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Lavelle F, McKernan C, Shrewsbury V, Wolfson JA, Taylor RM, Duncanson K, Martins CA, Elliott C, Collins CE. An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland. J Hum Nutr Diet 2024. [PMID: 38606553 DOI: 10.1111/jhn.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. RESULTS Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. CONCLUSIONS Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.
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Affiliation(s)
- Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachael M Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Carla A Martins
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
- Institute of Food and Nutrition, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Christopher Elliott
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Urquhart L, Roberts K, Duncanson K, Brown LJ, Fisher K. Sustaining an Aboriginal wellbeing program: Informing health promotion practice and policy. Health Promot J Austr 2024; 35:457-469. [PMID: 37466162 DOI: 10.1002/hpja.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander Peoples' holistic concepts of wellbeing are inadequately represented in the health promotion discourse. The aim of this article was to explore what sustains an Aboriginal wellbeing program, to inform critical reflection and reorientation to empower Aboriginal wellbeing approaches in health promotion practice and policy. METHODS Aboriginal and non-Indigenous researchers collaboratively designed a critically framed, strengths-based research approach with Aboriginal Community Controlled Health Service staff and wellbeing program participants. Data from Individual Yarning (n = 15) with program participants and staff inspired co-researchers to co-develop interpretations over two half-day Collaborative Yarning sessions (n = 9). RESULTS Co-researchers depicted five lifeworld qualities that sustain an Aboriginal wellbeing program: love, connection, respect, culture and belonging. The lifeworld qualities are relational, communicative and involve the dynamics of identity, power and self-determination. CONCLUSIONS The five qualities support a lifeworld approach to an Aboriginal wellbeing program, opening communicative and relational opportunities to mediate culturally responsive interactions. The qualities mediated interactions between people in the lifeworld including program participants and coordinators, and systems representatives including health service providers. A lifeworld approach provides a way to empower Aboriginal self-determination and leadership through embedment of cultural determinants of health in wellbeing programs. SO WHAT?: Health service providers and policy makers can use lifeworld approaches to guide critical reflection and reorient practice and policy related to Aboriginal health. The lifeworld qualities that encompass this approach in wellbeing programs are communicative and relational, centred on local community voices and co-produced with community for Aboriginal identity, empowerment and self-determination.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Coffs Harbour, New South Wales, Australia
| | - Karen Roberts
- Galambila Aboriginal Health Service, Coffs Harbour, New South Wales, Australia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive Health, University of Newcastle, Callaghan, New South Wales, Australia
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Leanne J Brown
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
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Koloski N, Duncanson K, Ramanathan SA, Rao M, Holtmann G, Talley NJ. What impact has the Centre of Research Excellence in Digestive Health made in the field of gastrointestinal health in Australia and internationally? Study protocol for impact evaluation using the FAIT framework. BMJ Open 2024; 14:e076839. [PMID: 38514142 PMCID: PMC10961498 DOI: 10.1136/bmjopen-2023-076839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION The need for public research funding to be more accountable and demonstrate impact beyond typical academic outputs is increasing. This is particularly challenging and the science behind this form of research is in its infancy when applied to collaborative research funding such as that provided by the Australian National Health and Medical Research Council to the Centre for Research Excellence in Digestive Health (CRE-DH). METHODS AND ANALYSIS In this paper, we describe the protocol for applying the Framework to Assess the Impact from Translational health research to the CRE-DH. The study design involves a five-stage sequential mixed-method approach. In phase I, we developed an impact programme logic model to map the pathway to impact and establish key domains of benefit such as knowledge advancement, capacity building, clinical implementation, policy and legislation, community and economic impacts. In phase 2, we have identified and selected appropriate, measurable and timely impact indicators for each of these domains and established a data plan to capture the necessary data. Phase 3 will develop a model for cost-consequence analysis and identification of relevant data for microcosting and valuation of consequences. In phase 4, we will determine selected case studies to include in the narrative whereas phase 5 involves collation, data analysis and completion of the reporting of impact.We expect this impact evaluation to comprehensively describe the contribution of the CRE-DH for intentional activity over the CRE-DH lifespan and beyond to improve outcomes for people suffering with chronic and debilitating digestive disorders. ETHICS AND DISSEMINATION This impact evaluation study has been registered with the Hunter New England Human Research Ethics Committee as project 2024/PID00336 and ethics application 2024/ETH00290. Results of this study will be disseminated via medical conferences, peer-reviewed publications, policy submissions, direct communication with relevant stakeholders, media and social media channels such as X (formely Twitter).
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Affiliation(s)
- Natasha Koloski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- School of Health & Behavioural Sciences, University of Queensland, St Lucia, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Shanthi Ann Ramanathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Melanie Rao
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Nieva C, Pryor J, Williams GM, Hoedt EC, Burns GL, Eslick GD, Talley NJ, Duncanson K, Keely S. The Impact of Dietary Interventions on the Microbiota in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2023:jjad204. [PMID: 38102104 DOI: 10.1093/ecco-jcc/jjad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Diet plays an integral role in the modulation of the intestinal environment, with the potential to be modified for management of individuals with inflammatory bowel disease (IBD). It has been hypothesised that poor "Western-style" dietary patterns select for a microbiota that drives IBD inflammation and that through dietary intervention, a healthy microbiota may be restored. This study aimed to systematically review the literature and assess current available evidence regarding the influence of diet on the intestinal microbiota composition in IBD patients and how this may affect disease activity. METHODS MEDLINE, EMBASE, Scopus, Web of Science and Cochrane Library were searched from January 2013 to June 2023, to identify studies investigating diet and microbiota in IBD. RESULTS Thirteen primary studies met the inclusion criteria and were selected for narrative synthesis. Reported associations between diet and microbiota in IBD were conflicting due to the considerable degree of heterogeneity between studies. Nine intervention studies trialled specific diets and did not demonstrate significant shifts in the diversity and abundance of intestinal microbial communities or improvement in disease outcomes, whilst the remaining four cross-sectional studies did not find a specific microbial signature associated with habitual dietary patterns in IBD patients. CONCLUSIONS Diet modulates the gut microbiota, and this may have implications for IBD; however, the body of evidence does not currently support clear dietary patterns or food constituents that are associated with a specific microbiota profile or disease marker in IBD patients. Further research is required with a focus on robust and consistent methodology to achieve improved identification of associations.
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Affiliation(s)
- Cheenie Nieva
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jennifer Pryor
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Georgina M Williams
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Emily C Hoedt
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Grace L Burns
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Guy D Eslick
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kerith Duncanson
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Digestive Health, The University of Newcastle, Newcastle, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Schwartzkoff E, Burrows T, Bailey A, Sneddon E, Duncanson K. What are health professionals' perceptions of conducting routine growth assessments and lifestyle interventions? A qualitative study involving allied health professionals, nurses and doctors in rural and regional New South Wales. Aust J Prim Health 2023; 29:596-605. [PMID: 37380151 DOI: 10.1071/py22251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Allied health professionals, nurses and doctors within the New South Wales (NSW) public health system provide trusted health information to a large proportion of families across the state. This means they are well positioned to opportunistically assess and discuss child weight status with families. Prior to 2016, weight status was not routinely addressed in most NSW public health settings, however recent policy changes promote quarterly growth assessments for all children aged under 16years who attend these facilities. The Ministry of Health recommend health professionals use the 5 As framework, a consultation approach to encourage behaviour change, to identify and manage children with overweight or obesity. This study aimed to explore allied health professionals', nurses' and doctors' perceptions of conducting routine growth assessments and providing lifestyle support to families in a local health district in rural and regional NSW, Australia. METHODS This descriptive, qualitative study involved online focus groups and semi-structured interviews with health professionals. Audio recordings were transcribed and coded for thematic analysis, with rounds of data consolidation between research team members. RESULTS Allied health professionals, nurses and doctors who work in a variety of settings within a local health district of NSW participated in one of four focus groups (n =18 participants) or semi-structured interviews (n =4). The predominant themes related to: (1) health professionals' professional identity and their perceived scope of practice; (2) interpersonal qualities of health professionals; (3) the service delivery ecosystem in which health professionals worked. Diversity in attitudes and beliefs about routine growth assessments were not necessarily specific to discipline or setting. CONCLUSIONS Allied health professionals, nurses and doctors recognise the complexities involved in conducting routine growth assessments and providing lifestyle support to families. The 5 As framework used in NSW public health facilities to encourage behaviour change may not allow clinicians to address these complexities in a patient centred way. The findings of this research will be used to inform future strategies aimed at embedding preventive health discussions into routine clinical practice, and to support health professionals to identify and manage children with overweight or obesity.
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Affiliation(s)
- Emma Schwartzkoff
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; and School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tracy Burrows
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Bailey
- Research and Knowledge Translation, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Eloise Sneddon
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Kerith Duncanson
- Heath Education and Training Institute (NSW Health), St Leonards, NSW 2067, Australia; and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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Burns GL, Potter M, Mathe A, Bruce J, Minahan K, Barnes JL, Pryor J, Nieva C, Sherwin S, Cuskelly A, Fairlie T, Cameron R, Bollipo S, Irani MZ, Foster R, Gan LT, Shah A, Koloski N, Foster PS, Horvat JC, Walker MM, Powell N, Veysey M, Duncanson K, Holtmann G, Talley NJ, Keely S. TRAV26-2 T-Cell Receptor Expression Is Associated With Mucosal Lymphocyte Response to Wheat Proteins in Patients With Functional Dyspepsia. Clin Transl Gastroenterol 2023; 14:e00638. [PMID: 37753952 PMCID: PMC10749711 DOI: 10.14309/ctg.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION An association between functional dyspepsia (FD) and wheat-containing foods has been reported in observational studies; however, an adaptive response has not been demonstrated. We examined whether antigens present in wheat could provoke a response from FD duodenal lymphocytes. METHODS Lamina propria mononuclear cells (LPMCs) were isolated from duodenal biopsies from 50 patients with FD and 23 controls. LPMCs were exposed to gluten (0.2 mg/mL) or gliadin (0.2 mg/mL) for 24 hours. Flow cytometry was performed to phenotype lymphocytes. Quantitative PCR was used to measure the expression of gliadin-associated T-cell receptor alpha variant ( TRAV ) 26-2. RESULTS In response to gliadin (but not gluten) stimulation, the effector Th2-like population was increased in FD LPMCs compared with that in controls and unstimulated FD LPMCs. Duodenal gene expression of TRAV26- 2 was decreased in patients with FD compared with that in controls. We identified a positive association between gene expression of this T-cell receptor variant and LPMC effector Th17-like cell populations in patients with FD, but not controls after exposure to gluten, but not gliadin. DISCUSSION Our findings suggest that gliadin exposure provokes a duodenal effector Th2-like response in patients with FD, supporting the notion that food antigens drive responses in some patients. Furthermore, these findings suggest that altered lymphocyte responses to wheat proteins play a role in FD pathogenesis.
