Quality evaluation of nutrition policies in early childhood education and care services in Nerang, QLD

ISSUE ADDRESSED

Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland.

METHODS

Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool.

RESULTS

Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100).

CONCLUSIONS

All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

Barriers and enablers to a healthy food environment in Australian childcare services: Exploring directors' perspectives

ISSUE ADDRESSED

Early childhood education and care (ECEC) settings are ideal environments to optimise nutrition and positively influence children's food behaviours. However, recent research has identified the need to improve nutrition policies, food provision, and mealtime environments in Australian ECEC settings. This study explored the perceptions of ECEC directors regarding barriers and enablers to a health-promoting food environment within ECEC services.

METHODS

Eleven directors from ECEC services in Nerang, Queensland, and surrounding areas, participated in qualitative interviews between March and May 2021. Transcripts were analysed using qualitative content analysis that followed a deductive-inductive approach employing nutrition-related domains from the Wellness Child Care Assessment Tool, these being: (i) nutrition policy; (ii) nutrition education; (iii) food provision; and (iv) mealtimes. Transcripts were coded independently by two researchers in NVivo and consensus for barriers and enablers was achieved through discussion.

RESULTS

Barriers and enablers were reported across four domains (nutrition policy, nutrition education, food provision, and mealtimes). Comprehensive nutrition-related policies were an enabler to a healthy nutrition environment but were sometimes described as lacking detail or customisation to the service. Nutrition education for children was described as competing with other activities for time and resources in an already-crowded curriculum. Financial and time pressures faced by families were a barrier to healthy food provision in services where families provided food for children. The ability of staff to sit with children and engage in conversation during mealtimes was an enabler; however, competing demands on time and the unavailability of food for staff were cited as barriers to health-promoting mealtimes.

CONCLUSIONS

Directors in ECEC services report both barriers and enablers to a healthy food environment. Nutrition policies were an enabler when comprehensive and relevant but a barrier when vague and not tailored to the service environment. ECEC services should be supported to develop and implement service-specific nutrition policies and practices by engaging with parents and staff. SO WHAT?: The barriers and enablers reported in this study should be considered when designing and implementing future evidence-based interventions to improve the nutrition environment in ECEC services.

Burnout Rates in Clinical Radiation Oncology and Variations across Professional Subgroups

PURPOSE/OBJECTIVE(S)

Physician and medical professional burnout has emerged as an important issue in clinical medicine and has been shown to negatively affect patient outcomes. The aim of this study is to determine how rates of burnout vary between different radiation oncology professional subgroups.

MATERIALS/METHODS

Participants were selected from those employed in one of the professional subgroups (radiation therapists, nurses, physicists, dosimetrists, and physicians) at two institutions that cover a total of seven sites. 126 individuals were recruited to participate. In addition to demographics, participants were asked to respond to questions regarding professional burnout utilizing the Maslach Burnout Inventory (MBI). Responses were on a seven-point Likert scale with subcategories of Exhaustion, Depersonalization, and Personal Achievement. Each participant's score per subcategory was categorized as either low, moderate, or high. For our primary outcome, frequencies and proportions were reported and Fisher's Exact Test was used to evaluate whether there was a statistically significant difference in proportions in categorized burnout scores across professional subgroups. Secondary analyses were performed comparing burnout across sex, age, and categorized years in position. An alpha level of 0.05 was used for all analyses.

RESULTS

In total, 55 participants responded to the survey: 12 nurses, 8 dosimetrists, 12 physicians, 5 physicists, and 18 radiation therapists for a response rate of 43.6%. Demographics were consistent across professional subgroups with the exception of participant sex (p = .0397), which had a greater proportion of females (72.22%) in the Radiation Therapist subgroup. Among the three subcategories, only Exhaustion had a significant difference between groups (p = .0494) with Dosimetrists (62.50%) and Physicists (40.00%) experiencing the highest level of burnout. For Depersonalization, at least one individual in each subgroup identified high burnout with higher rates among the Dosimetrists (25.00%) and Physicists (40.00%). Similarly, at least one person in each subgroup reported high burnout in Personal Achievement, but the highest response was among Dosimetrists (37.50%). In total, at least 12.75% of participants reported high burnout in at least one subcategory. No statistically significant differences in burnout were detected in our secondary analyses across sex, age, and years in position.

CONCLUSION

Our study showed that burnout rates are moderate in members of the radiation oncology team, with dosimetrists and physicists displaying the highest levels of burnout. In order to better estimate professional burnout, larger studies should be conducted to determine causes of burnout. Furthermore, wellness programs should be encouraged and incentivized to help reduce burnout and improve workplace morale, occupational fulfillment, and effective patient care.

