Tanya Lawlis

Barriers and enablers that influence sustainable interprofessional education: a literature review

Abstract The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key “fundamental elements” critical to achieving sustainable IPE in higher education curricula.

School canteens: A systematic review of the policy, perceptions and use from an Australian perspective

Aim This review aimed to identify current research related to the use of school canteens in Australia, with a focus on their food and drink policy. In Australia, approximately 25% of 5–17-year olds are considered overweight and obese. Up to 41% of energy intake for children aged between 4 and 18 years is found to come from discretionary foods. The structured nature of the school environment provides an ideal environment to address childhood obesity and encourage a culture of healthy eating. Methods A systematic review of three key nutrition databases: ‘CINAHL’, ‘Academic search complete’ and ‘Medline’ (inception to 2015) was conducted. Inclusion criteria were: Australian, peer-reviewed studies; studies regarding the purchase of food from school canteens; canteen studies involving students aged 5–18 years, school principals, parents, canteen managers, Parent and Citizen Association members and teachers. Results The search identified 2741 studies with 12 meeting the inclusion criteria. In the main, studies were descriptive in nature with data summarised into four categories: (i) characteristics of canteens; (ii) canteen use and food availability; (iii) stakeholder perceptions and the role of school canteens; and (iv) compliance with policies and the barriers to healthy food implementation. Overall, compliance with healthy canteen policies was low, guidelines were rarely adhered to in terms of product provision and children had preferences for non-healthy foods. Conclusions Strategies to improve compliance, overcome the challenges and encourage stakeholder buy-in are necessary if food habits are to be changed and healthy cultures developed within the school environment.

Feeding the brain – The effects of micronutrient interventions on cognitive performance among school-aged children: A systematic review of randomized controlled trials

BACKGROUND & AIMS Micronutrients are essential for brain development with deficiencies in specific nutrients linked to impaired cognitive function. Interventions are shown to be beneficial to childrens mental development, particularly in subjects who were micronutrient-deficient at baseline but results on healthy subjects remain inconsistent. This systematic review evaluated the effect of micronutrient inventions on different cognitive domains. Studies conducted in both developing and developed countries, and trials that investigate the effect of both single and multiple micronutrient intervention were reviewed. METHODS Systematic searches of Medline, CINAHL Plus and Academic Search database were undertaken to identify trials published after year 2000. Randomized controlled trials (RCTs) that evaluate the effect of micronutrients on cognitive performance or academic performance among children aged 4-18 years were included. RESULTS 19 trials were identified from 18 articles. The major cognitive outcomes assessed included fluid intelligence, crystallized intelligence, short-term memory, long-term memory, cognitive processing speed, attention and concentration, and school performance. Eight of ten trials assessing fluid intelligence reported significant positive effects of micronutrient supplementation among micronutrient-deficient children, especially those who were iron-deficient or iodine-deficient at baseline. The effects of micronutrient interventions on other domains were inconsistent. CONCLUSION Improvement in fluid intelligence among micronutrient-deficient children was consistently reported. Further research is needed to provide more definite evidence on the beneficial effects of micronutrient inventions on other cognitive domains and the effects in healthy subjects.

Interprofessional education in practice: Evaluation of a work integrated aged care program

Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.

Food allergy in schools: The importance of government involvement

AIM Children have the highest rates of food-related allergic reactions. While 85% of children outgrow allergies including cows milk and eggs by five years of age, allergies to peanuts and seafood continue into adulthood. The school setting poses a high-risk environment for allergen exposure. The aim of the present study was to examine the availability, drivers and communication of school food allergy awareness and management policies/guidelines in one Australian education jurisdiction. METHODS A cross-sectional study comprising an online survey of principals on school allergy awareness (n = 100) was conducted in public, catholic and independent primary and high schools in an Australian education jurisdiction between August 2011 and November 2012. RESULTS Sixty-three per cent (17/27) of schools responding to the survey reported using food allergy management guidelines. An average of 13 students per school were reported to have a food allergy with 93% of schools reported having students with at least one food allergy. Parents, not government policy, were identified as primary drivers of food allergy guideline implementation and a third of schools provided anaphylaxis training annually. Communication of food allergy management was limited with only 42 school websites either providing access to policies/guidelines or providing a food allergy statement. CONCLUSIONS Detailed awareness and management guidelines are integral for schools to adequately manage food-induced allergic reactions, including anaphylaxis, in the school environment. To enable this, national government support through legislation and policy is needed to ensure a consistent, up-to-date and policed approach to food allergy management in the Australian education sector.