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Affiliation(s)
- Grace L. Burns
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michael Potter
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
| | - Andrea Mathe
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jessica Bruce
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kyra Minahan
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jessica L. Barnes
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jennifer Pryor
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Cheenie Nieva
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Simonne Sherwin
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Annalisa Cuskelly
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, Australia
| | - Thomas Fairlie
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia.
| | - Raquel Cameron
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Steven Bollipo
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
| | - Mudar Zand Irani
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
| | - Robert Foster
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
| | - Lay T. Gan
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
| | - Ayesha Shah
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia.
| | - Natasha Koloski
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia.
| | - Paul S. Foster
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jay C. Horvat
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Marjorie M. Walker
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Nick Powell
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Martin Veysey
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Hull-York Medical School, University of Hull, Hull, United Kingdom
| | - Kerith Duncanson
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Gerald Holtmann
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia.
| | - Nicholas J. Talley
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine & Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Simon Keely
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Talley NJ, Burns GL, Hoedt EC, Duncanson K, Keely S. Beyond Eosinophilic Esophagitis: Eosinophils in Gastrointestinal Disease-New Insights, "New" Diseases. J Can Assoc Gastroenterol 2023; 6:199-211. [PMID: 38106480 PMCID: PMC10723938 DOI: 10.1093/jcag/gwad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Functional dyspepsia (FD) is a highly prevalent disorder. Upper endoscopy is normal, and according to the Rome IV criteria, there is no established pathology. Data accumulated over the last 15 years has challenged the notion FD is free of relevant pathology, and in particular, increased duodenal eosinophils have been observed. Intestinal eosinophils play important roles in microbial defence, immune regulation, tissue regeneration and remodelling, and maintaining tissue homeostasis and metabolism; degranulation of eosinophils releases toxic granule products (e.g., major basic protein, eosinophil-derived neurotoxin) which can damage nerves. Normal cut-offs for eosinophil infiltration into the duodenum histologically are less than five eosinophils per high power field (<25 per five high power fields). In clinical practice there is evidence that pathologically increased intestinal eosinophils may often be overlooked. In a meta-analysis duodenal eosinophils were significantly increased in FD although there was substantial heterogeneity; degranulation of duodenal eosinophils was also significantly higher in FD without significant heterogeneity. In addition, increased duodenal permeability, systemic immune activation, and an altered mucosa-associated duodenal microbiome have been identified that may help explain why symptoms arise, often occur after food with exposure to food antigens, and typically fluctuate. Several potentially reversible risk factors for FD have now been identified. We evaluate the current evidence linking duodenal microinflammation and immune activation with FD and disorders of gut-brain interactions that overlap with FD. We propose a two-hit disease model for eosinophilic functional dyspepsia (EoFD) with management implications.
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Affiliation(s)
- Nicholas J Talley
- University of Newcastle, University Drive, Callaghan NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, Locked Bag 1000, New Lambton NSW 2305, Australia
| | - Grace L Burns
- University of Newcastle, University Drive, Callaghan NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, Locked Bag 1000, New Lambton NSW 2305, Australia
| | - Emily C Hoedt
- University of Newcastle, University Drive, Callaghan NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, Locked Bag 1000, New Lambton NSW 2305, Australia
| | - Kerith Duncanson
- University of Newcastle, University Drive, Callaghan NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, Locked Bag 1000, New Lambton NSW 2305, Australia
| | - Simon Keely
- University of Newcastle, University Drive, Callaghan NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, Locked Bag 1000, New Lambton NSW 2305, Australia
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Collins RA, Duncanson K, Skinner JA, Hay PJ, Paxton SJ, Burrows TL. Exploring Psychological Constructs in People Receiving Treatment for Addictive Eating Behaviours: "I Hate Loving Food as Much as I Do". Behav Sci (Basel) 2023; 13:817. [PMID: 37887467 PMCID: PMC10604454 DOI: 10.3390/bs13100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Research into the complexities of addictive eating behaviours continues to develop, as a deeper understanding of this construct beyond self-report diagnostic tools emerges. In this study, we undertook structured interviews with 40 participants engaged in a personality-based management program for addictive eating, to gain insight into what situations lead people with addictive eating behaviours to overeat, and how they believe their lives would be different if they had control over their eating. A phenomenological analysis to explore compulsion and control in the context of food experiences for participants was used to construct two main themes of the addictive eating paradox and striving to transition from 'other' to 'normal'. The addictive eating paradox identified multiple contradictory experiences of a situation, e.g., 'loving food' but 'hating food'. Striving to transition from 'other' to 'normal' encompassed the idea that participants envisaged that by gaining control over their eating they could become 'normal'. This study emphasises the need to provide support and strategies to help people navigate paradoxical thoughts and presents new ideas to increase the effectiveness of interventions for individuals struggling with the complex self-beliefs held by those with addictive eating behaviours.
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Affiliation(s)
- Rebecca A. Collins
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.S.); (T.L.B.)
- Food & Nutrition Program, New Lambton, NSW 2305, Australia;
| | - Kerith Duncanson
- Food & Nutrition Program, New Lambton, NSW 2305, Australia;
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Janelle A. Skinner
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.S.); (T.L.B.)
- Food & Nutrition Program, New Lambton, NSW 2305, Australia;
| | - Phillipa J. Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
- Campbelltown Hospital, South West Sydney Local Health District, Sydney, NSW 2560, Australia
| | - Susan J. Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Tracy L. Burrows
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.S.); (T.L.B.)
- Food & Nutrition Program, New Lambton, NSW 2305, Australia;
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9
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Temperley IA, Seldon AN, Reckord MA, Yarad CA, Islam FT, Duncanson K, Lea RA, Lechner-Scott J, Maltby VE. Dairy and gluten in disease activity in multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231218107. [PMID: 38130338 PMCID: PMC10734333 DOI: 10.1177/20552173231218107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Background Many diets promoted specifically for multiple sclerosis have been suggested to improve disease activity. Dairy and gluten are two components for which the recommendations vary between these diets. Existing research into the association between these dietary components and disease activity has been conflicting. Objective To explore the relationship between dairy and gluten intake and disease activity in multiple sclerosis over a 2-year period, using no evidence of disease activity (NEDA) 3 status. Methods 186 participants' dairy and gluten intake was retrospectively estimated over 2 years using a dairy and gluten dietary screener. Estimated dairy and gluten intake was compared to disease activity, indicated by no evidence of disease activity 3 status, and quality of life, assessed by the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire. Results No significant association was found between mean estimated dairy or gluten intake and NEDA 3 status (p = 0.15 and 0.60, respectively). Furthermore, there was no significant relationship between dairy or gluten intake and MusiQoL) scores (p = 0.11 and 0.51, respectively). Conclusion Whilst we cannot rule out modest benefits due to our small sample size, we found that neither dairy nor gluten intake was associated with disease activity or quality of life in this study.
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Affiliation(s)
- Isabel A Temperley
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alexandra N Seldon
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Madeline Aw Reckord
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Claudia A Yarad
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Farihah T Islam
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive Health, University of Newcastle, Callaghan, NSW, Australia
| | - Rodney A Lea
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Vicki E Maltby
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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10
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McMullen B, Duncanson K, Schmidt D, Collins C, MacDonald-Wicks L. A critical realist exploration of factors influencing engagement in diabetes prevention programs in rural settings. Aust J Prim Health 2023; 29:510-519. [PMID: 37121604 DOI: 10.1071/py22256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Diabetes prevention programs are intended to reduce progression to type 2 diabetes, but are underutilised. This study aimed to explore people with prediabetes' knowledge and attitudes about prediabetes, and their perceptions about engagement in preventive programs in a rural setting. The findings will inform strategies and recommendations to increase preventive health program engagement. METHODS Using a qualitative approach with a critical realist methodology, semi-structured interviews were conducted with 20 rural participants with prediabetes from the Northern New South Wales Local Health District in 2021. Interviews were audio-recorded, transcribed verbatim and thematically analysed. The social-ecological model was used as a framework to interpret and action the study findings. RESULTS Factors that empowered participants and facilitated a desire to engage in preventive programs included knowledge about prediabetes, a high level of social support, trusting and supportive relationships with health professionals, and a strong desire not to progress to diabetes. Barriers to program engagement included low health literacy levels, limited support, negative experiences with health services, and social and physical constraints. The factors that influenced engagement with preventive health programs were mapped to an individual, interpersonal, organisational, community and policy level, which highlighted the complex nature of behaviour change and the influence of underlying mechanisms. CONCLUSIONS Engagement in diabetes prevention programs was dependent on individual agency factors and structural barriers, each of which related to a level of the social-ecological model. Understanding the perceptions of people with prediabetes will inform strategies to overcome multi-level barriers to preventive health program engagement in rural settings.
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Affiliation(s)
- Britney McMullen
- Northern New South Wales Local Health District, Lismore, NSW 2480, Australia; and School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kerith Duncanson
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Health Education and Training Institute, NSW Health, St Leonards, NSW 2065, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - David Schmidt
- Health Education and Training Institute, NSW Health, St Leonards, NSW 2065, Australia
| | - Clare Collins
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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11
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Cameron R, Duncanson K, Hoedt EC, Eslick GD, Burns GL, Nieva C, Keely S, Walker MM, Talley NJ. Does the microbiome play a role in the pathogenesis of colonic diverticular disease? A systematic review. J Gastroenterol Hepatol 2023; 38:1028-1039. [PMID: 36775316 PMCID: PMC10946483 DOI: 10.1111/jgh.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIMS The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology. METHODS Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies. RESULTS Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome. CONCLUSION Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.
