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Introduction: Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments., Methods and Analysis: The 'Food for Thought' study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim is to investigate whether anthocyanin consumption, either through diet or supplementation, can prevent memory loss progression and improve inflammatory and cardiovascular health in older adults at risk for dementia. Eligible participants will include those aged 60-85 years with a diagnosis of amnestic mild cognitive impairment or with a self-referral of memory concerns and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment screening test. Participants will be randomised to one of three arms: High anthocyanin ('purple foods') diet (aiming for a target of 250 mg anthocyanins/day); freeze-dried product derived from blackcurrants (250 mg anthocyanins/day); or control (coloured maltose powder). The primary outcome is auditory anterograde memory functioning assessed by the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall. Secondary outcomes are additional cognitive functions including processing speed, working memory, aspects of executive functioning (attentional shifting and word generativity) and premorbid estimate as well as subjective memory problems and self-reported depression symptoms. Additional secondary outcomes are blood pressure, inflammatory biomarkers, brain-derived neurotrophic factor, fatty acid profile, apolipoprotein E and polyphenol metabolites, gut microbiota composition and function and vascular and microvascular endothelial function tests. Repeated measures analysis of variance and/or mixed linear modelling will evaluate changes over time, with the inclusion of covariates., Ethics and Dissemination: Ethics approval has been obtained from the Greater Western Human Research Ethics Committee (2021/ETH12083). A Consumer Advisory Group was established to guide and review the protocol and dissemination strategy. The results of this trial are intended to be published in a peer-reviewed journal., Trial Sponsor: National Health and Medical Research Centre Dementia Collaborative Research Centre.Start date of clinical trial: 02 September 2022.Expected end date: 11 October 2024., Trial Registration Number: ACTRN12622000065796., Competing Interests: Competing interests: HB is or has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. There are no other conflicts of interest among the other authors., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Sleep disorders are associated with a range of health conditions, with poor sleep often further exacerbating individuals' health, well-being, and ability to participate in daily occupations. Weighted blankets offer a potentially simple nonpharmacological sleep intervention option., Objective: To summarize available literature on instrumentation and outcomes associated with overnight use of weighted blankets for therapeutic purpose., Evidence Review: A scoping review following the PRISMA review guidelines was conducted. Sources included MEDLINE, Cochrane Library, CINAHL, PsycINFO, Scopus, Embase, and Google. Included studies reported on overnight use of weighted blankets. Critical appraisal of studies was conducted with standardized tools., Findings: Eighteen studies met the inclusion criteria. Positive outcomes were reported for adults, including improved sleep, reduction in medication use, and improved mood. Sleep outcomes were mixed for children and adolescents but included improved occupational performance. Methodological quality of included studies regarding effectiveness was variable. Ten studies included details of the intervention, whereas only one study reported on implementation. No specific guidelines for use were included., Conclusions and Relevance: Weighted blankets are used as a sleep intervention for individuals across the life span experiencing a range of health conditions. Currently, there is more evidence of effectiveness with adults, although parents are favorable regarding weighted blanket use for children. Implementation and recommendation of weighted blankets are typically led by occupational therapists, with knowledge of the intervention facilitating use. This review provides information to inform occupational therapists' clinical decision-making and continued implementation of weighted blankets for individuals with sleep problems. Plain-Language Summary: This scoping review summarizes what is known about the use of weighted blankets as a sleep intervention for people of all ages. There is more evidence for overnight use of weighted blankets for adults, with improvements reported in sleep, mood, medication use, and pain. Although there is little evidence of improvement in sleep for children, some children show improvement in everyday functioning, and parents report positive outcomes from overnight use of weighted blankets. These findings suggest that occupational therapists should consider offering or recommending weighted blankets as a sleep intervention option for people of all ages, alongside consideration of individuals' preferences. Development of practice guidelines that incorporate current research findings is urgently needed to support occupational therapists' use of weighted blankets., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)

Amidst a backdrop of attacks on both LGBTQ+ individuals and LGBTQ+ venues coupled with the ongoing changing landscape of urban queer spaces across the UK, this article offers a timely autoethnographic and socio-spatial account of queer "safety." This article examines when and how queer spaces are experienced as "safe." Specifically, the article offers reflections from the author's experience of two queer spaces: (1) The Proud Place, a purpose-built community center in Manchester, England and (2) The concert of a queer female artist that took place in Bristol, England. The article concludes that queer spaces are contextually safe spaces. Through an analysis of (in)visibility and exclusivity in queer spaces, the article reveals the social structures and power dynamics impacting perceptions of safety.

Background: Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours., Methods: A mixed-methods study between January and December 2022. Patients aged ≥40 years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed., Results: Of 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol ≥5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide., Conclusions: Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To examine associations between three different plant-based diet quality indices, chronic kidney disease (CKD) prevalence and related risk factors in a nationally representative sample of the Australian population., Design: Cross-sectional analysis. Three plant-based diet scores were calculated using data from two 24-h recalls: an overall plant-based diet index (PDI), a healthy PDI (hPDI) and an unhealthy PDI (uPDI). Consumption of plant and animal ingredients from 'core' and 'discretionary' products was also differentiated. Associations between the three PDI scores and CKD prevalence, BMI, waist circumference (WC), blood pressure (BP) measures, blood cholesterol, apo B, fasting TAG, blood glucose levels (BGL) and HbA1c were examined., Setting: Australian Health Survey 2011-2013., Participants: n 2060 adults aged ≥ 18 years (males: n 928; females: n 1132)., Results: A higher uPDI score was associated with a 3·7 % higher odds of moderate-severe CKD (OR: 1·037 (1·0057-1·0697); P = 0·021)). A higher uPDI score was also associated with increased TAG ( P = 0·032) and BGL ( P < 0·001), but lower total- and LDL-cholesterol ( P = 0·035 and P = 0·009, respectively). In contrast, a higher overall PDI score was inversely associated with WC ( P < 0·001) and systolic BP ( P = 0·044), while higher scores for both the overall PDI and hPDI were inversely associated with BMI ( P < 0·001 and P = 0·019, respectively)., Conclusions: A higher uPDI score reflecting greater intakes of refined grains, salty plant-based foods and added sugars were associated with increased CKD prevalence, TAG and BGL. In the Australian population, attention to diet quality remains paramount, even in those with higher intakes of plant foods and who wish to reduce the risk of CKD.

