between the age groups. Based on food group serves, intakes were inadequate for iron in 82% of clients and for calcium in 72%. Iron status declined in both groups during the pregnancy, while adolescents had less adequate calcium intake (p = 0.0001). Supplement use was more common in clients with poor iron (p = 0.015) or vitamin D status (p < 0.0001).

Conclusion: Iron and calcium intakes were inadequate in this nutritionally vulnerable population. Further research would be beneficial to identify effective interventions to improve nutrition in this cohort.

Aims: Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.

Methods: The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.

Results: During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.

Conclusions: The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.

Aim: Gamification may be an effective tool in motivating sustained behaviour change. This study aimed to explore perspectives of Australian-based healthcare professionals, including dietitians, towards gamification in their practice when assisting patients/clients to achieve health-related goals.

Methods: Semi-structured online interviews were conducted with healthcare professionals. Data was audio-recorded, transcribed verbatim, de-identified and thematically analysed to identify key themes and inform the creation of personas.

Results: Six dietitians, two psychologists, two exercise physiologists, one medical specialist, with 1-24 years of work experience, participated. Most participants (n = 7, 64%) were unable to articulate a definition of gamification, however, when offered more context, they could identify examples. Overall, participants were positive towards gamification, regardless of prior experience/exposure. Three themes emerged; (1) Variable familiarity with gamification, (2) Context matters, (3) Barriers hinder engagement/adoption. Stage of career rather than profession influenced participants' views of gamification, as reflected in three characterising personas; 'Joel: Early-Career, Progressive', 'Bella: Mid-Career, Stable' and 'Sam: Advanced-Career, Expert'.

Conclusions: Findings suggest that gamification is not widely used in health practice in Australia. Concerns about participation costs and data privacy are adoption barriers. Promotion of the effectiveness of gamification as a valuable adjunct tool to encourage behaviour change needs support from peak bodies. Embedding gamification in university curricula could better prepare graduates to engage with gamification in future practice. Further research capturing more diverse healthcare professionals' perspectives is required to fully understand the potential of gamification to change health behaviours, and to design feasible gamified solutions.

Aims: To co-create strategies and identify opportunities to integrate eating disorder content within dietetics curricula at one Australian university with stakeholders using a design thinking approach.

Methods: A pragmatic mixed-methods, participatory design approach was used. An online survey explored the learning needs of dietetic students and recent graduates regarding eating disorders. Following the survey, a one-day design thinking retreat was held with stakeholders who were identified from the research team's professional networks. Eating disorder dietitians, learning experts, dietetic students, graduates, and those with lived experience were asked to identify strategies to enhance students' confidence and competence to provide care for people living with eating disorders. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using inductive coding and reflexive thematic analysis.

Results: Sixty-four students (n = 55, 86%) and recent graduates (n = 9, 14%) completed the online survey (26% response). Seventeen stakeholders attended the retreat. Four themes were identified: (1) changing perceptions of eating disorder care from specialist to 'core business'; (2) desiring and advocating for a national change to dietetics curricula; (3) importance of lived experience at the centre of curriculum design and delivery; and (4) collaborating to co-design and deliver eating disorder content at university.

Conclusion: Raising awareness, upskilling students and educators, enhanced collaboration between universities and stakeholders, and the inclusion of lived experience were key to preparing students to provide care to people seeking support for eating disorders. Further research is needed to assess the impact these strategies have on dietetic students' confidence and competence.

Aims: Healthcare needs of the Australian population are changing, providing an opportunity for dietitians to embrace innovation and entrepreneurship to meet evolving demands. This study explored the expectations and experiences of participants in a 12-month mentoring circle designed to provide entrepreneurship learning and formal mentoring for the Provisional Accredited Practising Dietitians Program.

Methods: A qualitative study design was employed. New graduate dietitians (<2 years) participating in the Entrepreneurial Dietetics Mentoring Circle in 2019, 2020 or 2021 were invited to participate. Baseline demographic and employment data were collected via survey. Semi-structured interviews were conducted before mentoring circle session 1 (baseline) and after the final session (completion), exploring insights into participant expectations and experiences in entrepreneurship. Thematic analysis, using methods outlined by Braun and Clark, was conducted to identify themes and subthemes.

Results: Twenty-eight dietitians participated (85% of mentees). Participants were mostly female (89%), less than 12 months post-graduation (75%), registered as Provisional Accredited Practising Dietitians (82%) and employed at least part-time (55%). Forty five interviews were conducted (28 baseline, 18 completion). Themes developed were: (1) entrepreneurial career path as a deliberate choice; (2) the value of being prepared for entrepreneurial careers; and (3) the importance of networks to support entrepreneurship.