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Affiliation(s)
- Raquel Cameron
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Emily C Hoedt
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Grace L Burns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Cheenie Nieva
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Marjorie M Walker
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
| | - Nicholas J Talley
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleNSWAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleAustralia
- Immune Health Research ProgramHunter Medical Research InstituteNewcastleAustralia
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12
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Duncanson K, Tikhe D, Williams GM, Talley NJ. Irritable bowel syndrome - controversies in diagnosis and management. Expert Rev Gastroenterol Hepatol 2023; 17:649-663. [PMID: 37317843 DOI: 10.1080/17474124.2023.2223975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The irritable bowel syndrome (IBS) is the best-recognized disorder of gut brain interactions (DGBI). However, it is controversial if the Rome IV criteria iteration for IBS diagnosis is fit for purpose. AREAS COVERED This review critically evaluates Rome IV criteria for diagnosis of IBS and addresses clinical considerations in IBS treatment and management, including dietary factors, biomarkers, disease mimics, symptom severity, and subtypes. The role of diet in IBS is critically reviewed along with the influence of the microbiota, including small intestinal bacterial overgrowth. EXPERT OPINION Emerging data suggest the Rome IV criteria are more suitable for identifying severe IBS and least useful for sub-diagnostic patients who are still likely to benefit from IBS treatment. Despite convincing evidence that IBS symptoms are diet-driven and often postprandial, a relationship to eating is not a Rome IV diagnostic criterion. Few IBS biomarkers have been identified, suggesting the syndrome is too heterogeneous to be measured by a single marker, and combined biomarker, clinical, dietary, and microbial profiling may be needed for objective characterization. With many organic diseases mimicking and overlapping with IBS, it's important clinicians are knowledgable about this to mitigate the risk of missing comorbid organic intestinal disease and to optimally treat IBS symptoms.
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Affiliation(s)
- Kerith Duncanson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Dhanashree Tikhe
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
| | - Georgina M Williams
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
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13
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Hassapidou M, Duncanson K, Shrewsbury V, Ells L, Mulrooney H, Androutsos O, Vlassopoulos A, Rito A, Farpourt N, Brown T, Douglas P, Ramos Sallas X, Woodward E, Collins C. EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents. Obes Facts 2023; 16:29-52. [PMID: 36349767 PMCID: PMC9890183 DOI: 10.1159/000527540] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). METHODS It is based on the best evidence available from systematic reviews of randomized controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature. RESULTS Multicomponent behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy-dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialized dietetic-related skills and co-designed with families, are associated with greater treatment effects. DISCUSSION Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.
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Affiliation(s)
- Maria Hassapidou
- Department of Nutritional Sciences & Dietetics, International Hellenic University, Thessaloniki, Greece
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
| | - Kerith Duncanson
- School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Hilda Mulrooney
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Life Sciences, Pharmacy and Chemistry, SEC Faculty, Kingston University London, Kingston upon Thames, UK
| | - Odysseas Androutsos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Nutrition-Dietetics, University of Thessaly, Trikala, Greece
| | - Antonis Vlassopoulos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- *Maria Hassapidou,
| | - Ana Rito
- National Institute of Health Ricardo Jorge I.P., Lisbon, Portugal
| | - Nathalie Farpourt
- Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology and Therapeutic Education, Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Tamara Brown
- Applied Obesity Research Centre in the School of Health, Leeds Beckett University, Leeds, UK
| | - Pauline Douglas
- Nutrition Innovation Center for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, UK
| | | | - Euan Woodward
- European Association for the Study of Obesity, Teddington, UK
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
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14
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Schmidt D, Duncanson K, Webster E, Saurman E, Lyle D. Critical realist exploration of long-term outcomes, impacts and skill development from an Australian Rural Research Capacity Building Programme: a qualitative study. BMJ Open 2022; 12:e065972. [PMID: 36600329 PMCID: PMC9743409 DOI: 10.1136/bmjopen-2022-065972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Research capacity building programmes usually only examine short-term outcomes, following up participants after 1 or 2 years. Capacity building in health research requires a long-term view to understand the influence and impact of capacity building endeavours. This study examined long-term outcomes for individuals regarding the maintenance and use of research skills and the conduct of real-world research in a rural area. We also explored the changes individuals had seen in their career, work team or organisation as a result of this training. DESIGN A qualitative study underpinned by critical realism and based on interviews and focus groups with graduates of the Rural Research Capacity Building Programme (RRCBP), a researcher development programme that has been delivered since 2006. SETTING Rural and remote areas of New South Wales, Australia. PARTICIPANTS 22 graduates of the RRCBP from the 2006 to 2015 cohorts (20 female, 2 male). All were experienced rural-based health workers at the time of training. RESULTS Focus groups and interviews yielded three themes about capacity building outcomes: (1) developed research capable individuals; (2) embedded research capability into teams and (3) real-world research that makes a difference within an organisation. CONCLUSIONS Research training improved graduates' skill, experience, confidence and employability. Research capable individuals enabled others, enhancing team research capacity and raising the profile of research within their organisation.Training in research, alongside tangible organisational support for research activity, creates real-world impacts for policy and clinical practice. Providing ongoing opportunities for researchers to undertake research would enhance return on investment and assist with retention of experienced staff.
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Affiliation(s)
- David Schmidt
- Rural and Remote Portfolio, NSW Health Education and Training Institute, Gladesville, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerith Duncanson
- Rural and Remote Portfolio, NSW Health Education and Training Institute, Gladesville, New South Wales, Australia
| | - Emma Webster
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Emily Saurman
- Department of Rural Health, The University of Sydney, Broken Hill, New South Wales, Australia
| | - David Lyle
- Department of Rural Health, The University of Sydney, Broken Hill, New South Wales, Australia
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15
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Urquhart L, Roberts (Dunghutti) K, Gibbs (Muruwari) C, Fisher K, Brown LJ, Duncanson K. Experiences of co-designing research about a rural Aboriginal well-being program: Informing practice and policy. Aust J Rural Health 2022; 30:747-759. [PMID: 36250967 PMCID: PMC10092418 DOI: 10.1111/ajr.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore data and Aboriginal and non-Aboriginal researchers' experiences and reflexivity in co-designing research about a rural Aboriginal well-being program to inform practice and policy. SETTING Gumbaynggirr, Birpai, Kamilaroi and Awabakal countries located in regional and rural New South Wales, Australia. PARTICIPANTS Rural and regionally located research team who co-designed processes to challenge the status quo about a critically framed, rural-based Aboriginal well-being research project. DESIGN Researchers drew on data from a research project in an interpretive cycle of collaborative Yarning. Data included 90 published articles, 12 Yarning transcripts and 26 reflective journal text sets, as well as researcher experiences and reflexivity. RESULTS The Duguula Gayirray (Yarning together), Yandaarray (walking together) and Duguula Nguraljili (sharing together) co-design practice model was developed to represent key actions in the context of an Aboriginal well-being program in a rural context. Actions were supported by seven interpersonal ways of being and were underpinned by respectful relationships between community and researchers. DISCUSSION Duguula Gayirray, Yandaarray and Duguula Nguraljili are critical to co-design practice and are grounded in respectful relationships. Our experiences led us to critique our perceptions of power sharing, equitable partnerships and collaborative knowledges towards opportunity for collective research co-design. CONCLUSION Duguula Gayirray, Yandaarray and Duguula Nguraljili transformed our understanding of achieving liberation from dominant western research in the context of a rurally located Australian Aboriginal well-being program. This study contributes to progression of Aboriginal health research practice and policy recommendations, enabling real cultural change in health care with rurally located Aboriginal communities.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleCoffs HarbourNew South WalesAustralia
| | | | | | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
| | - Leanne J. Brown
- Department of Rural Health, College of Health, Medicine and WellbeingThe University of NewcastleTamworthNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Kerith Duncanson
- Centre of Research Excellence in Digestive HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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16
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Sukovic S, Eisner J, Duncanson K. Observing, spanning and shifting boundaries: working with data in non-clinical practice. GKMC 2022. [DOI: 10.1108/gkmc-02-2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose
Effective use of data across public health organisations (PHOs) is essential for the provision of health services. While health technology and data use in clinical practice have been investigated, interactions with data in non-clinical practice have been largely neglected. The purpose of this paper is to consider what constitutes data, and how people in non-clinical roles in a PHO interact with data in their practice.
Design/methodology/approach
This mixed methods study involved a qualitative exploration of how employees of a large PHO interact with data in their non-clinical work roles. A quantitative survey was administered to complement insights gained through qualitative investigation.
Findings
Organisational boundaries emerged as a defining issue in interactions with data. The results explain how data work happens through observing, spanning and shifting of boundaries. The paper identifies five key issues that shape data work in relation to boundaries. Boundary objects and processes are considered, as well as the roles of boundary spanners and shifters.
Research limitations/implications
The study was conducted in a large Australian PHO, which is not completely representative of the unique contexts of similar organisations. The study has implications for research in information and organisational studies, opening fields of inquiry for further investigation.
Practical implications
Effective systems-wide data use can improve health service efficiencies and outcomes. There are also implications for the provision of services by other health and public sectors.
Originality/value
The study contributes to closing a significant research gap in understanding interactions with data in the workplace, particularly in non-clinical roles in health. Research analysis connects concepts of knowledge boundaries, boundary spanning and boundary objects with insights into information behaviours in the health workplace. Boundary processes emerge as an important concept to understand interactions with data. The result is a novel typology of interactions with data in relation to organisational boundaries.