Background: In Australia, the prevalence of food insecurity increased by 1.5% between 2014 and 2016 and 2018 and 2020 due to effects of the COVID-19 pandemic. OzHarvest offers a 6-week Nutrition Education and Skills Training (NEST) programme to adults at risk of food insecurity. NEST provides 2.5-h weekly cooking workshops on simple, healthy and affordable meals. This study aimed to determine the immediate (post) and longer-term (6 months) impacts of participation in NEST., Methods: A quasi-experimental study with pre-post surveys (n = 258) and 6-month follow-up surveys (n = 20) was conducted from June 2019 to July 2022. Survey results were obtained from NEST programme participants (≥18 years) from six major Australian cities., Results: Participants demonstrated immediate improvement in nutrition knowledge (p < 0.001), food preparation behaviours (p < 0.001) and confidence and self-efficacy (n = 222; p < 0.001). Intake of discretionary foods decreased (p < 0.001), whereas fruit, vegetable and water intake increased (p < 0.001). Food security improved from 57% to 68% immediately after the completion of the programme (p < 0.001). Participants demonstrated longer-term improvements in nutrition knowledge (p < 0.001), cooking confidence (n = 8; p = 0.03), food preparation behaviours (p = 0.003) and increased vegetable (p = 0.03) and fruit intake (p = 0.01)., Conclusions: Participation in OzHarvest's NEST programme results in short-term improvements in food security levels and dietary behaviours. Over the longer term, these changes were sustained but to a lesser degree, indicating that systemic changes are required to address underlying socio-economic disadvantages., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background: PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems (EMS) were inexperienced in delivering such research., Aim: To identify barriers and facilitators to delivery of the PARAMEDIC2 (Adrenaline) trial by five UK NHS EMS., Methods: This qualitative study took a grounded theory approach to thematic analysis of workshop data. Members of the trial teams from each service attended a workshop in November 2018 and discussed their experiences in answer to two prompt questions. Data were coded and themes presented., Results: Three main themes were identified: professionalism, organisational investment and unique features of EMS . The study provided an opportunity for recruiting paramedics and research paramedics to demonstrate their professionalism . Research paramedics felt it was part of their professional duty to initiate discussions with the patient/family regarding the trial rather than leave this task to the hospital teams as would usually happen. Organisational investment was reflected by prioritising trial training and further development of research paramedics. By these means, research culture was developed. The unique features of EMS such as geographical challenges were often addressed with technological solutions and through building relationships with internal teams., Conclusion: Barriers to trial delivery included infrequent exposure to the condition of interest and lack of continuity in research paramedic roles. Facilitators identified included flexibility of the research protocol, and organisational investment in the development of research paramedics.Participating in PARAMEDIC2 was challenging for the EMS involved, but ultimately strengthened their research culture., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: HP is a member of the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support task force committee. She holds a grant from the National Institute for Health and Social Care Research (NIHR)/Health Education England (ICA-CDRF-2018-04-ST2-05). NR, IG, MD, KC, MJ, CS, EE, RF: Nil., (© 2024 The Author(s).)

Background: During out of hospital cardiac arrest (OHCA) paramedics must make decisions to commence, continue, terminate or withhold resuscitation. These decisions are known to be complex, subject to variability and often dependent on provider preference. This study aimed to understand paramedic decision-making regarding the commencement of resuscitation using a discrete choice experiment., Methods: A discrete choice experiment between October-December 2022 surveying paramedics from ten National Health Service ambulance trusts in England and Wales. Respondents were presented with fourteen vignettes, each comprising thirteen attributes, and asked to decide if they would provide resuscitation or not., Results: Eight hundred and sixty-four paramedics completed the survey (61.8% male, median age 36 years (IQR 17.1)) and half had < 5 years clinical experience (n = 443 (51.2%). Respondents expressed a general preference to offer resuscitation (p = <0.01). All attributes except patient gender were statistically significant and important regarding an offer of resuscitation. Cut-offs where an offer of resuscitation was less likely were patient age of 73 years (p=>0.05), mild dementia (p = >0.05) and moderate frailty (p = <0.01). Paramedic characteristics of female gender, longest (>10 years) and shortest (<5 years) period qualified, lower academic qualification, lower skill level and attending fewer OHCA's were more likely to result in an offer of resuscitation., Conclusion: During OHCA paramedics use objective and non-objective factors to make pragmatic decisions regarding an offer of resuscitation. Future research should focus on how best to support paramedics to make decisions during OHCA, how variability in decision-making impacts patient outcomes and how this relates to patient and public expectations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024 Published by Elsevier B.V.)

Context: Prior research has explored the effect of synbiotics, the combination of probiotics and prebiotics, on the gut microbiota in clinical populations. However, evidence related to the effect of synbiotics on the gut microbiota in healthy adults has not been reviewed to date., Objective: A systematic review and meta-analysis was conducted to comprehensively investigate the effect of synbiotics on the gut microbiota and inflammatory markers in populations of healthy adults., Data Sources: Scopus, PubMed, Web of Science, ScienceDirect, MEDLINE, CINAHL, and The Cochrane Library were systematically searched to retrieve randomized controlled trials examining the primary outcome of gut microbiota or intestinal permeability changes after synbiotic consumption in healthy adults. Secondary outcomes of interest were short-chain fatty acids, inflammatory biomarkers, and gut microbiota diversity., Data Extraction: Weighted (WMD) or standardized mean difference (SMD) outcome data were pooled in restricted maximum likelihood models using random effects. Twenty-seven articles reporting on 26 studies met the eligibility criteria (n = 1319)., Data Analysis: Meta-analyses of 16 studies showed synbiotics resulted in a significant increase in Lactobacillus cell count (SMD, 0.74; 95% confidence interval [CI], 0.15, 1.33; P = 0.01) and propionate concentration (SMD, 0.22; 95% CI, 0.02, 0.43; P = 0.03) compared with controls. A trend for an increase in Bifidobacterium relative abundance (WMD, 0.97; 95% CI, 0.42, 2.52; P = 0.10) and cell count (SMD, 0.82; 95% CI, 0.13, 1.88; P = 0.06) was seen. No significant differences in α-diversity, acetate, butyrate, zonulin, IL-6, CRP, or endotoxins were observed., Conclusion: This review demonstrates that synbiotics modulate the gut microbiota by increasing Lactobacillus and propionate across various healthy adult populations, and may result in increased Bifidobacterium. Significant variations in synbiotic type, dose, and duration should be considered as limitations when applying findings to clinical practice., Systematic Review Registration: PROSPERO no. CRD42021284033., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Objective: Diet quality is significantly impacted by social and environmental factors. People experiencing socio-economic disadvantage face inequitable barriers to accessing nutritious foods and health services, resulting in significant health disparities. This study aimed to explore the barriers faced by organisations that provide food support to people experiencing disadvantage as well as to identify potential strategies to enhance this support for improved well-being of clients., Design: Semi-structured interviews using an exploratory approach and inductive thematic analysis., Setting: Australia., Participants: Individuals from organisations involved in the provision of food support for people experiencing disadvantage aged ≥16 years., Results: Two major themes were identified from thirteen interviews. 'Dignity and respect for clients' serves as a guiding principle for food-related services across all organisations, while 'food' was a point of connection and a potential gateway to additional support pathways. Five additional subthemes included 'food as a platform to reduce social isolation, foster connection and promote participation', challenges with 'servicing clients with diverse experiences and needs', 'dependence on staff and volunteers with varying knowledge and skillsets', ensuring 'adequate access to services, resources and facilities' and 'necessity of community collaboration'., Conclusions: This study highlights the unique position of organisations involved in food support to identify client-specific needs and implement broader holistic health support. Future interventions should prioritise dignity, respect and social connection in design. Organisations require an adequately trained, sustainable workforce, with shared or enhanced services, resources and facilities, and greater community coordination with other services to maximise effectiveness.