Achieving the four dimensions of food security for resettled refugees in Australia: A systematic review: Refugee food security: A systematic review

AIM Food security is defined by four dimensions: food availability, access, utilisation and stability. Resettled refugees face unique struggles securing these dimensions and, thus, food security when moving to a new country. This systematic review aimed to identify the challenges Australian refugees experience in achieving the four dimensions of food security. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed; the SPIDER tool was used to determine eligibility criteria. Three databases were searched using terms relating to food in/security and refugees from 2000 to 20 May 2017. RESULTS Seven articles were retained for analysis. Studies were categorised against the four dimensions, with four studies identifying challenges against all dimensions. Challenges contributing to high levels of food insecurity in each dimension included: availability and cost of traditional foods, difficulty in accessing preferred food outlets, limited food knowledge and preparation skills and food stability due to low income and social support. CONCLUSIONS Food insecurity adversely impacts refugee health and integration. Methodical research framed by the four dimensions of food security is imperative to address challenges to securing food security in refugee groups and assisting in the development of sustainable interventions.

Women's Risk of Food Insecurity

Women are at high risk of becoming food insecure. While emergency food relief assistance is available, an underlying clientele culture and stigma combined with entrenched societal power inequality and gender role identification create barriers for women to access safe and nutritious food. This commentary aims to discuss this issue and provide suggestions on what needs to be done to ensure that those at highest vulnerability are food secure. within the household or those they are caring for, placing themselves as risk of poor physical and mental health [3,5,7]. Food security is defined as ‘when all people at all times have physical and economic access to sufficient safe and nutritious food that meets individual dietary needs and food preferences for an active and healthy life’ [1]. Underpinned by four dimensions: food availability; food access; food utilization; and, the stability or vulnerability of the previous 3 pillars, food insecurity is a global problem and impacts vulnerable people, in particular women [1]. Power inequalities, such male control [5] and domestic or intimate partner violence [3] further exacerbate the risk of women becoming food insecure. These situations create an environment of economic and/or physical abuse, and instill gender role identification. For those that leave, homelessness, poverty and a reliance on relief assistance ensues [3,5]. Being food insecure not only means experiencing hunger or undernourishment, but exists on many levels from being mildly food insecure whereby there are difficulties in obtaining adequate nutrition food for oneself or family members to experiencing severe food insecurity [10]. Where Do Vulnerable Women Access Food? Initially women sacrifice their needs for others [3,5,7]; any food that is purchased has to be cheap and last until the next pay or income support is received. In many cases healthy food, although preferred, is not a feasible choice due to cost and product life [5]. When there are few choices for food access, emergency relief may seem the only solution. Emergency relief assistance is defined as “the provision of financial and material aid to people in immediate need, or a referral to link people with specialist community services” [11]. Food is a major component of emergency relief assistance and in this context is recognized as a mechanism to foster engagement and communication and is seen by some as a symbol of security and safety [12]. The emergency relief sector comprises a variety of levels. At the coalface there are numerous religious, community, government and welfare organizations that provide clients with a safe refuge, food and individualized services such as health appointments, job interviews, budgeting and cooking skills [12]. In Australia, many of these organizations receive donated food from local food businesses and food rescue organizations such as Food bank. Collectively, it is these organizations that are increasingly Context Women due to a range of socio-economic conditions, such as domestic violence, poor employment and education may be more vulnerable to insecurity in their daily lives [1-4]. In the United States (US), it has been noted that female-led households have a high prevalence of household insecurity, 30.2% compared to 11% in the general population [4], with often poor economic and social implications, for example, women are more likely to live in a food insecure household than men, with women who are alone or are single parents at a higher risk of food insecurity than married women [2,5]. Such women may be vulnerable to food insecurity, due to low income, lack of support and the drive to put their children and others before themselves [5-8]. Due to the fluidity of individual food security and the lack of academic reporting regarding women and food insecurity in Australia, it is difficult to ascertain the exact numbers of women experiencing food insecurity in Australia. However, other measures such as poverty, a strong predictor for food insecurity, can be used to indicate the extent of the problem. In 201112, approximately 14.7% of Australian women experienced poverty [9] and thus were at risk of or experienced food insecurity. In Australia 46% of the workforce is female, however their average weekly full-time wage is18.2% lower than for men and they are more likely to be employed in part-time positions [8], thus reducing their earning capacity and placing them at risk of poverty, a primary determinant of food insecurity [6]. Lower income means a reprioritization of funds, food is replaced by accommodation costs, utility bills and other urgent costs, such as medical expenses [5]. As primary caregivers and mothers, women reallocate what food and resources they have to ensure household members remain healthy and free of illness. By internalizing the care giving role, women sacrifice their own hunger and prioritize other members either

Optimizing Gestational Weight Gain With the Eating4Two Smartphone App: Protocol for a Randomized Controlled Trial

Background Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. Objective The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. Methods This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women’s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. Results Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. Conclusion Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo) Registered Report Identifier RR1-10.2196/9920