Nutrition & Dietetics最新文献

Aims: To assess the feasibility of implementing data standards in Australian primary care dietetics practices.

Methods: A mixed-methods pragmatic study of dietitians working in primary care. Using a four-point Likert scale, participants were surveyed on their baseline use of the 45 business and 33 clinical evidenced-based data standards. The content validity index and kappa statistic for each standard were calculated with a kappa statistic of 0.60-0.74 considered 'Good' and > 0.74 'Excellent'. After 4 weeks of assessment, dietitians were surveyed on the feasibility of implementing each standard and standards in total. Qualitative feedback on enablers and barriers to implementing standards was gathered and triangulated with interviews with select participants.

Results: Forty-five dietitians from every Australian state and territory completed both surveys (response rate: 100%). At baseline, 24% of business and 79% of clinical standards were rated 'Good' or 'Excellent' for current usage. The feasibility of implementing standards was rated 'Good' or 'Excellent for 86% of the business and 97% of the clinical standards. Software, training and time limitations are enablers and barriers to implementing standards.

Conclusion: Embedding data standards within dietetics practices are feasible and have broad applicability for assessing outcomes of care.

Aim: To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy.

Method: Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand.

Results: Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand.

Conclusions and implications: Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Aims: To investigate anxiety and depression after primary treatment for ovarian cancer in relation to diet quality and intake.

Methods: In a cohort of women with ovarian cancer in Australia, levels of anxiety and depression (normal, subclinical, and clinical) were assessed using the Hospital Anxiety and Depression Scale at 9 months post-diagnosis. Dietary intake was assessed using a validated food frequency questionnaire at 12 months post-diagnosis and scored using the Healthy Eating Index 2015. Multinomial logistic regression and bivariate analyses were used to investigate relationships between levels of anxiety and depression and subsequent diet quality and intake of food groups.

Results: Of 595 women, anxiety and depression were identified among 128 (21%) and 80 (13%) women, respectively. Compared to women without anxiety or depression, women with subclinical anxiety (odds ratio = 0.49, 95% confidence interval: 0.25-0.98) and those with clinical depression (odds ratio = 0.25, 95% confidence interval: 0.07-0.93) were less likely to score in the highest quartile for diet quality. Separate adjustment for age, education, employment, disease stage, body mass index, and smoking status did not attenuate these associations. In bivariate analyses, women with subclinical anxiety were more likely to report higher intakes of sweet foods. Those with clinical depression were more likely to report lower intakes of orange vegetables and wholegrains, higher intakes of sweetened beverages, and not consume alcohol or soya foods.

Conclusions: Anxiety or depression after primary treatment for ovarian cancer may be associated with poorer diet quality. Efforts to improve diet quality post-treatment should consider support for mental health.

Aim: This study aimed to identify how dietitians and other healthcare providers work to build trust in food systems in the course of providing dietary education.

Methods: Qualitative semi-structured interviews were conducted with 15 purposefully sampled dietitians (n = 5), general practitioners (n = 5), and complementary and alternative medicine practitioners (n = 5) within metropolitan South Australia. Interview data were then interpreted using an inductive thematic analysis approach, involving the construction of themes representing trust-enhancing roles around which beliefs about professional roles, the 'patient', and food and health were clustered.

Results: Healthcare providers communicate beliefs regarding (dis)trust in food systems through: (i) responding to patient queries and concerns following a food incident or scare; (ii) helping patients to identify (un)trustworthy elements of food supply systems; and (iii) encouraging consumption of locally produced and minimally processed food. Importantly, the expression of these roles differed according to participant beliefs about food and health (medico-scientific versus alternative medicine) and their adoption of professional projects that sought to promote medico-scientific ways of thinking about health and diet or manage the failures of Western medicine.

Conclusion: The development and consolidation of trust-enhancing roles amongst healthcare providers likely requires disciplinary reflection on professional values and the processes by which practitioners apply these values to understanding food systems.

Aim: Male dietitians are under-represented in the global dietetics workforce, including in Australia. This study explores Australian males' experiences as dietitians in the Australian workforce, with the aim to identify influences that initially attracted them to dietetics, as well as barriers that may affect their decision to stay in or leave the profession.

Methods: A cross-sectional, semi-quantitative web-based survey was distributed to male dietitians using purposive, snowball sampling. Closed and open-ended questions were included. Descriptive statistics were generated, and content analysis of free-text responses identified major themes.

Results: Seventy-one respondents opened the survey link, of which 65 respondents attempted the survey. Fifty-four (83.1%) respondents agreed that dietetics is female-dominated. An interest in food and nutrition was the most reported reason for studying dietetics (73.8%). Of the 55 respondents who were not intending to retire in the next 5 years, 15 (27.3%) stated they were somewhat or extremely likely to leave the profession of dietetics. Respondents identified issues that impacted their experiences as a male dietitian, including gender differences, a lack of male role models, barriers to career progression/employment, and perceptions of a lack of respect and impact within healthcare.

Conclusions: Australian male dietitians perceive systemic, social, and personal factors that have influenced their career experiences. Greater exposure to prominent male role models may be self-perpetuating in improving male dietitian recruitment and eventually, retention. A multi-pronged approach is needed to improve the rate of recruitment of male dietitians, with a role for tertiary education providers and peak dietetics bodies.