Ulcerative Colitis (UC), a type of Inflammatory Bowel Disease (IBD), is a chronic, relapsing gastrointestinal condition with increasing global prevalence. The gut microbiome profile of people living with UC differs from healthy controls and this may play a role in the pathogenesis and clinical management of UC. Probiotics have been shown to induce remission in UC; however, their impact on the gut microbiome and inflammation is less clear. Anthocyanins, a flavonoid subclass, have shown anti-inflammatory and microbiota-modulating properties; however, this evidence is largely preclinical. To explore the combined effect and clinical significance of anthocyanins and a multi-strain probiotic, a 3-month randomised controlled trial will be conducted in 100 adults with UC. Participants will be randomly assigned to one of four groups: anthocyanins (blackcurrant powder) + placebo probiotic, probiotic + placebo fruit powder, anthocyanin + probiotic, or double placebo. The primary outcome is a clinically significant change in the health-related quality-of-life measured with the Inflammatory Bowel Disease Questionnaire-32. Secondary outcomes include shotgun metagenomic sequencing of the faecal microbiota, faecal calprotectin, symptom severity, and mood and cognitive tests. This research will identify the role of adjuvant anti-inflammatory dietary treatments in adults with UC and elucidate the relationship between the gut microbiome and inflammatory biomarkers in this disease, to help identify targeted individualised microbial therapies. ANZCTR registration ACTRN12623000630617., (© The Author(s) 2024.)

Aims: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest., Methods: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained., Conclusion: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: GDP is co-chair of the International Liaison Committee on Resuscitation (ILCOR). CD and JPN are emeritus members of the ILCOR Advanced Life Support task force. KC and HP are current members of the ILCOR Advanced Life Support task force. GDP is editor-in-chief and JPN is founding editor of Resuscitation Plus. KC is associate editor of Resuscitation Plus and guest editor for the research methodology special edition., (© 2023 The Authors.)

Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer management, for an improved quality of life. However, limited research has been conducted to understand how the decision to amputate is made for people with a chronic ulcer when amputation is not required as a medical emergency. Therefore, the aim was to identify and map key concepts in the literature which describe the decision-making for diabetes-related amputations. This review followed Arksey and O'Malley's PRISMA scoping review framework. Five electronic databases and grey literature were searched for papers which described clinical reasoning and/or decision-making processes for diabetes-related amputation. Data were extracted and mapped to corresponding domains of the World Health Organisation's International Classification of functioning, Disability and Health (ICF) framework. Ninety-four papers were included. Personal factors including emotional wellbeing, quality of life, and treatment goals are key considerations for an elective amputation. It is important to consider an individual's lifestyle and personal circumstances, as well as the pathology when deciding between amputation or conservative management. This highlights the importance of a holistic and shared decision-making process for amputation which includes assessment of a person's lifestyle and function., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Immediate action is needed to stabilise the climate. Dietitians require knowledge of how the therapeutic diets they prescribe may contribute to climate change. No previous research has quantified the climate footprint of therapeutic diets. This study sought to quantify and compare the climate footprint of two types of therapeutic diets for people with chronic kidney disease (CKD) with two reference diets., Methods: A usual diet for an individual with CKD and a novel plant-based diet for CKD were compared with the current Australian diet and the Australian-adapted EAT Lancet Planetary Health Diet (PHD). The climate footprint of these diets was measured using the Global Warming Potential (GWP*) metric for a reference 71-year-old male., Results: No diets analysed were climate neutral, and therefore, all contribute to climate change. The novel plant-based diet for CKD (1.20 kg carbon dioxide equivalents [CO 2 e] per day) produced 35% less CO 2 e than the usual renal diet for an individual with CKD (1.83 kg CO 2 e per day) and 50% less than the current Australian diet (2.38 kg CO 2 e per day). The Australian-adapted EAT Lancet PHD (1.04 kg CO 2 e per day) produced the least amount of CO 2 e and 56% less than the current Australian diet. The largest contributors to the climate footprint of all four diets were foods from the meats and alternatives, dairy and alternatives and discretionary food groups., Conclusions: Dietetic advice to reduce the climate footprint of therapeutic diets for CKD should focus on discretionary foods and some animal-based products. Future research is needed on other therapeutic diets., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background: Civil society organisations (CSOs) are increasingly participating in food system governance in ways that challenge the dominant industrialised profit-driven system., Methods: An online survey of Australian CSOs that self-identified as being involved in food system governance was conducted to identify their objectives and activities and the enablers of, and barriers to, their participation in food system governance. Respondents were nongovernment organisations/registered charities, social enterprises, businesses and collaborative research initiatives involved in food system governance in Australia (n = 43)., Results: Organisations undertook activities across all dimensions of the food system (food growing/production, distribution, sale, marketing, access and consumption) and had diverse goals related to health, sustainability and social and economic development. They engaged in food system governance via activities such as advocacy and lobbying for policy and legislative change and guiding policy development. Key enablers of this engagement included funding, internal capacity, external supports and collaborations, and inclusive consultation processes and, when not present, were considered barriers., Conclusions: CSOs play an important role in food system governance in Australia, including by influencing policy outcomes, contributing to more inclusive and democratic forms of governance and leading community-based food system policies. For CSOs to play a more central role, provision of longer-term funding; creation of dedicated food and nutrition policies at local, state and federal government levels; and governance processes that are inclusive, accessible and minimise power differentials are required. This study's findings can be used to identify many opportunities for dietitians to engage with CSOs in education, research and advocacy roles for food system transformation., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Inflammatory bowel diseases (IBD) are chronic conditions arising from an intricate interplay of genetics and environmental factors, and are associated with gut dysbiosis, inflammation, and gut permeability. In this study, we investigated whether the inflammatory potential of the diet is associated with the gut microbiota profile, inflammation, and permeability in forty patients with IBD in clinical remission. The dietary inflammatory index (DII) score was used to assess the inflammatory potential of the diet. The fecal microbiota profile was analyzed using 16SrRNA (V3-V4) gene sequencing, while fecal zonulin and calprotectin levels were measured with enzyme-linked immunosorbent assays. We found a positive correlation between the DII score and elevated calprotectin levels (Rho = 0.498; p = 0.001), but not with zonulin levels. Although α- and β-diversity did not significantly differ across DII quartiles, the most pro-inflammatory diet group exhibited a higher fecal abundance of Veillonella rogosae ( p = 0.026). In addition, the abundance of some specific bacteria sequences showed an exponential behavior across DII quartiles and a correlation with calprotectin or zonulin levels ( p ≤ 0.050). This included a positive correlation between sq702. Veillonella rogosae and fecal calprotectin levels (Rho = 0.419, p = 0.007). DII, calprotectin, and zonulin levels were identified as significant predictors of 6-month disease relapse ( p ≤ 0.050). Our findings suggest a potential relationship of a pro-inflammatory diet intake with Veillonella rogosae and calprotectin levels in IBD patients in clinical remission, which may contribute to disease relapse.