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Fisher E, Luscombe G, Schmidt D, Brown L, Duncanson K. Using an interactive nutrition technology platform to predict malnutrition risk. J Hum Nutr Diet 2022; 36:912-919. [PMID: 36083834 DOI: 10.1111/jhn.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
AIMS The Nutrition Dashboard is an interactive nutrition technology platform that displays food provision and intake data used to categorise the nutrition risk of hospitalised individuals. This study aimed to investigate the Nutrition Dashboard's ability to identify malnutrition compared to a validated malnutrition screening tool. METHODS A retrospective observational study at a 99-bed hospital was conducted using medical record and food intake data presented via the Nutrition Dashboard. Inter-Rater Reliability of food intake estimation between hospital catering staff and a dietitian reported good agreement across 912 food items (κ = 0.69, 95% CI 0.65-0.72, p < 0.001). Default nutritional adequacy thresholds of 4500kJ and 50g protein were applied for Nutrition Dashboard categorisation of supply and intake. Generalised estimating equation regression models explored the association between the Nutrition Dashboard risk categories and the Malnutrition Screening Tool, with and without controlling for patient demographic characteristics. RESULTS Analyses from 216 individuals (1783 hospital-stay days) found those in the highest risk Nutrition Dashboard Category were 1.93 times more likely to have a Malnutrition Screening Tool score indicating risk compared to the lowest Nutrition Dashboard Category (unadjusted odds ratio 1.93, 95% CI, 1.17-3.19, p<0.01). When patient weight was added to the model, lower weight became the only significant predictor of MST≥2 (p<0.01) CONCLUSIONS: This study indicates a role for nutrition intake technology in malnutrition screening. Further adaptions that address the complexities of applying this technology could improve the use of the Nutrition Dashboard to support identification of malnutrition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erin Fisher
- Armidale Rural Referral Hospital, Hunter New England Local Health District and University of Newcastle Department of Rural Health
| | - Georgina Luscombe
- University of Sydney School of Rural Health, 1502 Forest Road PO Box 1191, Orange, NSW, Australia, 2800
| | - David Schmidt
- NSW Health Education Training Institute, 1 Reserve Road, St Leonards, NSW, Australia, 2065
| | - Leanne Brown
- University of Newcastle, Department of Rural Health and Hunter Medical Research Institiute Tamworth Education Centre, 114 - 148 Johnston Street, Tamworth, NSW, Australia, 2340
| | - Kerith Duncanson
- NSW Health Education Training Institute and University of Newcastle, 1 Reserve Road, St Leonards, NSW, Australia, 2065
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18
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Henström M, Duncanson K, Collins CE, Ashton LM, Davidson E, Ball R. Online reach and engagement of a child nutrition peer-education program (PICNIC): insights from social media and web analytics. BMC Public Health 2022; 22:836. [PMID: 35473610 PMCID: PMC9041288 DOI: 10.1186/s12889-022-13252-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents frequently seek parental advice online and on social media; thus, these channels should be better utilized in child health interventions. The Parents in Child Nutrition Informing Community (PICNIC) program aims to facilitate peer-to-peer sharing of evidence-based child feeding information and support parents within their social networks. The present study aimed to explore web and social media analytics to evaluate reach and user engagement with the PICNIC online components. METHODS Online user activity data from the PICNIC Facebook closed group and public Page were collected through Facebook Insights, and program-specific website traffic data through Google Analytics. Analytics data from Nov-2019 to April-2021 was evaluated through visualisation and summary statistics to obtain insights into program growth and current reach in Australia, compare demographics of audience reached through the online channels, and explore parents' use and engagement in PICNIC content. RESULTS Results showed steady program growth in the 18 months of recruitment; participant numbers grew from 102 to 261 peer educators while the Facebook Page audience increased threefold, totalling 1615 followers. Intervention posts shared on Facebook (4-5 posts/week) typically reached only a portion of PICNIC Page followers each week, but also reached a wider audience through their friends. Throughout the evaluated period, Facebook users actively engaged in PICNIC posts, although the level of engagement varied considerably from post to post. Furthermore, results from this study suggest the strategy of directing potentially interested parents from social media to the website for program sign-up was successful. Finally, the explored data gave insights into users' availability, demographics and engagement, which will be used to inform refinement of the PICNIC website and social media strategies. CONCLUSIONS Our findings confirm the benefits of using a peer education approach and existing social network channels to disseminate evidence-based child feeding information to parents. This study also demonstrates the usefulness of web and social media analytics to be used as part of a continuous evaluation for gaining insight to inform further development and improvement of program strategies. TRIAL REGISTRATION The PICNIC project was retrospectively submitted for registration with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12622000230752 (09/02/2022).
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Affiliation(s)
- Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, 141 83, Huddinge, Sweden. .,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Lee M Ashton
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Emma Davidson
- Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Richard Ball
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Mid North Coast Local Health District, Port Macquarie, NSW, 2444, Australia
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19
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Asher RC, Jakstas T, Lavelle F, Wolfson JA, Rose A, Bucher T, Dean M, Duncanson K, van der Horst K, Schonberg S, Slater J, Compton L, Giglia R, Fordyce-Voorham S, Collins CE, Shrewsbury VA. Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health. Nutrients 2022; 14:nu14091778. [PMID: 35565746 PMCID: PMC9103694 DOI: 10.3390/nu14091778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Culinary education programs are generally designed to improve participants’ food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills’ content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-EdTM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-EdTM matrix structure, skill focus points included, and their order. The final Cook-EdTM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-EdTM matrix to regional food-based dietary guidelines and food cultures.
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Affiliation(s)
- Roberta C. Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (A.R.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
| | - Tammie Jakstas
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (A.R.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
| | - Fiona Lavelle
- School of Biological Sciences, Institute for Global Food Security, Queen’s University Belfast, Belfast BT9 5DL, UK; (F.L.); (M.D.)
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anna Rose
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (A.R.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
| | - Tamara Bucher
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
- School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Moira Dean
- School of Biological Sciences, Institute for Global Food Security, Queen’s University Belfast, Belfast BT9 5DL, UK; (F.L.); (M.D.)
| | - Kerith Duncanson
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Klazine van der Horst
- School of Health Professions, Bern University of Applied Sciences, 3012 Bern, Switzerland; (K.v.d.H.); (S.S.)
| | - Sonja Schonberg
- School of Health Professions, Bern University of Applied Sciences, 3012 Bern, Switzerland; (K.v.d.H.); (S.S.)
| | - Joyce Slater
- Department of Food and Human Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Leanne Compton
- Victorian Curriculum and Assessment Authority, Melbourne, VIC 3000, Australia;
| | - Roslyn Giglia
- Foodbank Western Australia, Perth, WA 6105, Australia;
| | | | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (A.R.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
| | - Vanessa A. Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (A.R.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (T.B.); (K.D.)
- Correspondence: ; Tel.: +61-4921-7860
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20
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Windus JL, Duncanson K, Burrows TL, Collins CE, Rollo ME. Review of dietary assessment studies conducted among Khmer populations living in Cambodia. J Hum Nutr Diet 2022; 35:901-918. [PMID: 35377499 PMCID: PMC9545030 DOI: 10.1111/jhn.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Background Despite economic growth, Cambodia continues to have high rates of malnutrition, anaemia and nutrition‐related deficiencies. Government policies promote nutrition strategies, although dietary intake data is limited. A detailed synthesis of existing intake data is needed to inform nutrition policy and practice change. This review aims to characterise and assess quality of dietary assessment methods and outcomes from individual‐level ‘whole diet’ studies of Khmer people living in Cambodia. Methods Searches were conducted using PRISMA‐ScR guidelines. Included papers reported dietary intake at an individual level for ‘whole diet’. Studies using secondary data or lacking dietary assessment details were excluded. Extracted data included dietary assessment features, nutrient/food group intakes and database. Results Nineteen publications (15 studies) were included, with nine carried out among children under 5 years and six among women. Eleven studies reported intake by food groups and four by nutrients, prominently energy, protein, vitamin A, iron, calcium and zinc. Inconsistent intakes, food groupings and reporting of study characteristics limited data synthesis. All but one study used 24‐h recalls. Trained local fieldworkers used traditional interview‐administered data collection and varied portion estimation tools. Food composition databases for analysis were not tailored to the Cambodian diet. Overall quality was rated as ‘good’. Conclusions We recommend the development of a best‐practice protocol for conducting dietary assessment, a Cambodia‐specific food composition database and a competent trained workforce of nutrition professionals, with global support of expertise and funding for future dietary assessment studies conducted in Cambodia. Fifteen studies with highly variable intake data included in the review. The food composition databases used were not specific to Cambodian diet. Minimum reporting standards and best practice protocols recommended, including in‐country nutrition training. Lack of whole population dietary intake data indicates the need for a national survey.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
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21
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Burgess A, Hawkins J, Kostovski C, Duncanson K. Assessing cultural appropriateness of patient-reported outcome measures for Aboriginal people with diabetes: study protocol. Public Health Res Pract 2022; 32:31122105. [PMID: 35291000 DOI: 10.17061/phrp31122105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide patients with a platform to report on healthcare services and interventions, including the management of diabetes and other chronic diseases. Given the major disparity in incidence and prevalence of diabetes between Aboriginal and non-Aboriginal people, it is crucial that PROMs meet the cultural, spiritual and medical needs of this high-risk population. Anecdotal evidence indicates that PROMs do not capture accurate information about the healthcare of Aboriginal people with Type 2 diabetes. Therefore, the aim of this study is to explore the perceptions of Aboriginal people in regional New South Wales (NSW), Australia, about the cultural appropriateness of a set of PROMs relating to diabetes management. METHODS/DESIGN Up to 50 Aboriginal people aged 18 years or older with type 1 or type 2 diabetes living in the Shoalhaven region in NSW, will be recruited. Eligible, consenting participants will attend a focus group or individual interview where they will review the PROM tools (PROMIS 29 and PAID scale) currently used for diabetes management. Semi-structured questions will be used to gather information about PROMs and discussions will be recorded for analysis. Research team members will yarn about the data with Aboriginal co-researchers and community stakeholders to apply an Indigenous lens to coding and thematic analysis. CONCLUSION This study will explore the cultural appropriateness of government-initiated evaluation of health outcomes, and make recommendations about how these evaluations can be better suited to Aboriginal people. The lessons from this study will be of interest to those conducting research or quality assessment activities related to PROMs, and those involved with Aboriginal-focused research and project implementation.
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Affiliation(s)
- Alicia Burgess
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; High Risk Foot Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; Rural Research Capacity Building Program, Health Education and Training Institute, Sydney, Australia;
| | - Jessica Hawkins
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; High Risk Foot Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Catherine Kostovski
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; Aboriginal Chronic Care Unit, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Kerith Duncanson
- Rural and Remote Portfolio, Health Education and Training Institute, Sydney, Australia
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22
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Prasad SS, Walker MM, Talley NJ, Keely S, Kairuz T, Jones MP, Duncanson K. Healthcare Needs and Perceptions of People Living With Inflammatory Bowel Disease in Australia: A Mixed-Methods Study. Crohns Colitis 360 2022; 4:otab084. [PMID: 36777548 PMCID: PMC9802190 DOI: 10.1093/crocol/otab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis are inflammatory bowel diseases (IBDs) that adversely affect the healthcare needs and quality of life (QoL) of people with IBD. The aim of this study was to explore the needs and perceptions of people with IBD in a primary care setting. Methods This sequential explanatory mixed-methods study consisted of a cross-sectional survey (included validated tools), followed by semistructured interviews on participants' perceptions: IBD management, healthcare professionals, IBD care, flare management, and pharmacist's IBD roles. Results Sixty-seven participants completed the survey, and 8 completed interviews. Quantitative findings: Age at diagnosis had significant association with medication nonadherence (P = .04), QoL (P = .04), and disease control (P = .01) among the respondents. The odds of medication nonadherence were 8 times (adjusted odds ratio [AOR] = 8.04, 95% confidence interval [CI] = 1.08, 60.10) higher among younger participants aged <30 years. Those diagnosed with CD (P = .02) reported more likely to have unfavorable perceptions of pharmacists' role in managing their IBD (AOR = 9.45, 95% CI = 1.57, 56.62) than those with UC and indeterminate colitis. Qualitative findings: General practitioners were considered the most important care provider and the first point of contact for patients in managing all aspects of IBD. Participants identified their key need to be timely access to specialized IBD care and found that other primary healthcare professionals lacked disease-specific knowledge for managing IBD. Conclusions Primary healthcare professionals are well positioned but need targeted training to influence the needs of IBD patients. The specialty role of an IBD educator could complement existing services to deliver and address patient-specific care.