Conclusion: The mentoring circle at this single university was seen by participants as supporting their transition into entrepreneurial careers, while meeting their requirement to be formally mentored through their Provisional status. Future research could consider the applicability of the mentoring circle model across a wider graduate population to support innovative practice.

Aims: Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science.

Methods: Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science.

Results: We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems.

Conclusions: While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.

Aims: To describe an Aboriginal cultural immersion delivered to dietetics students at a large university in Australia and assess its effectiveness as a method to teach Aboriginal history, culture, diet, and health in dietetics.

Methods: Taking a strength-based approach, Aboriginal processes of learning were privileged, with the cultural immersion being co-designed with immersion educators, a First Nations researcher, and dietetics academic. The cultural immersion consisted of an opening ceremony and four stations of yarning, weaving, bush tucker, and artefacts/medicines. A mixed-methods approach was used, with triangulation of data from pre- and postsurveys, station mapping, and focus group interviews. Quantitative and qualitative data were simultaneously analysed from participating first-year Master of Nutrition and Dietetics students and then drawn together for an integrated understanding of the impact of the cultural immersion on student learnings.

Results: Fifty-three students completed pre- and postsurveys and 36 participated in focus groups. Through sharing lived experiences, learning through culture, and keeping sessions practical and Aboriginal leadership, each cultural immersion station utilised Aboriginal processes of learning that meaningfully engaged students with Aboriginal education content, appreciate holistic health and increased their general knowledge on Aboriginal history, culture, diet, and health (all p < 0.001).

Conclusion: Cultural immersion is one teaching method to enhance student knowledges and can be a part of a programmatic and integrated approach that embeds Aboriginal content throughout the whole curriculum. It is necessary that institutions recognise the value of cultural immersions to student learnings and commit to providing ongoing support.

Aim: The aim of this study was to examine expectations, perceptions and attitudes about dietetics services among the Australian and New Zealand public, to provide insights for building a future dietetics workforce that will meet consumer needs.

Methods: A cross-sectional, anonymous, online survey was employed to gain perspectives of a representative sample of Australian and New Zealand adults. Questions were purposely designed to collect views regarding sources of dietary information, expectations of dietetics service providers and factors influencing choice of dietetics service provider. Data were analysed descriptively and using Pearson's chi-square test to assess relationships between categorical variables. Free-text responses were analysed using content analysis.

Results: Of 2601 respondents, approximately one third (32%) had seen a dietitian. Doctors were the most trusted sources of dietary information (87%), particularly with participants over 60 years (χ(1) = 44.168, V = 0.130, p < 0.001). Cost was the most frequently reported factor influencing choice of dietetics services (56%), with 88% of respondents interested in accessing a dietitian, preferably in-person (64%), if they could do so for no cost. Participants anticipated that dietitians would offer services like meal plans (59%) and nutritional analysis (48%) as well as weight and other body measurements (56%). Some expectations such as blood tests (54%) were outside the usual scope of dietetic practice.

Conclusion: The results of this study have implications for practising dietitians, dietetics educators, and funders of dietetics services. Cost as a barrier suggests that advocacy to government for funding type, duration and number of visits to dietitians is still required.

Aims: To assess test-retest reliability of both food photography and food diary methods and validity of these data against known values derived from food labels.

Methods: Test-retest reliability analyses of food diary and food photography were compared using single foodstuffs using intra-class correlation coefficients, coefficients of variation, and limits of agreement. For food diaries, 24-h test-retest reliability was also examined. Validity was assessed against weighed analyses. As part of habitual intake, a single foodstuff (randomly allocated from 14 common foods) was consumed by 26 participants over 24-h. On two occasions (14 days apart), single-blind dietary analyses allowed estimation of foodstuff-specific energy and macronutrient content and 24-h intakes.

Results: For food diaries, test-retest reliability was acceptable (weight, energy, carbohydrate, protein, and fat: all intra-class correlation coefficients: >0.990, coefficient of variation percentage: <0.1%, limits of agreements: <0.1 to <0.1, p > 0.05, and effect size: <0.01). For food photography, test-retest reliability was acceptable for weight, energy, carbohydrate, and protein (all intra-class correlation coefficients: >0.898, coefficient of variation percentage: 3.6%-6.2%, limits of agreements: 1.1 to - 44.9, and effect size: 0.01-0.12). Food photography validity was worse than food diaries for all variables (percentage difference: 8.8%-15.3%, coefficient of variation percentage: 7.5%-13.8%, all p ≤ 0.05, and effect size: 0.001-0.11).

Conclusions: Greater reliability and validity occurred in food diaries versus food photography. These findings suggest that using food photography may lead to an underestimation of energy and macronutrient content, which may have implications for dietary interventions and nutritional strategies.