Oxidative stress is a common characteristic of psychiatric, neurological, and neurodegenerative disorders. Therefore, compounds that are neuroprotective and reduce oxidative stress may be of interest as novel therapeutics. Phenolic, flavonoid and anthocyanin content, ORAC and DPPH free radical scavenging, and Cu 2+ and Fe 2+ chelating capacities were examined in variations (fresh/capsule) of Queen Garnet plum (QGP, Prunus salicina ), black pepper ( Piper nigrum ) clove ( Syzygium aromaticum ), elderberry ( Sambucus nigra ), lemon balm ( Melissa officinalis ) and sage ( Salvia officinalis ), plus two blends ( Astralagus membranaceus -lemon balm-rich, WC and R8). The ability of samples to prevent and treat H 2 O 2 -induced oxidative stress in SH-SY5Y cells was investigated. Pre-treatment with WC, elderberry, QGP, and clove prevented the oxidative stress-induced reduction in cell viability, demonstrating a neuroprotective effect. Elderberry increased cell viability following oxidative stress induction, demonstrating treatment effects. Clove had the highest phenolic and flavonoid content, DPPH, and Cu 2+ chelating capacities, whereas QGP and elderberry were highest in anthocyanins. Black pepper had the highest ORAC and Fe 2+ chelating capacity. These findings demonstrate that plant extracts can prevent and treat oxidative stress-induced apoptosis of neuron-like cells in vitro. Further research into phytochemicals as novel therapeutics for oxidative stress in the brain is needed.

Background: Falls in older adults are an important issue internationally. They occur from complex interactions between biological, environmental and activity-related factors. As the sexes age differently, there may be sex differences regarding falls. This study aimed to determine the clinical effectiveness of a falls rapid response service (FRRS) in an English ambulance trust and to identify sex differences between patients using the service., Methods: A cross-sectional study between December 2018 and September 2020. Patients aged ≥ 60 years who had fallen within the study area were included. The FRRS comprised a paramedic and occupational therapist and responded 07:00-19:00, 7 days per week. Anonymised data regarding age, sex and conveyance were collected for all patients attended by the FRRS and standard ambulance crews. Clinical data regarding fall events were collected from consenting patients attended by the FRRS only., Results: There were 1091 patients attended by the FRRS versus 4269 by standard ambulance crews. Patient characteristics were similar regarding age and sex. The FRRS consistently conveyed fewer patients versus standard ambulance crews (467/1091 (42.8%) v. 3294/4269 (77.1%), p = < 0.01). Clinical data were collected from 426/1091 patients attended by the FRRS. In these patients, women were more likely to reside alone than men (181/259 (69.8%) v. 86/167 (51.4%), p = < 0.01), and less likely to experience a witnessed fall (16.2% v. 26.3%, p = 0.01). Women had a higher degree of comorbidity specific to osteoarthritis and osteoporosis, while men were more likely to report a fear of falling score of 0 (35.3% v. 22.7%, p = < 0.01)., Conclusion: The FRRS is clinically effective regarding falls compared to standard ambulance crews. Sex differences existed between men and women using the FRRS, indicating women are further along the falls trajectory than men. Future research should focus on demonstrating the cost effectiveness of the FRRS and how to better meet the needs of older women who fall., Competing Interests: None declared., (© 2023 The Author(s).)

Background: Cardio-metabolic risk factors, including hypertension, are increasingly appearing in childhood. The aims of this study were to examine the associations between dietary trajectories across childhood and subsequent blood pressure (BP) at age 10/11, and to further determine whether these associations were explained by BMI or fat mass., Methods: Data from 4360 participants from the Longitudinal Study of Australian Children were analysed. Dietary scores were computed based on similarity of intake to the Australian Dietary Guidelines. Group-based trajectory modelling was used to identify distinct dietary trajectories based on participant's individual dietary scores at up to four timepoints between age 4 and 11. Linear regression models examined the associations between dietary trajectories and BP measured at age 10/11. Models were adjusted for relevant covariates, and BMI or fat mass., Results: Four dietary trajectories were identified: "never healthy" (4.3%); "moderately healthy" (23.1%); "becoming less healthy" (14.2%); and "always healthy" (58.4%). Children in the "always healthy" trajectory had a lower systolic (-2.19 mmHg; 95% CI -3.78, -0.59) and diastolic BP (-1.71; -2.95, -0.47), compared with children in the "never healthy" trajectory after covariate adjustment. These associations were attenuated after additional adjustment for BMI or fat mass, but remained significant for diastolic BP., Conclusions: A dietary trajectory mostly aligned with the Australian Dietary Guidelines across childhood was associated with slightly lower BP at age 10/11, which was not fully explained by BMI or fat mass. These findings support the need to encourage and enable healthy dietary habits early in childhood to attenuate the increasing burden of cardio-metabolic disease., (© 2023. The Author(s).)

Background: Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women., Methods: We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the health system incremental cost and effects of the breastfeeding intervention relative to usual care., Discussion: Evidence will be given on the effectiveness of Aboriginal peer support workers to promote the initiation and continuation of breastfeeding of Aboriginal babies. The findings of this study will provide evidence of effectiveness and cost-effectiveness of including peer support workers in postnatal care to promote breastfeeding practices., Trial Registration: ACTRN12622001208796 The impact of breastfeeding peer support on nutrition of Aboriginal infants., (© 2023. The Author(s).)