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Affiliation(s)
- Sharmila S Prasad
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia,NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,Address correspondence to: Sharmila S. Prasad, MPharm, Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia ()
| | - Marjorie M Walker
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Nicholas J Talley
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia,NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Therése Kairuz
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia
| | - Kerith Duncanson
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
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23
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Burgess A, Hawkins J, Kostovski C, Kennedy M, Penkala S, Duncanson K. Aboriginal people’s perceptions of patient-reported outcome measures in the assessment of diabetes health-related quality of life†. Aust J Prim Health 2022; 29:165-174. [PMID: 37079465 DOI: 10.1071/py22150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide clinicians and consumers a platform to inform and improve healthcare planning and management. Aboriginal people experience disproportionately high rates of chronic diseases, including type 2 diabetes. Treatment and management require holistic approaches that draw on culturally relevant resources and assessment tools. This study explored perceptions of Aboriginal people about two diabetes management-related PROMs (PROMIS-29, PAID Scale). METHODS Twenty-nine Aboriginal people living with diabetes in the Shoalhaven discussed two PROMs in one of four focus groups or at an individual interview. Preliminary data coding was conducted by clinician researchers, with thematic analysis overseen by Aboriginal co-researchers. Subsequent individual interviews with participants were undertaken to seek further feedback and articulate what is needed to improve methods of evaluating Aboriginal people's self-reported quality of life and diabetes management. RESULTS The PROMs did not capture information or knowledge that Aboriginal people considered relevant to their diabetes-related health care. Participants' recommendations included adapting survey materials to be more culturally sensitive; for example, by improving the alignment of measures with common day-to-day activities. This study also describes a genuine collaborative, Aboriginal community-guided approach to evaluate 'fit-for-purpose' diabetes management tools. CONCLUSIONS Appropriate evaluation methods are paramount to address the disproportionate burden of diabetes experienced by Aboriginal peoples and overcome inverse diabetes care. Our learnings will contribute to development of tools, resources or methods that capture culturally tailored outcome measures. Study findings are relevant to clinicians and researchers using and/or developing Patient Reported Measures, particularly in relation to the practicality of tools for First Nations peoples.
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Affiliation(s)
- Alicia Burgess
- University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia; and Illawarra Shoalhaven Local Health District, High Risk Foot Service, Wollongong, NSW, Australia; and NSW Health Education and Training Institute, Rural Research Capacity Building Program, St Leonards, NSW, Australia
| | - Jessica Hawkins
- Illawarra Shoalhaven Local Health District, High Risk Foot Service, Wollongong, NSW, Australia; and NSW Health Education and Training Institute, Rural Research Capacity Building Program, St Leonards, NSW, Australia
| | - Catherine Kostovski
- Illawarra Shoalhaven Local Health District, Aboriginal Chronic Care Unit, Warrawong, NSW, Australia
| | - Michelle Kennedy
- University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia; and Hunter Medical Research Institute, Equity in Health and Wellbeing Research Program, Newcastle, NSW, Australia
| | - Stefania Penkala
- Western Sydney University, School of Health Sciences, Sydney, NSW, Australia; and Western Sydney University, Translational Health Research Institute, Sydney, NSW, Australia
| | - Kerith Duncanson
- NSW Health Education and Training Institute, Rural Research Capacity Building Program, St Leonards, NSW, Australia; and University of Newcastle, Centre of Research Excellence in Digestive Health, Callaghan, NSW, Australia; and Hunter Medical Research Institute, Immune Health Program, Newcastle, NSW, Australia
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24
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Ball R, Duncanson K, Ashton L, Bailey A, Burrows TL, Whiteford G, Henström M, Gerathy R, Walton A, Wehlow J, Collins CE. Engaging New Parents in the Development of a Peer Nutrition Education Model Using Participatory Action Research. Int J Environ Res Public Health 2021; 19:102. [PMID: 35010363 PMCID: PMC8750105 DOI: 10.3390/ijerph19010102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.
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Affiliation(s)
- Richard Ball
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
| | - Kerith Duncanson
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Health Education and Training Institute (HETI), 1 Reserve Road, St. Leonards, NSW 2065, Australia
| | - Lee Ashton
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Tracy L. Burrows
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
| | - Gail Whiteford
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
- School of Community Health, Charles Sturt University, Port Macquarie, NSW 2444, Australia
| | - Maria Henström
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Department of Biosciences and Nutrition, Karolinska Institutet, 14183 Huddinge, Sweden
| | - Rachel Gerathy
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Alison Walton
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Jennifer Wehlow
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
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Urquhart L, Fisher K, Duncanson K, Roberts K, Munro S, Gibbs C, Brown L. First Nation Peoples' nutrition and exercise group programmes: transforming success through the lifeworld. Int J Qual Stud Health Well-being 2021; 16:1990197. [PMID: 34749597 PMCID: PMC8583907 DOI: 10.1080/17482631.2021.1990197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. METHODS In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. RESULTS Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. CONCLUSIONS Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making.
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Affiliation(s)
- Lisa Urquhart
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Coffs Harbour, New South Wales, Australia
| | - Karin Fisher
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Kerith Duncanson
- The Priority Research Centre for Digestive Health and Neurogastroenterology, Callaghan, New South Wales, Australia
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Roberts
- Galambila Aboriginal Health Service, Coffs Harbour, New South Wales, Australia
| | - Simon Munro
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Clinton Gibbs
- Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Leanne Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Tamworth, New South Wales, Australia
- The Priority Research Centre for Digestive Health and Neurogastroenterology, Callaghan, New South Wales, Australia
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Pryor J, Eslick GD, Talley NJ, Duncanson K, Keely S, Hoedt EC. Clinical medicine journals lag behind science journals with regards to "microbiota sequence" data availability. Clin Transl Med 2021; 11:e656. [PMID: 34870904 PMCID: PMC8647683 DOI: 10.1002/ctm2.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/10/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jennifer Pryor
- School of Biomedical Sciences and PharmacyCollege of HealthMedicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Guy D. Eslick
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Nicholas J. Talley
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Kerith Duncanson
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- School of Biomedical Sciences and PharmacyCollege of HealthMedicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Emily C. Hoedt
- NHMRC Centre for Research Excellence in Digestive HealthUniversity of NewcastleNewcastleAustralia
- School of Medicine and Public HealthCollege of HealthMedicine and WellbeingUniversity of NewcastleAustralia
- Hunter Medical Research InstituteNewcastleAustralia
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Garcia T, Duncanson K, Shrewsbury VA, Wolfson JA. A Qualitative Study of Motivators, Strategies, Barriers, and Learning Needs Related to Healthy Cooking during Pregnancy. Nutrients 2021; 13:nu13072395. [PMID: 34371903 PMCID: PMC8308614 DOI: 10.3390/nu13072395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023] Open
Abstract
Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage.
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Affiliation(s)
- Travertine Garcia
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
- Department of Human Nutrition, Foods & Exercise, Virginia Tech, Blacksburg, VA 24061, USA
| | - Kerith Duncanson
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan 2308, Australia; (K.D.); (V.A.S.)
| | - Vanessa A. Shrewsbury
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan 2308, Australia; (K.D.); (V.A.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +410-955-3781
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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Duncanson K, Burns G, Pryor J, Keely S, Talley NJ. Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia. Nutrients 2021; 13:1109. [PMID: 33800668 PMCID: PMC8066021 DOI: 10.3390/nu13041109] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of 'trigger' foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.
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Affiliation(s)
- Kerith Duncanson
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Grace Burns
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Pryor
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicholas J. Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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Grech A, Collins CE, Holmes A, Lal R, Duncanson K, Taylor R, Gordon A. Maternal exposures and the infant gut microbiome: a systematic review with meta-analysis. Gut Microbes 2021; 13:1-30. [PMID: 33978558 PMCID: PMC8276657 DOI: 10.1080/19490976.2021.1897210] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 02/04/2023] Open
Abstract
Early life, including the establishment of the intestinal microbiome, represents a critical window of growth and development. Postnatal factors affecting the microbiome, including mode of delivery, feeding type, and antibiotic exposure have been widely investigated, but questions remain regarding the influence of exposures in utero on infant gut microbiome assembly. This systematic review aimed to synthesize evidence on exposures before birth, which affect the early intestinal microbiome. Five databases were searched in August 2019 for studies exploring pre-pregnancy or pregnancy 'exposure' data in relation to the infant microbiome. Of 1,441 publications identified, 76 were included. Factors reported influencing microbiome composition and diversity included maternal antibiotic and probiotic uses, dietary intake, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), diabetes, mood, and others. Eleven studies contributed to three meta-analyses quantifying associations between maternal intrapartum antibiotic exposure (IAP), BMI and GWG, and infant microbiome alpha diversity (Shannon Index). IAP, maternal overweight/obesity and excessive GWG were all associated with reduced diversity. Most studies were observational, few included early recruitment or longitudinal follow-up, and the timing, frequency, and methodologies related to stool sampling and analysis were variable. Standardization and collaboration are imperative to enhance understanding in this complex and rapidly evolving area.