Cannabinol (CBN; 30 and 300 mg) effects on sleep and next-day function in insomnia disorder ('CUPID' study): protocol for a randomised, double-blind, placebo-controlled, cross-over, three-arm, proof-of-concept trial

OBJECTIVE

Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of Cannabis sativa derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans.

METHODS

The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights; each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness; and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials.

ETHICS AND DISSEMINATION

Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences.

TRIAL REGISTRATION NUMBER

NCT05344170.

Preparation procedures of food and beverage samples for oxygen bomb calorimetry: A scoping review and reporting checklist

Standardised bomb calorimetry methods are essential to accurately quantify the gross energy within food and beverages, yet no accepted protocols exist. The objective of this review was to synthesise literature on food and beverage sample preparation methods used for conducting bomb calorimetry. This synthesis enhances our understanding of the extent to which methodological variances may currently affect estimates of the caloric values of dietary items. Five electronic databases were searched for peer reviewed literature on food and beverage energy measurement via bomb calorimetry. Data were extracted on seven identified methodological themes, including: (1) initial homogenisation, (2) sample dehydration, (3) post-dehydration homogenisation, (4) sample presentation, (5) sample weight, (6) sample frequency, and (7) equipment calibration. A tabular and narrative approach was used to synthesise the data. Studies that specifically explored the impact of any methodological variance on the energy derived from foods and/or beverages were also considered. In total, 71 documents describing food and beverage sample preparation techniques and processes used for bomb calorimetry were identified. Only 8% of studies described all seven identified sample preparation and calibration processes. The most frequent approaches used included: initial homogenisation - mixing or blending (n = 21); sample dehydration - freeze drying (n = 37); post-dehydration homogenisation - grinding (n = 24); sample presentation - pelletisation (n = 29); sample weight - 1g (n = 14); sample frequency - duplicate (n = 17); and equipment calibration - benzoic acid (n = 30). The majority of studies that have measured food and beverage energy via bomb calorimetry do not describe sample preparation and calibration methods in detail. The extent to which different sample preparation processes influence the energy derived from food and beverage items is yet to be fully elucidated. Use of a bomb calorimetry reporting checklist (described within) may assist with improving the methodological quality of bomb calorimetry studies.

Muscle fiber typology is associated with the incidence of overreaching in response to overload training

Variability in the performance responses following an overload training period and subsequent taper was associated with the variation in the muscle fiber typology of the gastrocnemius. Runners with an estimated higher proportion of type I fibers (i.e., lower carnosine z-score) were able to maintain performance in response to an overload training period and subsequently achieve a superior performance supercompensation. These findings show that muscle fiber typology contributes to the variability in performance responses following training.

Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) for chronic insomnia disorder ('CANSLEEP' trial): protocol for a randomised, placebo-controlled, double-blinded, proof-of-concept trial

INTRODUCTION

Insomnia is a highly prevalent and costly condition that is associated with increased health risks and healthcare utilisation. Anecdotally, cannabis use is frequently reported by consumers to promote sleep. However, there is limited research on the effects of cannabis on sleep and daytime function in people with insomnia disorder using objective measures. This proof-of-concept study will evaluate the effects of a single dose of an oral cannabis-based medicine on sleep and daytime function in participants with chronic insomnia disorder.

METHODS AND ANALYSIS

A randomised, crossover, placebo-controlled, single-dose study design will be used to test the safety and efficacy of an oral oil solution ('ETC120') containing 10 mg Δ9-tetrahydrocannabinol (THC) and 200 mg cannabidiol (CBD) in 20 participants diagnosed with chronic insomnia disorder. Participants aged 35-60 years will be recruited over an 18-month period commencing August 2019. Each participant will receive both the active drug and matched placebo, in a counterbalanced order, during two overnight study assessment visits, with at least a 1-week washout period between each visit. The primary outcomes are total sleep time and wake after sleep onset assessed via polysomnography. In addition, 256-channel high-density electroencephalography and source modelling using structural brain MRI will be used to comprehensively examine brain activation during sleep and wake periods on ETC120 versus placebo. Next-day cognitive function, alertness and simulated driving performance will also be investigated.

ETHICS AND DISSEMINATION

Ethics approval was received from Bellberry Human Research Ethics Committee (2018-04-284). The findings will be disseminated in a peer-reviewed open-access journal and at academic conferences.