Objectives: Care home residents comprise a significant minority of ambulance patients, but little is known about how care homes impact ambulance service workload. This study aims to quantify differences in the workload of ambulance paramedics associated with patient residence (care home vs private)., Design: This was an observational study using routine ambulance service data and Clinical Frailty Scale scores from patients attended by 112 study paramedics between January 1, 2021, and June 30, 2021., Setting and Participants: 3056 patients (459 in care homes) aged ≥50 attended by the North East Ambulance Service NHS Foundation Trust, England., Methods: This study used 2 outcome measures of treatment: time spent at scene and conveyance to hospital. Anonymized patient data and incident time logs were collected from ambulance electronic patient care records. The relationships between care home residency, conveyance to hospital, and time spent at scene were investigated using ordinal logistic regression and quantile regression. Models were weighted to address potential sampling imbalance using anonymised call logs containing all eligible ambulance callouts., Results: Care home residents were less likely to be conveyed to hospital [odds ratio: 0.75 (0.59-0.96)] and received shorter treatment time than community residents [median -7.0 (-12.0, -1.9) minutes for patients conveyed to hospital, -2.8 (-5.4, -0.3) minutes for patients discharged at scene]., Conclusions and Implications: Our results suggest that care homes provide support that reduces demand on the ambulance service and other "downstream" services in secondary care. This study also points to a need to enhance care for older people in private households to contain the demands on ambulance services. These findings have implications for countries like England, where ambulance services struggle to meet target response times, which may affect patient outcomes., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Issues Addressed: Urgent action is required by all levels of government to create a food system capable of nourishing a rapidly growing population while remaining within planetary boundaries. This study investigated policies and programs implemented by Australian local governments (LGs) that aim to contribute to a healthy, sustainable and equitable food system., Methods: An online survey was completed by LGs (n = 64) in New South Wales and Victoria, Australia. Questions focused on LGs' food system-related policies and programs, barriers to and enablers of engaging in food system work and organisational responsibilities for food system work., Results: Preventing food waste, organising food-related social/cultural events and providing potable water were the most commonly reported activities. Few LGs reported policies/activities on market gardening or sustainable agricultural practices, or strengthening food system resilience. LGs implemented a wide range of initiatives, such as hosting food forums, using research to identify and address food access issues and providing healthy food and drink options within LG-owned/managed facilities. Enablers of food system work included internal LG support, human resources, external funding and partnerships. Barriers included lack of community interest, short-term and/or project-based funding, internal governance issues and restrictive state government planning frameworks., Conclusion: Australian LGs undertake a wide range of actions addressing diverse food system issues; however, internal and external barriers constrain their involvement in creating a healthy, sustainable and equitable food system. SO WHAT?: Legislative reform, combined with increased financial and human resource capacity, would support LGs to expand, strengthen and sustain their food system work., (© 2022 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Issued Addressed: To assess the impact of a multi-lingual education video on the healthy eating knowledge of individuals in refugee and newly arrived migrant community groups., Methods: A mixed methods, pre- and post-test study design was used. Participants completed a verbal questionnaire with pictorial answer sheets prior to and immediately after viewing one chapter of a healthy eating video. Qualitative data was obtained through semi-structured, focus group discussions following the video viewing. Eighty-six participants were recruited via convenience sampling through refugee community organisations in the Illawarra Shoalhaven, South Western Sydney and Northern Sydney Local Health Districts. Study participants self-selected to attend Arabic (n = 17), Dari (n = 12), Karen (n = 32) or Tibetan (n = 25) sessions., Results: In 85 participants with pre-post results, there was a significant improvement in healthy eating knowledge after viewing the video (mean score 61% [SD 23.2] vs 75% [SD 24.2]; [P < .05]). Increased mean scores were observed in all language groups except the Karen-speaking group. Focus group responses indicated the video improved food literacy, particularly in the areas of food safety, fruit and vegetable consumption, label reading, writing a shopping list and decreasing intake of sugary drinks., Conclusion: The video improved healthy eating knowledge of individuals in refugee and newly-arrived migrant community groups. SO WHAT?: There is potential for these nutrition education resources to inform and educate newly arrived refugees and migrants to Australia about healthy eating practices, however, future research is required to determine their effect on actual behaviour change., (© 2022 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Background: The research paramedic position is a relatively niche role undertaken by a small number of paramedics who support, deliver and promote research. Research paramedic roles provide opportunities to develop talented researchers who are recognised as vital elements of developing a research culture within ambulance services. The benefits of research-active clinicians have been recognised at a national level. The aim of this study was to explore the experience of people who work, or have worked, as research paramedics., Methods: A generic qualitative approach underpinned by phenomenological concepts was used. Volunteers were recruited via ambulance research leads and social media. Online focus groups allowed participants to discuss their roles with peers who may be geographically distant. Semi-structured interviews expanded on the focus group findings. Data were recorded, transcribed verbatim and analysed using framework analysis., Results: Eighteen paramedics (66% female, median involvement in research six (interquartile range 2-7) years) representing eight English NHS ambulance trusts participated in three focus groups and five interviews lasting around one hour, in November and December 2021.Six key themes were identified: starting as a research paramedic; barriers and facilitators to working as a research paramedic; research careers; opportunities; the community (support and networking); and the value of a clinical identity., Conclusions: Many research paramedics had similar experiences in terms of starting their career by delivering research for large studies, then building on this experience and the networks they create to develop their own research. There are common organisational and financial barriers to working as a research paramedic. Career progression in research beyond the research paramedic role is not well defined, but often involves building links outside of the ambulance service., Competing Interests: GM is the editor-in-chief of the BPJ., (© 2023 The Author(s).)

Handedness has proven to be the most effective and least intrusive measure of laterality in many species. Several studies have investigated paw preference in dogs (Canis familiaris) without considering the potential impact that owner's handedness may have on it, despite dogs being a domesticated species. The aim of this study was to investigate whether owner handedness influences paw preference in their dogs. Sixty-two dogs had their paw preference tested using a Paw Task and a Reach Task in their home over 10 days, recorded by their owners. Interestingly, it was found that left-handed owners were more likely to own a dog with a left paw bias, and right-handed owners were more likely to own a dog with a right paw bias. In the Paw Task, the hand presented to a dog did not significantly predict which paw the dog lifted in response. Furthermore, it was found that females displayed a right paw bias at all age groups. However, males had a left paw bias in puppyhood and right paw bias in older age groups. We conclude that owner handedness influences paw preference in dogs, and it should be considered when suitably pairing dogs to potential owners, especially in assistance work., (© 2022. The Author(s).)