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Affiliation(s)
- Allison Grech
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Holmes
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- School of Life and Environmental Sciences, Faculty of Science, University of Sydney, Camperdown, NSW, Australia
| | - Ravin Lal
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Rachael Taylor
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Adrienne Gordon
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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31
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Duncanson K, Shrewsbury V, Burrows T, Chai LK, Ashton L, Taylor R, Gow M, Ho M, Ells L, Stewart L, Garnett S, Jensen ME, Nowicka P, Littlewood R, Demaio A, Coyle DH, Walker JL, Collins CE. Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: a systematic review with meta‐analysis. J Hum Nutr Diet 2020; 34:147-177. [DOI: 10.1111/jhn.12831] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Affiliation(s)
- K. Duncanson
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
| | - V. Shrewsbury
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
| | - T. Burrows
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
| | - L. K. Chai
- Health and Wellbeing Queensland Queensland Government Milton QLD Australia
- Centre for Children’s Health Research Institute of Health and Biomedical Innovation Exercise and Nutrition Queensland University of Technology South Brisbane QLD Australia
| | - L. Ashton
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
| | - R. Taylor
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
| | - M. Gow
- Institute of Endocrinology and Diabetes The Children’s Hospital at Westmead Westmead NSW Australia
- Children’s Hospital at Westmead Clinical School The University of Sydney Westmead NSW Australia
| | - M. Ho
- School of Nursing The University of Hong Kong Pokfulam Hong Kong
| | - L. Ells
- School of Clinical and Applied Sciences Leeds Beckett University Leeds UK
- Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence Middlesbrough UK
| | - L. Stewart
- Appletree Healthy Lifestyle Consultancy Perth UK
| | - S. Garnett
- Institute of Endocrinology and Diabetes The Children’s Hospital at Westmead Westmead NSW Australia
- Children’s Hospital at Westmead Clinical School The University of Sydney Westmead NSW Australia
| | - M. E. Jensen
- Priority Research Centre Grow Up Well and Faculty of Health and Medicine The University of Newcastle Callaghan NSW Australia
| | - P. Nowicka
- Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
| | - R. Littlewood
- Health and Wellbeing Queensland Queensland Government Milton QLD Australia
- School of Human Movement and Nutrition Sciences The University of Queensland St Lucia QLD Australia
| | - A. Demaio
- Victorian Health Promotion Foundation Carlton South VIC Australia
| | - D. H. Coyle
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - J. L. Walker
- School of Human Movement and Nutrition Sciences The University of Queensland St Lucia QLD Australia
| | - C. E. Collins
- School of Health Sciences Faculty of Health and Medicine Priority Research Centre for Physical Activity and Nutrition The University of Newcastle Callaghan NSW Australia
- The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence Callaghan NSW Australia
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Asher RC, Jakstas T, Wolfson JA, Rose AJ, Bucher T, Lavelle F, Dean M, Duncanson K, Innes B, Burrows T, Collins CE, Shrewsbury VA. Cook-Ed TM: A Model for Planning, Implementing and Evaluating Cooking Programs to Improve Diet and Health. Nutrients 2020; 12:nu12072011. [PMID: 32640756 PMCID: PMC7400850 DOI: 10.3390/nu12072011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022] Open
Abstract
Domestic cooking education programs are typically designed to improve an individual’s food and cooking skills, although not necessarily diet quality. Currently, there are no comprehensive models to guide the planning, implementation and evaluation of domestic cooking education programs that focus on improving diet and health. Our aim was to address this through development of the Cooking Education (“Cook-EdTM”) model, using the PRECEDE-PROCEED model as the underlying Cook-EdTM framework. A review of the food and cooking skills education literature informed the content of the Cook-EdTM model. Cook-EdTM was critiqued by experts in consumer behaviour, cooking and nutrition education research and education until consensus on model content and format was reached. Cook-EdTM leads cooking program developers through eight distinct stages, engaging key stakeholders in a co-design process from the outset to tailor programs to address the need of individuals and inform the development of program content, program delivery, and evaluation. A Cook-EdTM scenario applied in practice is described. The proposed Cook-EdTM model has potential to be adapted for use in domestic cooking education programs delivered in clinical, community, school or research settings. Further research will establish Cook-EdTM’s utility in enhancing program development and in improving food and cooking skills, dietary patterns and health outcomes.
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Affiliation(s)
- Roberta C. Asher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
| | - Tammie Jakstas
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
| | - Julia A. Wolfson
- Department of Health Management and Policy and Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Anna J. Rose
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Environmental and Life Science, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK;
| | - Moira Dean
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK;
| | - Kerith Duncanson
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
| | - Beth Innes
- Challenge Community Services, Wickham, NSW 2293, Australia;
| | - Tracy Burrows
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
| | - Vanessa A. Shrewsbury
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.C.A.); (T.J.); (T.B.); (K.D.); (T.B.); (C.E.C.)
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (A.J.R.); (M.D.)
- Correspondence: ; Tel.: +61-24921-7860
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Potter MDE, Duncanson K, Jones MP, Walker MM, Keely S, Talley NJ. Wheat Sensitivity and Functional Dyspepsia: A Pilot, Double-Blind, Randomized, Placebo-Controlled Dietary Crossover Trial with Novel Challenge Protocol. Nutrients 2020; 12:nu12071947. [PMID: 32629906 PMCID: PMC7400003 DOI: 10.3390/nu12071947] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction: Functional dyspepsia (FD), characterised by symptoms of epigastric pain or early satiety and post prandial distress, has been associated with duodenal eosinophilia, raising the possibility that it is driven by an environmental allergen. Non-coeliac gluten or wheat sensitivity (NCG/WS) has also been associated with both dyspeptic symptoms and duodenal eosinophilia, suggesting an overlap between these two conditions. The aim of this study was to evaluate the role of wheat (specifically gluten and fructans) in symptom reduction in participants with FD in a pilot randomized double-blind, placebo controlled, dietary crossover trial. Methods: Patients with Rome III criteria FD were recruited from a single tertiary centre in Newcastle, Australia. All were individually counselled on a diet low in both gluten and fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) by a clinical dietitian, which was followed for four weeks (elimination diet phase). Those who had a ≥30% response to the run-in diet, as measured by the Nepean Dyspepsia Index, were then re-challenged with ‘muesli’ bars containing either gluten, fructan, or placebo in randomised order. Those with symptoms which significantly reduced during the elimination diet, but reliably reappeared (a mean change in overall dyspeptic symptoms of ≥30%) with gluten or fructan re-challenge were deemed to have wheat induced FD. Results: Eleven participants were enrolled in the study (75% female, mean age 43 years). Of the initial cohort, nine participants completed the elimination diet phase of whom four qualified for the rechallenge phase. The gluten-free, low FODMAP diet led to an overall (albeit non-significant) improvement in symptoms of functional dyspepsia in the diet elimination phase (mean NDI symptom score 71.2 vs. 47.1, p = 0.087). A specific food trigger could not be reliably demonstrated. Conclusions: Although a gluten-free, low-FODMAP diet led to a modest overall reduction in symptoms in this cohort of FD patients, a specific trigger could not be identified. The modified Salerno criteria for NCG/WS identification trialled in this dietary rechallenge protocol was fit-for-purpose. However, larger trials are required to determine whether particular components of wheat induce symptoms in functional dyspepsia.
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Affiliation(s)
- Michael D. E. Potter
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Correspondence:
| | - Michael P. Jones
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Psychology Department, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia
| | - Marjorie M. Walker
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Simon Keely
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicholas J. Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; (M.D.E.P.); (M.P.J.); (M.M.W.); (S.K.); (N.J.T)
- Australian Gastrointestinal Research Alliance (AGIRA), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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Ball R, Vaschak R, Bailey A, Whiteford G, Burrows TL, Duncanson K, Collins CE. Study Protocol of the Parents in Child Nutrition Informing Community (PICNIC) Peer Education Cohort Study to Improve Child Feeding and Dietary Intake of Children Aged Six Months to Three Years Old. Children (Basel) 2019; 7:children7010003. [PMID: 31892113 PMCID: PMC7023363 DOI: 10.3390/children7010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022]
Abstract
One in five Australian pre-schoolers are overweight or obese, meaning the first years of life are vital for obesity primary prevention. Parent child feeding practices impact on children’s dietary intake, which in turn impacts on their weight status. Parents’ child feeding beliefs are heavily influenced by parenting peers. The aim of this cohort study is to evaluate the impact of the Parents in Child Nutrition Informing Community (PICNIC) study on parents feeding practices and diet quality. The secondary outcomes are the perceptions of trained peer educators and education recipients based on their involvement in PICNIC. One hundred parents with a child aged 0–2 years at time of recruitment will participate in peer educator training, then disseminate nutrition and child feeding content to other parents over an intervention period of 12 months, supported by project-specific, evidence-based social media pages and website. An additional 100 new parents, recruited by peer educators, will participate in the study as nutrition education recipients. Both peer educators and education recipients will complete quantitative child feeding surveys before and during the 12 month intervention and a dietary intake survey at a time point 12 months post intervention. Following the intervention, 30 education recipients will be asked to participate in semi-structured phone interviews about their experiences with PICNIC. Peer educators will contribute as co-researchers and active participants in the evolution of the PICNIC model. This study will contribute to enhanced understanding of contemporary health literacy strategies for communicating nutrition and feeding messages to new parents and the impact of these strategies on parents feeding practices and children’s dietary intake in a community setting.
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Affiliation(s)
- Richard Ball
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.)
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (T.L.B.); (C.E.C.)
- Correspondence: ; Tel.: +612-467-003-875
| | - Rebecca Vaschak
- Coffs Harbour Women’s Health Centre, Coffs Harbour, NSW 2450, Australia;
| | - Andrew Bailey
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.)
| | - Gail Whiteford
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.)
- School of Community Health, Charles Sturt University, Port Macquarie, NSW 2444, Australia
| | - Tracy L. Burrows
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (T.L.B.); (C.E.C.)
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Kerith Duncanson
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- Health Education and Training Institute (HETI), Gladesville, NSW 2111, Australia
| | - Clare E. Collins
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (T.L.B.); (C.E.C.)
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
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Duncanson K, Burrows T, Keely S, Potter M, Das G, Walker M, Talley NJ. The Alignment of Dietary Intake and Symptom-Reporting Capture Periods in Studies Assessing Associations between Food and Functional Gastrointestinal Disorder Symptoms: A Systematic Review. Nutrients 2019; 11:E2590. [PMID: 31661839 PMCID: PMC6893476 DOI: 10.3390/nu11112590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Food ingestion is heavily implicated in inducing symptoms of irritable bowel syndrome (IBS) and functional dyspepsia (FD), which affect over one-third of adults in developed countries. The primary aim of this paper was to assess the alignment of dietary assessment and symptom-reporting capture periods in diet-related studies on IBS or FD in adults. Secondary aims were to compare the degree of alignment, validity of symptom-reporting tools and reported significant associations between food ingestion and symptoms. A five-database systematic literature search resulted in 40 included studies, from which data were extracted and collated. The food/diet and symptom capture periods matched exactly in 60% (n = 24/40) of studies, overlapped in 30% (n = 12/40) of studies and were not aligned in 10% (n = 4/40) of studies. Only 30% (n = 12/40) of studies that reported a significant association between food and global gastrointestinal symptoms used a validated symptom-reporting tool. Of the thirty (75%) studies that reported at least one significant association between individual gastrointestinal symptoms and dietary intake, only four (13%) used a validated symptom tool. Guidelines to ensure that validated symptom-reporting tools are matched with fit-for-purpose dietary assessment methods are needed to minimise discrepancies in the alignment of food and symptom tools, in order to progress functional gastrointestinal disorder research.
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Affiliation(s)
- Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Tracy Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Simon Keely
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Michael Potter
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Gayatri Das
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Marjorie Walker
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Nicholas J Talley
- Priority Research Centre, Digestive Health and Neurogastroenterology, The University of Newcastle, Newcastle, NSW 2308, Australia.