TRIAL REGISTRATION NUMBER

ANZCTRN12619000714189.

p53, Cyclin D1, p21 (WAF1) and Ki-67 (MIB1) Expression at Invasive Tumour Fronts of Oral Squamous Cell Carcinomas and Development of Local Recurrence

BACKGROUND

Expression of p53, cyclin D1, p21 (WAF1) and Ki-67 (MIB1) was evaluated in oral squamous cell carcinoma (OSCC) to test whether levels of these markers at invasive tumour fronts (ITFs) could predict the development of local recurrence.

MATERIALS AND METHODS

Archived paraffin-embedded specimens from 51 patients with T1/T2 tumours were stained immunohistochemically and analysed quantitatively. Local recurrence-free survival was tested with Kaplan-Meier survival plots (log-rank test) using median values to define low and high expression groups and with a Cox's proportional hazards model in which the expression scores were entered as continuous variables.

RESULTS

The assessment of expression of all markers was highly reliable, univariate analysis showing that patients with clear surgical margins, with low cyclin D1 and high p21 expression at the ITF had the best local recurrence-free survival. Multivariate analysis showed that these three parameters were independent prognostic factors but that neither p53 nor MIB1 expression were of prognostic value.

CONCLUSIONS

Assessment of p53, cyclin D1, p21 (WAF1), and Ki-67 (MIB1) at the ITF could help to predict local recurrence in early stage oral squamous cell carcinoma cases.

Incidence and management of high grade glioma in Māori and non-Māori patients

A retrospective analysis of 301 patients was undertaken between 1993 and 2003 to evaluate the relationship of ethnicity with incidence, treatment and survival in patients undergoing surgery for high grade glioma (HGG) in New Zealand. There was no difference in age standardised incidence of HGG in Māori compared to non-Māori patients; 4.2/100,000 person years (95% confidence interval [CI] 2.6-6.9) versus 4.1 (95% CI 3.6-4.6). Māori were more likely to have complete tumour resection (odds ratio 3.59 (95% CI 1.01-12.76)) but waited 1.32 (95% CI 0.98-1.79) times longer for radiotherapy. Median survival was 29 weeks with poorer survival in Māori compared to non-Māori (hazard ratio 1.55 [95% CI 0.95-2.55]). We concluded that the incidence of HGG in Māori is similar to non-Maori. However, Māori with HGG have higher rates of complete resection but wait longer for radiotherapy and may have poorer overall survival than non-Māori.

Replicon particle vaccine protects swine against influenza

An alphavirus derived replicon particle (RP) vaccine expressing the cluster IV H3N2 swine influenza virus (SIV) hemagglutinin (HA) gene induced protective immunity against homologous influenza virus challenge. However, pigs with maternal antibody had no protective immunity against challenge after vaccination with RP vaccines expressing HA gene alone or in combination with nucleoprotein gene.

Periodontics: 9. Periodontitis and systemic conditions--is there a link?

The possibility that periodontal diseases have an effect on systemic health is being widely investigated. This paper reviews the potential links and the mechanism of these effects.

CLINICAL RELEVANCE

Although the effects of periodontitis on systemic health do not yet have an effect on clinical decisions, knowledge and understanding of the link, effects and mechanism are important.

Periodontics: 8. Periodontal problems associated with compromised anterior teeth

Periodontal disease can significantly impact on the appearance of the anterior teeth. Prior to any definitive treatment, stabilization of the periodontal condition is a requirement. Treatment options can range from the placement of simple restorations, through orthodontic realignment, to the extraction and replacement of hopeless teeth. Each treatment plan must be individually tailored to the patient and level of periodontal disease, and must include provision for maintenance periodontal therapy.

CLINICAL RELEVANCE

Periodontal diseases may compromise the prognosis of anterior teeth. Management is challenging and clinicians should take into consideration the short and long-term survival in treatment planning.

Periodontics: 6. The management of gingival recession

Gingival recession is a common condition affecting the dentition. This paper describes the aetiology of gingival recession and discusses the appropriate management of this condition.

CLINICAL RELEVANCE

Careful examination to detect gingival recession, or the factors that may place the patient at risk for recession, are important for prevention.

Periodontics: 7. Periodontal problems associated with compromised posterior teeth

Periodontitis affecting multi-rooted teeth presents a challenge for non-surgical and surgical management. This paper reviews the management of compromised posterior teeth.

CLINICAL RELEVANCE

Successful management of compromised posterior teeth requires careful assessment of all contributing factors and the implementation of a long term maintenance programme.