South Africa was among the first countries to adopt mandatory regulation in 2016 to lower the salt content in processed foods, aiming to reduce population salt intake to <5 g/day. To assess the effectiveness of this regulation in 20-30 year-old adults, we determined the change in salt intake over a mean follow-up time of 4.56-years spanning the implementation of the regulation. This observational study included baseline (2013-2016; N = 668; 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data (2018-ongoing; N = 311; 25.4 ± 3.05 years; 51.1% black; 43.4% men) for participants of the African-PREDICT study. Salt intake was estimated from 24-h urinary sodium excretion. Median salt intake at baseline (N = 668) was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [7.26 g/day (5.30)] [unadjusted median: -0.82 g/day]. After adjusting for baseline salt intake to address regression to the mean, the mean salt reduction was -1.2 g/day. The greatest reductions were in men [mean difference: -1.47 g/day], black adults [mean difference: -2.04 g/day], and participants from low [mean difference: -1.89 g/day] or middle [mean difference: -1.84 g/day] socio-economic status groups, adjusting for baseline salt intake. Our preliminary findings suggest that South Africa's salt regulation has been effective in lowering salt intake in young adults by ~1.2 g salt/day. Our study supports the effectiveness of upstream interventions to lower population salt intake, particularly for vulnerable groups who may typically consume more processed foods. It needs to be determined if the legislation has the anticipated population health gains., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD)., Objectives: To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU)., Methods: This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020.Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium., Results: The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27-3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients., Conclusions: This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice., Competing Interests: The authors have no conflict of interest to declare.

Background: Little is known about frailty in the ambulance setting, or its association with outcomes relevant to ambulance services. We sought to measure frailty in people aged ≥ 50 attended by an ambulance, and describe the relationship between frailty, odds of conveyance to hospital, and duration at scene., Methods: An observational study between 01/01/2021-30/06/2021 in North East Ambulance Service, England. Participants were aged ≥ 50 attended by an ambulance, excluding patients requiring immediate treatment for a life-threatening condition or with Glasgow Coma Scale < 15. Paramedics (n = 112) measured patient frailty using the Clinical Frailty Scale (CFS). Additional information was extracted from ambulance care records. Weighted regression models examined associations between frailty, hospital conveyance, and duration at scene., Results: Three thousand and fifty-six callouts were observed (mean patient age: 78.1 years, 57.2% female). Frailty prevalence (CFS ≥ 5) was 58.7%. Median duration at scene was 47.0 min (interquartile range 34.0-67.0 min). Ambulances spent a median of 8.2 (95%CI:5.4-11.0) minutes longer with frail patients than non-frail patients. Frail patients were less likely to be conveyed to hospital than non-frail patients (OR:0.75, 95%CI:0.60-0.94)., Conclusion: Frailty is common among people aged ≥ 50 attended by an ambulance and an important influence on workload. Ambulance services need a good understanding of frailty to meet patient needs. As populations age, community support should be prioritised to deliver appropriate frailty care and reduce demands on ambulance services., (© 2022. The Author(s).)

Background: Bystander cardiopulmonary resuscitation (BCPR) is undertaken in only 40% of out of hospital cardiac arrests (OHCAs) in the UK. Lower rates of BCPR and public access defibrillator (PAD) use have been correlated with lower socio-economic status (SES). The aim of this study was to examine knowledge and attitudes towards BCPR and PAD's using a study specific questionnaire, and to understand how these potentially interact with individual characteristics and SES., Methods: Cross-sectional study between July-December 2021 across areas of varying SES in North England., Results: Six hundred and one individuals completed the survey instrument (mean age = 51.9 years, 52.2 % female). Increased age was associated with being less willing to call 999 (p < 0.001) and follow call handler advice (p < 0.001). Female respondents were less comfortable performing BCPR than male respondents (p = 0.006). Individuals from least deprived areas were less likely to report comfort performing CPR, (p = 0.016) and less likely to know what a PAD is for, (p = 0.025). Higher education level was associated with increased ability to recognise OHCA (p = 0.005) and understanding of what a PAD is for (p < 0.001). Individuals with higher income were more likely to state they would follow advice regarding BCPR (p = 0.017) and report comfort using a PAD (p = 0.029)., Conclusion: Individual characteristics such as age and ethnicity, rather than SES, are indicators of knowledge, willingness, and perceived competency to perform BCPR. Policy makers should avoid using SES alone to target interventions. Future research should examine how cultural identity and social cohesion intersect with these characteristics to influence willingness to perform BCPR., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2022 Published by Elsevier B.V.)

Anthocyanins are present in bright colored fruit and vegetables with growing evidence for their health benefits. Several methods exist in the literature to measure the total monomeric anthocyanin content in foods. Although the simplest method uses UV-Vis spectrophotometry, it requires the use of anthocyanin molar absorption coefficients (Ɛ). While commonly reported for some compounds, these values vary substantially between studies. This study collated and compared existing Ɛ values for a range of anthocyanin-3-glucosides, measured new Ɛ values for these compounds and underwent an inter-laboratory validation of spectrometry methods. The Ɛ values used for the determination of anthocyanin content in Australian blueberries, were shown to greatly affect the estimated total anthocyanin. Significant differences in the Ɛ values were observed when measured at 520 nm, or their absorbance maximum and substantial difference in the estimated total anthocyanins were observed when expressed as equivalent of cya-3-glu or mal-3-glu., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To analyse local government (LG) policies concerned with creating a healthy, sustainable and equitable food system., Methods: All relevant policies on LG websites were identified and analysed against a framework of 34 recommendations for LG action on food system issues., Results: A total of 13 of 207 (New South Wales 128, Victoria 79) LGs had dedicated food system policies. Most actions on food system issues were in general (non-food specific) policies. Most LGs acted on food safety, sustainable local food production, food waste, drinking water access and food system-related education. Few used economic measures to support the consumption of healthier foods, restricted unhealthy food advertising, developed and implemented dietary guidelines in LG-managed settings or influenced the opening of unhealthy/healthy retail food outlets., Conclusions: LGs undertook a range of actions relevant to creating a healthy, sustainable and equitable food system. Strategic opportunities for LGs include regulating the sale and marketing of unhealthy food and ensuring policy coherence., Implications for Public Health: LGs can be supported to act further on food system issues, including through 'joined-up' state and federal policies. Further research should address how relevant LG policies can be developed, implemented and monitored effectively to address the complex challenges created by contemporary food systems., (© 2022 The Authors.)