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Weston N, Luscombe G, Duncanson K. Effects of a Laxation and Probiotic Bowel Preparation Regimen: A Randomized Controlled Trial in Patients Undergoing Prostate Radiation Therapy. Nutr Cancer 2019; 72:999-1003. [DOI: 10.1080/01635581.2019.1669675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nicole Weston
- Central West Cancer Care Centre, Orange Health Service, Orange, NSW, Australia
| | - Georgina Luscombe
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, NSW, Australia
| | - Kerith Duncanson
- Health Education and Training Institute, The Junction, NSW, Australia
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Van der Horst K, Bucher T, Duncanson K, Murawski B, Labbe D. Consumer Understanding, Perception and Interpretation of Serving Size Information on Food Labels: A Scoping Review. Nutrients 2019; 11:nu11092189. [PMID: 31514395 PMCID: PMC6770558 DOI: 10.3390/nu11092189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 01/30/2023] Open
Abstract
The increase in packaged food and beverage portion sizes has been identified as a potential factor implicated in the rise of the prevalence of obesity. In this context, the objective of this systematic scoping review was to investigate how healthy adults perceive and interpret serving size information on food packages and how this influences product perception and consumption. Such knowledge is needed to improve food labelling understanding and guide consumers toward healthier portion size choices. A search of seven databases (2010 to April 2019) provided the records for title and abstract screening, with relevant articles assessed for eligibility in the full-text. Fourteen articles met the inclusion criteria, with relevant data extracted by one reviewer and checked for consistency by a second reviewer. Twelve studies were conducted in North America, where the government regulates serving size information. Several studies reported a poor understanding of serving size labelling. Indeed, consumers interpreted the labelled serving size as a recommended serving for dietary guidelines for healthy eating rather than a typical consumption unit, which is set by the manufacturer or regulated in some countries such as in the U.S. and Canada. Not all studies assessed consumption; however, larger labelled serving sizes resulted in larger self-selected portion sizes in three studies. However, another study performed on confectionary reported the opposite effect, with larger labelled serving sizes leading to reduced consumption. The limited number of included studies showed that labelled serving size affects portion size selection and consumption, and that any labelled serving size format changes may result in increased portion size selection, energy intake and thus contribute to the rise of the prevalence of overweight and obesity. Research to test cross-continentally labelled serving size format changes within experimental and natural settings (e.g., at home) are needed. In addition, tailored, comprehensive and serving-size-specific food literacy initiatives need to be evaluated to provide recommendations for effective serving size labelling. This is required to ensure the correct understanding of nutritional content, as well as informing food choices and consumption, for both core foods and discretionary foods.
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Affiliation(s)
- Klazine Van der Horst
- Department of Health Professions, Bern University of Applied Sciences, 3005 Bern, Switzerland.
- Société des Produits Nestlé S.A., Nestlé Research, Institute of Material Science, 1000 Lausanne, Switzerland.
| | - Tamara Bucher
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Beatrice Murawski
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia.
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - David Labbe
- Société des Produits Nestlé S.A., Nestlé Research, Institute of Material Science, 1000 Lausanne, Switzerland.
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Schmidt DD, Webster E, Duncanson K. Building research experience: Impact of a novice researcher development program for rural health workers. Aust J Rural Health 2019; 27:392-397. [PMID: 31245898 DOI: 10.1111/ajr.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/17/2019] [Accepted: 04/07/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the effect of the Rural Research Capacity Building Program on self-reported research experience of rural health workers. DESIGN A repeat cross-sectional study design was used to assess self-reported research experience at the commencement and completion of a novice researcher development program. SETTING Candidates in the Rural Research Capacity Building Program are health workers employed in the rural NSW public health service who have not completed research higher degrees. PARTICIPANTS One hundred and thirty candidates of the Rural Research Capacity Building Program from the 2006 to 2013 cohorts were participated. INTERVENTIONS The Rural Research Capacity Building Program is an experiential learning program in which candidates gain research experience by undertaking a new, self-selected, local health service endorsed research project over a 2-year period, supported by 10 days face-to-face teaching, weekly teleconferencing and mentoring. MAIN OUTCOME MEASURES Change in self-assessed research experience using a validated 10-item measurement tool known as the Research Spider which measures 10 domains of research experience. RESULTS Reported research experience demonstrated statistically significant increases across all 10 domains of research experience. The largest change was 'writing and presenting a research report' and 'writing a research protocol'. CONCLUSIONS Significant increases in Research Spider results across all 10 domains demonstrated that completing the Rural Research Capacity Building Program significantly improves self-assessed research experience. Rural health workers who are experienced and confident to undertake research are more capable of studying health problems and finding solutions unique to the rural setting.
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Affiliation(s)
- David D Schmidt
- Health Education and Training Institute, NSW Health, Bega, New South Wales, Australia
| | - Emma Webster
- Faculty of Medicine and Health, School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Kerith Duncanson
- Health Education and Training Institute, NSW Health, Newcastle, New South Wales, Australia
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Shrewsbury VA, Burrows T, Ho M, Jensen M, Garnett SP, Stewart L, Gow ML, Ells LJ, Chai LK, Ashton L, Walker JL, Littlewood R, Coyle D, Nowicka P, Ashman A, Demaio A, Duncanson K, Collins C. Update of the best practice dietetic management of overweight and obese children and adolescents: a systematic review protocol. JBI Database System Rev Implement Rep 2018; 16:1495-1502. [PMID: 29995710 DOI: 10.11124/jbisrir-2017-003603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
REVIEW QUESTION/OBJECTIVE To update an existing systematic review series of randomized controlled trials (RCT) that include a dietary intervention for the management of overweight or obesity in children or adolescents.Specifically, the review questions are: In randomized controlled trials of interventions which include a dietary intervention for the management of overweight or obesity in children or adolescents.
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Affiliation(s)
- Vanessa A Shrewsbury
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Tracy Burrows
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Mandy Ho
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Megan Jensen
- Priority Research Centre Grow Up Well and Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, Australia
| | - Laura Stewart
- Nutrition and Dietetic Service, NHS Tayside, Perth Royal Infirmary, Perth, United Kingdom
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, Australia
| | - Louisa J Ells
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
- Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence
| | - Li Kheng Chai
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Lee Ashton
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Robyn Littlewood
- Dietetics and Food Services, Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Daisy Coyle
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Paulina Nowicka
- Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Amy Ashman
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Alessandro Demaio
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
- The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
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Bucher T, Murawski B, Duncanson K, Labbe D, Van der Horst K. The effect of the labelled serving size on consumption: A systematic review. Appetite 2018; 128:50-57. [PMID: 29859775 DOI: 10.1016/j.appet.2018.05.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/03/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022]
Abstract
Guidance for food consumption and portion control plays an important role in the global management of overweight and obesity. Carefully conceptualised serving size labelling can contribute to this guidance. However, little is known about the relationship between the information that is provided regarding serving sizes on food packages and levels of actual food consumption. The aim of this systematic review was to investigate how serving size information on food packages influences food consumption. We conducted a systematic review of the evidence published between 1980 and March 2018. Two reviewers screened titles and abstracts for relevance and assessed relevant articles for eligibility in full-text. Five studies were considered eligible for the systematic review. In three of the included studies, changes in serving size labelling resulted in positive health implications for consumers, whereby less discretionary foods were consumed, if serving sizes were smaller or if serving size information was provided alongside contextual information referring to the entire package. One study did not find significant differences between the conditions they tested and one study suggested a potentially negative impact, if the serving size was reduced. The influence of labelled serving size on consumption of non-discretionary foods remains unclear, which is partially due to the absence of studies specifically focusing on non-discretionary food groups. Studies that investigate the impact of serving size labels within the home environment and across a broad demographic cross-section are required.
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Affiliation(s)
- Tamara Bucher
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan NSW 2308, Australia.
| | - Beatrice Murawski
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan NSW 2308, Australia.
| | - Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan NSW 2308, Australia.
| | - David Labbe
- Nestlé Research Center, Lausanne 1000, Switzerland.
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Duncanson K, Webster EL, Schmidt DD. Impact of a remotely delivered, writing for publication program on publication outcomes of novice researchers. Rural Remote Health 2018; 18:4468. [PMID: 29793344 DOI: 10.22605/rrh4468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Increased publication of clinician-led health research is important for improving patient care and health outcomes. The aim of this retrospective cohort study conducted in rural Australia was to determine the impact of a writing for publication (WFP) program delivered by teleconference on the publication rates and skill acquisition of novice researchers who have graduated from the New South Wales (NSW) Health Education and Training Institute Rural Research Capacity Building Program (RRCBP). METHODS Between 2012 and 2015, eight WFP 'bootcamp' programs were offered by the New South Wales Health Education and Training Institute to 112 RRCBP graduates, resulting in 50 participants completing at least one bootcamp. Participants completed a once-weekly WFP group teleconference for six consecutive weeks, and were expected to complete homework activities between sessions and participate in two follow-up teleconferences within 3 months of program conclusion. The primary outcome measure was manuscript publication resulting from participation in bootcamp, with secondary measures being changes in skills, knowledge and confidence in WFP, publication rate and cost per publication. RESULTS Twenty-one participants (42%) published their bootcamp paper or a related paper that directly resulted from bootcamp WFP skills. Five other participants submitted their bootcamp manuscript for publication, but had not yet had it accepted for publication. The overall publication rate of RRCBP graduates who completed bootcamp was 0.80 compared to 0.23 who did not complete bootcamp. On a 1 to 5 scale, mean scores increased for writing (knowledge, experience, confidence) from 2.0 to 3.5 (p<0.01) and for publishing from 1.1 to 3.4 (p<0.01). The estimated cost incurred by the RRCBP to deliver the program was $230 per publication. CONCLUSION WFP workshops delivered by teleconference support rural clinician researchers to improve their skills in writing and publishing. A remotely conducted WFP program was effective in increasing publication rates among novice researchers who had conducted a clinically based research project. This shows that novice researchers respond to similar intervention features as experienced researchers do when engaging with WFP, and that WFP outcomes can be increased substantially with modest investment of funding and resources by the host organisation.
