Nutrition & Dietetics最新文献

Aims: Child malnutrition remains a significant issue worldwide, particularly in developing regions like Asia. Age 6-23 months is critical for preventing malnutrition, yet numerous children within this range do not receive nutritionally sufficient complementary foods. This study aimed to explore factors influencing complementary feeding practices among Asian parents and caregivers.

Methods: Searches for this qualitative systematic review were undertaken in May-June 2023, in five databases (Medline, Cochrane, EMBASE, PubMed, and Global Health). The review included studies from Asian countries that utilised qualitative or mixed methods, published in English. Studies involving infants with pre-existing conditions or mothers with mental health conditions were excluded. The 2018 Critical Appraisal Skills Programme checklist was used to evaluate the included studies, and data were synthesised to extract key themes related to complementary feeding practices. The appraisal certainty of review findings were assessed using the GRADE-certainty of qualitative evidence approach.

Results: This review identified 14 findings from 16 studies with 955 participants. Influencing factors were categorised into four groups: individual factors (child's preferences, knowledge gaps, sources of information, the mother's self-efficacy, time constraints, insufficient breast milk), household factors (family dynamics, secondary caregivers support, economic status), socio-environmental factors (sociocultural norms, media influences, social support, access to food), and health services.

Conclusions: This study emphasises the need to consider parents' and caregivers' experiences when developing interventions. The presence of diverse factors across settings suggests customised nutrition education that considers local contexts and involves all relevant stakeholders.

Aims: Transition to employment is considered a vulnerable period for health professional graduates. This study aimed to follow the transition to employment for graduates from a single dietetics program, at several timepoints over 24 months to assess dietetic employment outcomes.

Methods: Griffith University dietetics graduates from 2017 to 2019 were invited to participate in the longitudinal Griffith Dietetics Graduate Outcomes Study comprising four online surveys on employment preferences and outcomes: Survey 1 (graduation), Survey 2 (6-months), Survey 3 (12-months), and Survey 4 (24-months). Quantitative data were analysed using descriptive statistics, for cross-sectional findings (Surveys 3 and 4) and longitudinal analyses (Surveys 1-4).

Results: Of the 150 eligible graduates, 91.3%, 73.3%, 59.3% and 51.3% responded to Surveys 1-4 respectively. At Survey 3, 84.3% of respondents were employed as a dietitian, 60.0% working more than 32 h/week and 25.3% in permanent positions. At Survey 4, 85.7% worked as a dietitian, 69.7% more than 32 h/week, predominantly in hospitals (45.5%) and private practice (37.9%). Longitudinal analyses showed that of 44/62 (70.1%) respondents who preferred a hospital role at graduation, 25 (56.8%) worked in a hospital at 24 months. All but one of the 16/62 (25.8%) who preferred private practice at graduation worked there at 6 months (93.8%), 12 of whom remained in private practice at 24 months (75%).

Conclusion: Universities need to prepare graduates for the challenging transition to full-time employment within their preferred sector. For dietitians within this study, the most vulnerable period was the 12 months post-graduation. National, longitudinal studies to at least 24 months are needed to investigate graduate employment outcomes for all dietetics programs.

Aims: Dietitians play key roles in the care of patients undergoing metabolic and bariatric surgery, including micronutrient management. This study aimed to explore Australian dietitians' practices and perspectives on managing micronutrients in bariatric surgery.

Methods: A mixed methods study of sequential explanatory design was conducted including a cross-sectional survey and semi-structured interviews. Eligible participants were Accredited Practising Dietitians caring for patients undergoing bariatric surgery. A 20-item study-specific practice survey was distributed electronically, and results were analysed descriptively. Interviewees were recruited via the survey and professional networks. Interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. Findings were integrated following separate analysis.

Results: Forty-five eligible dietitians responded to the survey and eight dietitians were interviewed. Practice findings showed pathology tests were most frequently ordered at the 6- and 12-month postoperative timepoints, and oral multivitamins were recommended postoperatively. Divergence across dietitians was seen in repletion practice and the clinical resources used, particularly in private versus public services. Interview findings were mostly consistent with survey results, and two themes identified were individualising supplementation and anticipating future needs.

Conclusion: Dietitians' practice on monitoring micronutrient status and postoperative supplementation was broadly consistent. Inconsistent practice in repletion of deficiencies was related to differing models of care. Despite perceiving that patients have a high prevalence of micronutrient deficiency preoperatively, dietitians did not prioritise managing micronutrients until after surgery, largely for practical reasons. More research is needed to improve the evidence-based practice in this area.

Aims: Chronic diarrhoea in older adults in residential care is underreported. This study examined its prevalence, contributing factors, and impacts on the quality of life of older adults living in care throughout New Zealand.

Methods: This study had two components: (1) a retrospective observational study of resident clinical, medication, bowel chart and health care data from 36 residential care facilities electronically entered by nursing or care staff, and (2) an observational study in six facilities where residents completed validated gastrointestinal and quality of life questionnaires. Residents were categorised by bowel pattern (normal, constipation, and diarrhoea) using Rome IV criteria. Chi-square tests compared bowel patterns with quality of life outcomes. Associations between bowel symptom reporting in parts one and two were assessed using contingency tables.

Results: The retrospective data of 2411 residents revealed that 26% (618/2411) experienced chronic diarrhoea, most of whom were taking laxatives (402/618), presumably for constipation. The prevalence of chronic diarrhoea in non-laxative users was 8.8% (214/2411). Proportions were similar in part two: 21% (23/110) of residents experienced chronic diarrhoea, half of whom were also charted laxatives (12/23). Chronic diarrhoea was negatively associated with quality of life (p < 0.001) and associated with an increased risk of pressure injuries (n = 80, 12.9%) compared to having normal bowel motions (n = 20, 7%) (p < 0.001).

Conclusions: Chronic diarrhoea commonly affects older adults living in residential care, with laxative use appearing a significant contributor. Living with chronic diarrhoea can negatively impact quality of life and may be associated with an increased risk of pressure injury.

Aim: Caring for people with higher weight and complex health needs is increasingly common in hospitals. This study aimed to explore and compare inpatient and staff perspectives on the care of people with higher weight.

Methods: Cross-sectional study using purpose-designed surveys within Metropolitan Victoria, Australia. Inpatients (who weighed over 100 kg) and hospital staff who provide care across four hospitals were invited to complete an inpatient-specific or staff-specific survey, respectively. Surveys contained questions related to clinical care, environment and dignity/respect. Data was analysed using descriptive statistics of scale-based items, and textual synthesis of free-text responses.

Results: Thirty inpatients and 59 staff participated. Most inpatients reported their clinical care needs were met (73%-83%) and described appropriate equipment and staff support. However, 25% felt judged or emotionally unsupported, with some experiencing delays in care due to staffing or equipment availability. Staff were less positive, with 73% reporting difficulty accessing equipment, 71% citing inadequate staffing and only 39% agreeing that non-stigmatising care was provided. Differences in weight-related terminology preferences emerged: inpatients favoured the terms 'higher weight' (27%) or 'obese/overweight' (34%), while staff preferred 'bariatric' (71%). Three themes were identified: (1) Inappropriate equipment, delays to equipment-access can negatively impact on inpatient experience of care; (2) Processes of care and communication influence inpatient experience of care; and (3) Weight-related stigma.

Conclusions: Addressing gaps in care requires improved training, better resource access and alignment of language with consumer preferences to reduce stigma and deliver person-centred care.