Objective: To determine the affordability of a healthy food basket (HFB) for welfare recipients and average income earners in 2019 and to compare trends from 2011., Methods: Fifty-seven food items' prices were collected from fifteen stores across five suburbs representing low, medium and high socio-economic status. Costs were compared with average weekly income and welfare payments to assess the baskets' affordability for a family of four and five., Results: In 2019, a HFB was affordable (below 30% of household income) for a five-person reference family with a pensioner, representing 24.8% of weekly welfare payments, but not for a four-person reference family (33.0%). The cost of the HFB increased slightly over time from AU$288.91 in 2011 to AU$291.79 in 2019. The food affordability improved for a family of five including a pensioner over this period due to an increase of average weekly earnings and welfare payments., Conclusion: In 2019, the HFB was affordable for a five-person family; however, a four-person family receiving welfare benefits would have experienced significant "food stress," with the food basket costing above 30% of household income., Implications for Health Promotion: Inequity in the affordability of healthy food is a major public health concern and one that demands recognition and national action. The impact of policies affecting welfare support and wages needs to be considered, as well as food pricing strategies and possible food subsidies for those at greatest risk of food insecurity., (© 2021 Australian Health Promotion Association.)

Background/objectives: Vitamin D deficiency remains a global public health issue, particularly in minority ethnic groups. This review investigates the vitamin D status (as measured by 25(OH)D and dietary intake) of the African-Caribbean population globally., Subjects/methods: A systematic review was conducted by searching key databases (PUBMED, Web of Science, Scopus) from inception until October 2019. Search terms included 'Vitamin D status' and 'African-Caribbean'. A random effects and fixed effects meta-analysis was performed by combining means and standard error of the mean., Result: The search yielded 19 papers that included n = 5670 African-Caribbean participants from six countries. A meta-analysis found this population to have sufficient (>50 nmol/L) 25(OH)D levels at 67.8 nmol/L, 95% CI (57.9, 7.6) but poor dietary intake of vitamin D at only 3.0 µg/day, 95% CI (1.67,4.31). For those living at low latitudes 'insufficient' (as defined by study authors) 25(OH)D levels were found only in participants with type 2 diabetes and in those undergoing haemodialysis. Suboptimal dietary vitamin D intake (according to the UK recommended nutrient intake of 10 µg/day) was reported in all studies at high latitudes. Studies at lower latitudes, with lower recommended dietary intakes (Caribbean recommended dietary intake: 2.5 µg/day) found 'sufficient' intake in two out of three studies., Conclusions: 25(OH)D sufficiency was found in African-Caribbean populations at lower latitudes. However, at higher latitudes, 25(OH)D deficiency and low dietary vitamin D intake was prevalent., (© 2021. The Author(s).)

Purpose of Review: Food systems at all levels are experiencing various states of dysfunction and crisis, and in turn their governance contributes to other intensifying crises, such as climate change, biodiversity loss and the rapid expansion of dietary-related non-communicable diseases. In many jurisdictions governments at local, state and national levels are taking action to tackle some of the key challenges confronting food systems through a range of regulatory, legislative and fiscal measures. This article comprises a narrative review summarising recent relevant literature with a focus on the intersection between corporate power and public health. The review sought to identify some of the principal barriers for the design and support of healthy food systems and environments, as well as key reforms that can be adopted to address these barriers, with a focus on the role of local governments., Recent Findings: The review found that, where permitted to do so by authorising legislative and regulatory frameworks, and where political and executive leadership prioritises healthy and sustainable food systems, local governments have demonstrated the capacity to exercise legislative and regulatory powers, such as planning powers to constrain the expansion of the fast food industry. In doing so, they have been able to advance broader goals of public health and wellbeing, as well as support the strengthening and expansion of healthy and sustainable food systems. Whilst local governments in various jurisdictions have demonstrated the capacity to take effective action to advance public health and environmental goals, such interventions take place in the context of a food system dominated by the corporate determinants of health. Accordingly, their wider health-promoting impact will remain limited in the absence of substantive reform at all levels of government., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices., Setting: Urban local government authorities., Design: Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP) that targeted at least one healthy and sustainable diet-related practice. Grey literature was then searched to retrieve associated policy documentation. Data from both sources were charted against the MUFPP's monitoring framework to analyse the policy actions included in each overarching policy., Results: From 2624 screened peer-reviewed studies, 27 met inclusion criteria and cited 36 relevant policies amongst signatory cities to the MUFPP. Most were from high income countries (n 29; 81 %), considered health (n 31; 86 %), equity (n 29; 81 %) and the broader food system beyond dietary consumption (n 34; 94 %). Of the 66 policy actions described, the most common involved food procurement within public facilities (n 16; 44 %) and establishing guidelines for school-feeding programs (n 12; 33 %)., Conclusions: This review has demonstrated that urban local government authorities are implementing policies that consider multiple phases of the food supply chain to facilitate population-wide uptake of healthy and sustainable diet-related practices. Opportunities exist for local governments to leverage the dual benefits to human and planetary health of policy actions, such as those which discourage the overconsumption of food including less meat consumption and the regulation of ultra-processed foods.

Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment-Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients' experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n  = 25) identified that knowledge increased in 96% of staff (P  < 0.001). Fifty-five older adults who were screened (two malnourished, 10 'at risk of malnutrition') reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).

The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey ( n = 35) or an in-depth interview ( n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative.

Issue Addressed: This research aimed to develop and disseminate National Meal Guidelines for Australian home-delivered and centre-based meal programs., Methods: Development was led by a project group of dietitians and a steering group of representatives from the Australian Meals on Wheels Association. The process framework included three phases: (1) Review of existing standards and guidelines and systematic literature review (SLR), (2) stakeholder consultation conducted via six workshops, across six states (N = 212) and surveys with service providers, health professionals (N = 289) and customers (N = 337) and (3) review of the draft guidelines by stakeholders., Results: The final guidelines address: nutritional needs of older adults; meal and menu planning including nutrient requirements for meal components; presentation and meal enjoyment; special diets; and enhancing the meal service., Conclusion: These guidelines provide consistent guidance to services providing home-delivered and centre-based meal programs. Further evaluation of their uptake and impact on service practices and customer nutrition and satisfaction is required. SO WHAT?: The National Meal Guidelines provide nationally consistent, evidence-based guidance on menu planning and nutritional quality of meals to services providing home-delivered and centre-based meal programs. The guideline development framework outlined here also provides a process for future food service guideline development., (© 2021 Australian Health Promotion Association.)