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Affiliation(s)
- Kerith Duncanson
- NSW Health Education and Training Institute, Victoria Road, Gladesville, NSW
| | - Emma L Webster
- The University of Sydney School of Rural Health, 11 Moran Drive, Dubbo, NSW, Australia 2830
| | - David D Schmidt
- NSW Health Education and Training Institute, 1 McKee Drive, Bega, NSW, 2550
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Young KG, Duncanson K, Burrows T. Influence of grandparents on the dietary intake of their 2-12-year-old grandchildren: A systematic review. Nutr Diet 2018; 75:291-306. [DOI: 10.1111/1747-0080.12411] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/24/2017] [Accepted: 01/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kylie G. Young
- Communications; Mid North Coast Local Health District; Port Macquarie New South Wales Australia
| | - Kerith Duncanson
- Nutrition and Dietetics; The University of Newcastle; Newcastle New South Wales Australia
| | - Tracy Burrows
- Nutrition and Dietetics; The University of Newcastle; Newcastle New South Wales Australia
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Ball R, Duncanson K, Burrows T, Collins C. Experiences of Parent Peer Nutrition Educators Sharing Child Feeding and Nutrition Information. Children (Basel) 2017; 4:children4090078. [PMID: 28850096 PMCID: PMC5615268 DOI: 10.3390/children4090078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/02/2022]
Abstract
The aim of this study was to describe the experiences of parents as peer educators disseminating nutrition and child feeding information. Parents of infants aged from birth to three years were trained as peer educators in a face-to-face workshop, and then shared evidence-based child feeding and nutrition information via Facebook, email, and printed resources for six months to peers, family, and social media contacts. Semi-structured telephone or group interviews were conducted after a six-month online and face-to-face peer nutrition intervention period investigating peer educator experiences, barriers, enablers of information dissemination, and the acceptability of the peer educator model. Transcripts from interviews were independently coded by two researchers and thematically analysed. Twenty-eight participants completed the study and were assigned to either group or individual interviews. The cohort consenting to the study were predominantly female, aged between 25 and 34 years, non-indigenous, tertiary educated, and employed or on maternity leave. Dominant themes to emerge from the interviews included that the information was trustworthy, child feeding practice information was considered most helpful, newer parents were the most receptive and family members the least receptive to child feeding and nutrition information, and sharing and receiving information verbally and via social media were preferred over print and email. In conclusion, parents reported positive experiences as peer nutrition educators, and considered it acceptable for sharing evidence-based nutrition information. Further research may determine the impact on diet quality and the food-related behaviours of babies and young children on a population level.
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Affiliation(s)
- Richard Ball
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia.
| | - Kerith Duncanson
- Department of Nutrition and Dietetics, The University of Newcastle, Newcastle, NSW 2308, Australia.
- NSW Health Education and Training Institute, NSW Health, Gladesville NSW 2111, Australia.
| | - Tracy Burrows
- Department of Nutrition and Dietetics, The University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Clare Collins
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW 2308, Australia.
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Dickson R, Duncanson K, Shepherd S. The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners. Australas J Ultrasound Med 2017; 20:5-17. [PMID: 34760465 DOI: 10.1002/ajum.12039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is a form of diagnostic ultrasonography, which has a defined role as a clinical adjunct in patient assessment and management. If it is to continue to develop as a core clinical skill, junior medical practitioners and trainees may benefit from dedicated ultrasound education and familiarisation early in their training. Controversy endures, however, as inappropriate use of this highly technical and operator-dependent imaging modality has negative clinical implications. Aims A systematic review was performed to assess the ability of doctors in training to perform clinically appropriate and beneficial diagnostic ultrasound after undergoing a formal training programme. Methods Studies meeting pre-defined inclusion criteria were identified in electronic databases MEDLINE, EMBASE, CINAHL, PUBMED and through Google Scholar. Methodological quality was assessed using an established series of indicators. Results Fifteen studies were included in the review. Ten of these were performed in the United States, and eight focused on emergency medicine trainees. After the teaching intervention, ten studies assessed overall ultrasound capacity by calculating the collective sensitivity and specificity of trainee-performed ultrasound. Five studies used a standardised objective assessment tool to evaluate ultrasound skills and technique. Studies varied in terms of the specific ultrasound use investigated, teaching programmes used and methodological quality. Consistently identified areas for further research included the definition of the trainee learning curve and what constitutes competency in ultrasound. Conclusions Ultrasound can feasibly be incorporated into junior medical practitioner training, but more research is required to assess its effectiveness and appropriateness.
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Affiliation(s)
- Robert Dickson
- Orange Health Service 1502 Forest Road Orange NSW 2800 Australia
| | - Kerith Duncanson
- Health Education and Training Institute Locked Bag 5022 Gladesville NSW 1675 Australia.,University of Newcastle University Drive Callaghan NSW 2308 Australia
| | - Shamus Shepherd
- Orange Health Service 1502 Forest Road Orange NSW 2800 Australia
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Duncanson K, Lee YQ, Burrows T, Collins C. Utility of a brief index to measure diet quality of Australian preschoolers in the Feeding Healthy Food to Kids Randomised Controlled Trial. Nutr Diet 2016; 74:158-166. [PMID: 28731642 DOI: 10.1111/1747-0080.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/23/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022]
Abstract
AIM The aim was to evaluate the utility of a brief dietary intake assessment tool in measuring nutritional adequacy of preschoolers and differences in food and nutrient intake between quartiles stratified by overall diet quality. METHODS Dietary intakes of preschoolers (n = 146) from the Feeding Healthy Food to Kids trial were reported by parents/caregivers using a 120-item food frequency questionnaire (FFQ). Diet quality was assessed using the Australian Recommended Food Score for Preschoolers. Analyses were performed using Kruskal-Wallis one-way analysis of variance, adjusted for Type 1 error. Participants were grouped into quartiles by total food score for comparison of subscale scores, food groups and nutrient intakes from the FFQ. RESULTS Participants who scored less than the median total food score of 36 were more likely to have suboptimal micronutrient intakes. Median fruit (9 vs 5, P < 0.0001) and vegetable (14 vs 7, P < 0.0001) subscale scores for preschoolers in the highest quartile were significantly higher than the lowest quartile, indicating much greater fruit and vegetable variety. Statistically significant differences in diet quality score by quartiles (P < 0.05) were found for total energy and percentage energy from core foods, protein, fibre and 11 micronutrients. CONCLUSIONS The Australian Recommended Food Score for Preschoolers is a practical brief diet quality assessment tool to measure food variety and nutritional adequacy in Australian preschoolers. Stratifying children by baseline diet quality in future nutrition interventions is recommended in order to identify those who are likely to benefit or require more targeted approaches to address specific nutritional needs in order to optimise food and nutrient intakes.
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Affiliation(s)
- Kerith Duncanson
- Nutrition and Dietetics Department, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Yu Qi Lee
- Nutrition and Dietetics Department, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Tracy Burrows
- Nutrition and Dietetics Department, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare Collins
- Nutrition and Dietetics Department, The University of Newcastle, Callaghan, New South Wales, Australia
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Collins CE, Bucher T, Taylor A, Pezdirc K, Lucas H, Watson J, Rollo M, Duncanson K, Hutchesson MJ, Burrows T. How big is a food portion? A pilot study in Australian families. Health Promot J Austr 2015; 26:83-88. [DOI: 10.1071/he14061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/31/2015] [Indexed: 12/18/2022] Open
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Collins CE, Burrows TL, Rollo ME, Boggess MM, Watson JF, Guest M, Duncanson K, Pezdirc K, Hutchesson MJ. The comparative validity and reproducibility of a diet quality index for adults: the Australian Recommended Food Score. Nutrients 2015; 7:785-98. [PMID: 25625814 PMCID: PMC4344560 DOI: 10.3390/nu7020785] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/01/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022] Open
Abstract
Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37-0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23-0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.
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Affiliation(s)
- Clare E Collins
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Tracy L Burrows
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Megan E Rollo
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - May M Boggess
- Occupational Health and Safety, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Jane F Watson
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Maya Guest
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle 2300, Australia.
| | - Kerith Duncanson
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Kristine Pezdirc
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
| | - Melinda J Hutchesson
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle 2300, Australia.
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Duncanson K, Burrows T, Collins C. Peer education is a feasible method of disseminating information related to child nutrition and feeding between new mothers. BMC Public Health 2014; 14:1262. [PMID: 25494911 PMCID: PMC4295413 DOI: 10.1186/1471-2458-14-1262] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 12/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined whether peer education based on the Theory of Planned Behaviour is a feasible method to share and disseminate nutrition and feeding information between mothers of babies and toddlers. METHODS The Peer Educator Nutrition Training (PeerENT) study was a feasibility study. Participants were recruited from an existing cohort of mothers of six month to two year olds. An online survey tool was used to collect and collate data, which was then analysed using STATA statistical software. RESULTS Thirty four mothers (35%) responded to the survey with 76% (n = 26) either very interested (n = 13) or interested (n = 13) in receiving child nutrition information from a trained peer educator, preferably in a structured group session. Sixty five per cent (n = 22) were "interested" or "very interested" in becoming a peer nutrition educator. The preferred methods of communicating information to other parents were online (n = 17), informally in a social group (n = 16) and via a face-to-face group program (n = 14). Participants predicted they would share child nutrition information with an average of fifteen people, a total reach of 510 individuals. CONCLUSIONS High levels of interest in peer educator training and the capacity for mothers to share resources widely and easily via social media offers a potential opportunity to disseminate evidence-based nutrition information. A pilot study investigating the impact of a well-designed, theory-based peer nutrition education program on the child feeding practices of mothers with children aged between six months to two years is warranted.
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Affiliation(s)
- Kerith Duncanson
- Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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Burrows TL, Collins K, Watson J, Guest M, Boggess MM, Neve M, Rollo M, Duncanson K, Collins CE. Validity of the Australian Recommended Food Score as a diet quality index for Pre-schoolers. Nutr J 2014; 13:87. [PMID: 25178263 PMCID: PMC4162955 DOI: 10.1186/1475-2891-13-87] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/29/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years. METHODS The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia. RESULTS Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, β-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks. CONCLUSION ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.
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Affiliation(s)
- Tracy L Burrows
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Kate Collins
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
| | - Jane Watson
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Maya Guest
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Environmental and Occupational Health and Safety, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - May M Boggess
- />Environmental and Occupational Health and Safety, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 2308 NSW Australia
- />School of Mathematical and Statistical Sciences, Arizona State University, Tempe, 85281 AZ USA
| | - Melinda Neve
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Megan Rollo
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Kerith Duncanson
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
- />Hunter New England Local Health District, Forster, 2428 NSW Australia
| | - Clare E Collins
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
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Collins C, Duncanson K, Burrows T. A systematic review investigating associations between parenting style and child feeding behaviours. J Hum Nutr Diet 2014; 27:557-68. [DOI: 10.1111/jhn.12192] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- C. Collins
- Nutrition and Dietetics; School of Health Sciences; Faculty of Health; The University of Newcastle; University Drive; Callaghan NSW Australia
- Priotity Research Center in Physical Activity and Nutrition; The University of Newcastle; Callaghan NSW Australia
| | - K. Duncanson
- Nutrition and Dietetics; School of Health Sciences; Faculty of Health; The University of Newcastle; University Drive; Callaghan NSW Australia
- Priotity Research Center in Physical Activity and Nutrition; The University of Newcastle; Callaghan NSW Australia
- Hunter New England Local Health District; Forster NSW Australia
| | - T. Burrows
- Nutrition and Dietetics; School of Health Sciences; Faculty of Health; The University of Newcastle; University Drive; Callaghan NSW Australia
- Hunter New England Local Health District; Forster NSW Australia
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