Claire Palermo

A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods

Hypertension is a public health priority in developed countries and worldwide, and is strongly associated with increased risk and progression of cardiovascular and renal diseases. A systematic review and meta-analysis were conducted to examine the association between dairy food intake during adulthood and the development of elevated blood pressure (EBP), specifically comparing the association of EBP with consumption of low-fat dairy foods versus high-fat dairy foods, as well as cheese versus fluid dairy foods (milk or yogurt). Seven databases were searched and five cohort studies selected for inclusion, involving nearly 45 000 subjects and 11 500 cases of EBP. Meta-analysis of consumption of dairy foods and EBP in adults gave a relative risk (RR) of 0.87 (95% confidence interval (CI) 0.81–0.94). Separation of high- and low-fat dairy foods, however, indicated a significant association with low-fat dairy foods only (RR of 0.84 (95% CI 0.74–0.95)). Additional analyses showed no association between EBP and cheese, although fluid dairy foods were significantly associated with a reduced development in EBP (RR of 0.92 (95% CI 0.87–0.98)). Little heterogeneity was observed among the data presented. This meta-analysis supports the inverse association between low-fat dairy foods and fluid dairy foods and risk of EBP. Understanding these relationships can aid in the development of public health messages involving dairy foods, and supports current recommendations.

Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review

Recent obesity trends in children and adolescents suggest a plateau. However, it is unclear whether such trends have been experienced across socioeconomic groups. We analysed whether recent trends in child and adolescent overweight and obesity differ by socioeconomic position (SEP) across economically advanced countries. Eligible studies reported overweight and obesity prevalence in children and/or adolescents (2–18 years), for at least two time points since 1990, stratified by SEP. Socioeconomic differences in trends in child and adolescent overweight and obesity over time were analysed. Differences in trends between SEP groups were observed across a majority of studies. Over half the studies indicated increasing prevalence among low SEP children and adolescents compared to a third of studies among children and adolescents with a high SEP. Around half the studies indicated widening socioeconomic inequalities in overweight and obesity. Since 2000 a majority of studies demonstrated no change or a decrease in prevalence among both high and low SEP groups. However around 40% of studies indicated widening of socioeconomic inequalities post‐2000. While our study provides grounds for optimism, socioeconomic inequalities in overweight and obesity continue to widen. These findings highlight the need for greater consideration of different population groups when implementing obesity interventions.

Development of a healthy food basket for Victoria

Objective: Access to an affordable, nutritious food supply is an important determinant of population health. Healthy food basket surveys have been used across Australia as a tool to monitor food cost, quality and variety. The release of the revised Nutrient Reference Values, together with local interest in food security, highlighted the need to develop a Victorian Healthy Food Basket to reflect the food access issues of the Victorian population.

Colorectal Cancer and Nonfermented Milk, Solid Cheese, and Fermented Milk Consumption: A Systematic Review and Meta-Analysis of Prospective Studies

Colorectal cancer is the second most prevalent cancer worldwide. A systematic review and meta-analysis of prospective studies was conducted to examine the association between intake of different types of dairy foods during adulthood and the development of colorectal cancer, specifically comparing nonfermented milk, solid cheese, and fermented milk. Seven databases were systematically searched and 15 cohort studies selected for inclusion, involving over 900,000 subjects and over 5200 colorectal cancer cases. Meta-analysis resulted in an overall relative risk of colon cancer of 0.74 (95% confidence interval 0.60–0.91) in men consuming nonfermented milk (highest intake category averaging 525 g/day). No association was found between consumption of nonfermented milk and rectal cancer in men or nonfermented milk and colon or rectal cancer in women. No protective association was found between consumption of solid cheese or fermented milk and colorectal cancer. Reasons for the differences in the impact of nonfermented milk, solid cheese, and fermented milk in the colon are discussed. This meta-analysis supports the inverse association between nonfermented milk consumption and risk of colon cancer in men, and provides an evidence base to assist in the formulation of dietary guidelines involving dairy foods.

An evaluation of a public health nutrition workforce development intervention for the nutrition and dietetics workforce.