Aim: This study aimed to describe dietitians' confidence in their knowledge and skills working with older adults in residential aged care facilities or home care services.

Methods: A novel, quantitative online survey was distributed to aged care dietitians. Activities, knowledge, and skills areas outlined by the Dietitians Australia 'Older Persons and Aged Care Dietitian Role Statement' were included in the 23-item survey. Likert scales captured participant responses. Median responses (n, %) are presented. Associations between participants' confidence in their knowledge and skills and years of experience working in aged care were explored using Pearson's chi-squared tests.

Results: Dietitians completed the survey (N = 125; age: 40 ± 13 years [mean ± SD]; 97.6% female). Dietitians reported they "always" worked collaboratively (n = 65%, 52%) and 'often' prescribed supplements (n = 52%, 41.6%) and utilised a food-first approach (n = 36%, 28.8%). Dietitians 'sometimes' conducted malnutrition screening (n = 28%, 22.4%), audits (n = 36%, 28.8%), nutrition education (n = 53%, 42.4%) and quality improvement activities (n = 28%, 22.4%). Dietitians 'rarely' utilised food service/standards (n = 38%, 30.4%) and nutrition/hydration procedures (n = 35%, 28.0%). Dietitians with ≥6 years of experience were more confident than dietitians with 0-5 years in providing support programs (p = 0.003), utilising healthcare policies (p = 0.013), interpreting quality assessment (p = 0.014) and communication skills (p = 0.047). Dietitians felt 'completely' or 'fairly' confident in all knowledge and skill areas, except for government and community support programs (n = 38%, 30.4%) rated 'somewhat' confident.

Conclusion: Aged care dietitians are confident in most aspects of their role but have opportunities to be better supported. Developing the confidence of higher-level systems and communication in early career dietitians is warranted.

Aims: In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues.

Methods: Two engagement events, in 2023, brought together experienced and mid- and early-career nutrition professionals for co-creation of implementation logic models.

Results: One hundred and nine early and mid-career professionals were involved. A revised model for the decadal plan pillars emerged from synthesis of all logic models. This new model integrated the precision and personalised nutrition pillar with nutrition mechanisms pillar. These combined pillars build towards the national data capability enabling platform and created new cross-cutting themes for education and training. The need arose for greater focus on respectful engagement with Aboriginal and Torres Strait Islander communities and sustained effort to build cross-disciplinary collaboration to realise the plan's societal determinants goals. A new alliance for nutrition science is proposed to become a unified advocacy voice and build trust in nutrition professionals.

Conclusions: A programmatic approach provides a road map for implementing the decadal plan for the final 5 years.

Aim: To explore the attitudes and experiences of allied health students working with older adults on residential aged care placements.

Method: A systematic literature search was conducted to identify studies of any design describing allied health student experience of residential aged care placements. Online databases searched to identify potentially relevant documents included Scopus, Web of Science, PubMed, CINAHL Complete (EBSCOhost) and Health and Medicine (ProQuest). Studies were excluded if residential aged care facilities or allied health professional students could not be extracted from the data. No restrictions were applied to methodological design, language, geographical location or year of publication. The Mixed Methods Appraisal Tool was used to assess methodological quality. Extracted studies were analysed to identify the study design, participant and placement characteristics, study methodology and student experience measures. Data from the included studies were analysed thematically using meta-synthesis.

Results: Six studies (total number of participants, n = 308) met inclusion criteria, with four papers scoring a 5/5 on the Mixed Methods Appraisal Tool. Studies included undergraduate and master's students from physiotherapy (n = 3), speech language pathology (n = 2), dietetics (n = 1) and audiology (n = 1). Placement length varied from two to 15 h, between one and six residential aged care visits. Three themes were identified; (1) Opportunity to improve skills and gain confidence, (2) Development of empathy and shift in attitudes towards older adults and (3) Recognised challenges associated with older adults and residential aged care settings.

Conclusion: While the size of the evidence-base is limited, the studies were largely consistent in demonstrating an increase in positive attitudes towards older adults following residential aged care placements. Future research, innovations and planning around workforce size, preparation and motivation must be prioritised to ensure older adults receive the care they need and deserve.

Background: Collective impact is gaining traction to improve population health outcomes. This study aimed to determine where and how collective impact is being used in nutrition and describe current understandings of its impacts or results on health or nutrition outcomes.

Methods: A systematic scoping review was undertaken with four databases ('CINAHL Plus', 'Sociological Abstracts', 'PsychInfo', and 'OVID Medline') using the search term 'Collective Impact' from 2011 up to November 2022. All studies were screened independently by two authors. Data were extracted and synthesised narratively.

Results: A total of 712 different documents were identified, with four studies included in the synthesis. Collective impact approaches focussed on breastfeeding, reducing sugar-sweetened beverage consumption, increasing access to healthy food, and obesity. Across the four included studies, promising results in improving health and nutrition were reported.

Conclusion: Evaluating and reporting on the outcomes of collective impact initiatives in nutrition using robust methods is needed.