BACKGROUND Workforce development is a key element for building the capacity to effectively address priority population nutrition issues. On-the-job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition; however, there is limited evidence for their effectiveness. METHODS An evaluation of a mentoring circle workforce development intervention was undertaken. Thirty-two novice public health nutritionists participated in one of three mentoring circles for 2 h, every 6 weeks, over a 7-month period. Pre- and post-intervention qualitative (questionnaire, interview, mentor diary) and quantitative (competence, time working in public health nutrition) data were collected. RESULTS The novice public health nutritionists explained the intervention facilitated sharing of ideas and strategies and promoted reflective practice. They articulated the important attributes of the mentor in the intervention as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback. Participants reported a gain in competency and had an overall mean increase in self-reported competence of 15% (range 3-48% change; P < 0.05) across a broad range of competency elements. Many participants described re-orienting their practice towards population prevention, with quantifiable increases in work time allocated to preventive work post-intervention. CONCLUSIONS Mentoring supported service re-orientation and competency development in public health nutrition. The nature of the group learning environment and the role and qualities of the mentor were important elements contributing to the interventions effects. Mentoring circles offer a potentially effective strategy for workforce development in nutrition and dietetics.

Empathy levels among health professional students: a cross-sectional study at two universities in Australia.

Background Empathy is paramount in the health care setting, optimizing communication and rapport with patients. Recent empirical evidence suggests that empathy is associated with improved clinical outcomes. Therefore, given the importance of empathy in the health care setting, gaining a better understanding of students’ attitudes and self-reported empathy is important. The objective of this study was to examine self-reported empathy levels of students enrolled in different health disciplines from two large Australian universities. Materials and methods A total of 1,111 students from two different universities enrolled in eight different health professions were administered the Jefferson Scale of Physician Empathy – Health Profession Students version, a 20-item 7-point Likert scale questionnaire to evaluate self-reported empathy levels. Results A total of 1,111 students participated in this study. The majority of participants were from Monash University (n=771), with 340 students from Edith Cowan University. No statistically significant differences were found between universities: Monash University (mean 110.1, standard deviation [SD] 11.8); Edith Cowan University (mean 109.2, SD 13.3, P=0.306). The mean female empathy score (mean 110.8, SD 11.7) was significantly higher than the mean male score (mean 105.3, SD 13.5; P<0.0001; d=0.44). Paramedic students had significantly lower empathy scores (mean 106.3, SD 12.73) than all other participants except nursing students (P<0.0001). Conclusion Results relating to sex are reflective of previous studies. There is some discrepancy in results relating to empathy and its incline/decline as students progress through a program. Further study is warranted to explore why there are variations in empathy levels in students of different health disciplines.

A qualitative evaluation of an Australian public health nutrition workforce development intervention involving mentoring circles

OBJECTIVE To evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices. DESIGN The mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness. SETTING Victoria, Australia. SUBJECTS Thirty-two novice public health nutrition practitioners employed in the state public health system. RESULTS Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness. CONCLUSIONS This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

Levels of empathy in undergraduate emergency health, nursing, and midwifery students: a longitudinal study

Purpose This research examines the extent and nature of empathy among emergency health (paramedic), nursing, and midwifery students at one Australian university and investigates the longitudinal changes in empathy levels across the course of study. Methods First-, second-, and third-year students at Monash University completed the Jefferson Scale of Empathy–Health Professional (JSE-HP) in 2008, 2009, and 2010, and the resulting mean empathy scores were analyzed by course, year of course, year of study, age, and sex. Results Midwifery students were found to have higher empathy levels than nursing and emergency health students. Second- and third-year students scored higher than their counterparts in the first year. Empathy levels dipped in 2009 and rose in 2010. Students aged 26–30 years and 31–35 years recorded higher scores than their younger colleagues, and female students were found to be more empathic than their male counterparts. Conclusion The finding that empathy levels are relatively stable over the term of study contributes to the understanding of how empathy evolves over the course of study and offers insights into the importance of incorporating and promoting empathy in health care curricula.

The role of mentoring in public health nutrition workforce development. Perspectives of advanced-level practitioners

OBJECTIVE To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists. DESIGN Qualitative study using in-depth interviews. SUBJECTS AND SETTING Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia. RESULTS The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition. CONCLUSIONS The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.

A qualitative evaluation of a mentoring program for Aboriginal health workers and allied health professionals

Objective: Effective partnerships between Aboriginal Health Workers and non‐Aboriginal health professionals are essential to achieve Aboriginal health outcomes. This study aimed to evaluate a mentoring workforce development strategy for Aboriginal Health Workers and non‐Aboriginal allied health professionals.