Purpose of Review: The 2013 Australian Dietary Guidelines (ADG) have been criticised for making only brief reference to sustainability considerations. With the ADG currently under review, the purpose of this rapid review was to determine the environmental impacts associated with food consumption in Australia and New Zealand., Recent Findings: Of the 20 articles included, greenhouse gas emissions (GHGe) were the most common environmental indicator (n = 12), followed by water use and water footprint (n = 7), and carbon footprint (n = 3). Whilst there are commonalities between different environmental indicators such as the large impact of discretionary food consumption on GHGe, cropland scarcity footprint, and water scarcity footprint, there is wide variation in these indicators for other food groups. Furthermore, modelling of current food consumption data to the recommended diet does not necessarily result in improvement of all indicators. The next iteration of the ADG should promote consumption of foods and dietary patterns that are associated with positive health and environmental outcomes., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators., Method: This pilot study used a two-phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45-min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one-to-one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire-Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups., Results: Post intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, "motivators driving learning," "delivery methods, structure and profile of the Wheelchair Skills Training Program," "managing risk and safety" and "confidence in wheelchair use.", Conclusions: The pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations., (© 2021 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

The vitamin D status of the United Kingdom (UK) African-Caribbean (AC) population remains under-researched, despite an increased risk of vitamin D deficiency due to darker skin phenotypes and living at a high latitude. This cross-sectional study explored the vitamin D status and intake of AC individuals ( n = 4046 with a valid serum 25(OH)D measurement) from the UK Biobank Cohort, aged ≥40 years at baseline (2006-2010). Over one third of the population were deficient (<25 nmol/L), 41.1% were insufficient (25-50 nmol/L) and 15.9% were sufficient (>50 nmol/L). Median (IQR) 25(OH)D was 30.0 (20.9) nmol/L. Logistic regression showed that brown/black skin phenotype, winter blood draw, not consuming oily fish and not using vitamin D supplements predicted increased odds of vitamin D deficiency, whilst older age and a summer or autumn blood draw were significantly associated with reduced odds of vitamin D deficiency. Vitamin D deficiency and insufficiency were prevalent in this AC population and is of considerable concern given the individual and societal implications of increased morbidity. Public health messaging for this group should focus on year-round vitamin D supplementation and increasing intakes of culturally appropriate vitamin D-rich foods. These data also support the urgent requirement for a revised vitamin D RNI for ethnic groups.

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.

Objective: Diet and nutrition in childhood has been associated with the risk of chronic disease later in life. The aim of this review was to identify key characteristics of successful experiential nutrition interventions aimed to change nutrition-related cognitive and behavioural outcomes in primary schoolchildren., Design: A systematic literature review was undertaken using search terms ('food security', 'school', 'nutrition' and 'program') applied to five scientific databases (CINAHL, Scopus, Web of Science, Medline and Academic Search complete), with outcomes defined as nutrition-related knowledge, attitudes and/or dietary behaviours., Participants: Primary school-aged children exposed to interventions conducted, at least partially, on school grounds., Results: A total of 3800 articles were identified from the initial search and manual searching, of which sixty-seven articles were eligible for inclusion. Forty-two articles met the criteria of being successful, defined as achieving significant differences in outcomes of interest, accompanied by a demonstrated reach. Interventions included school gardens (n 9), food provision (n 5), taste testing (n 8), cooking classes (n 10) and multicomponent programmes (n 10). Nutrition education (when combined with taste testing), cooking-related activities and gardening interventions increased children's willingness to taste unfamiliar foods including new fruits and vegetables, improved their cooking and food preparation skills and increased nutritional knowledge., Conclusions: This review provides evidence that nutrition education programmes in primary schoolchildren that are experiential in nature are most likely to be successful if they include multiple strategies, have parental involvement and focus specifically on vegetable intake.

Objective: To assess whether nutritional screening and intervention improve the nutritional status of older adults living in the community., Methods: The Kiama MOW service performed nutrition screening, after being trained by the research team and maintained the dataset. De-identified data was provided to the research team for analysis. Meals on Wheels staff also kept detailed notes during the nutrition screening process and in discussions with clients. These notes were provided to the research team along with the de-identified quantitative data, a summary of the measures taken following screening, including interventions that were recommended to clients by MOW staff. Staff were not formally interviewed about their experiences in conducting nutrition screening but their open-ended text comments were retrospectively summarised, as well as anecdotal comments made to the research team who were involved in training and supporting the MOW team during the intervention period., Results: Forty-one individuals (25 women, mean age = 79.8 ± 8.9 years) were referred (21 well-nourished, 16 at risk of malnutrition and 4 malnourished). After reassessment (n = 19), nutritional status had significantly improved (P = .008 for all referrals and P < .001 for those at risk of malnutrition or malnourished). The main interventions provided were as follows: nutrition education (100%), home-delivered meals (78%) and social outings including meals (17%)., Conclusion: The My Aged Care portal may be a feasible source of referral of this population to perform routine nutrition screening for appropriate intervention., (© 2021 AJA Inc.)

Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle-aged Australians around their health, lifestyle risks and chronic disease., Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk., Design: A qualitative descriptive study using semi-structured interviews. Reporting was guided by the COREQ checklist., Methods: Thirty-four participants aged 40-65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi-structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis., Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications., Conclusions: Understanding the perceptions of health of middle-aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease., Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person-centred health promotion and chronic disease prevention strategies in this age group., (© 2021 John Wiley & Sons Ltd.)

Purpose: Epidemiological evidence suggests higher dietary flavonoid intake is associated with lower risk of several chronic diseases. This study aimed to investigate the association between intake of flavonoids and their subclasses, and incidence of hypertension among Australian women in two age cohorts., Methods: This population-based study included 6599 middle-aged (52.5 ± 1.5 years) and 6099 reproductive-aged (27.5 ± 1.5 years) women from the Australian Longitudinal Study on Women's Health. Food frequency questionnaires were used to quantify intake of flavonoids by cross-referencing with the Phenol-Explorer food composition database. Generalised Estimating Equation analyses investigated associations with incident hypertension, adjusting for demographic and dietary variables and hypertension risk factors., Results: There were 1645 cases (24.9%) of hypertension during 15 years follow-up in the middle-aged cohort and 336 cases (5.5%) during 12 years follow-up in the reproductive-aged cohort. Higher intakes of flavones [adjusted relative risk (ARR) for quintile 5 vs. 1: 0.82, 95% CI 0.70-0.97], isoflavones (0.86, 0.75-0.99) and flavanones (0.83, 0.69-1.00) were associated with a lower risk of hypertension in the middle-aged cohort. In the reproductive-aged cohort, higher intakes of flavanols (0.70, 0.49-0.99) were associated with a lower risk of hypertension. Key foods that provided these flavonoids were oranges, orange juice, apples, red wine and soy milk., Conclusion: Higher intakes of total flavonoids and subclasses were associated with a lower risk of hypertension in Australian women. These findings can be used in nutrition messaging and policies for improved cardiovascular health of women., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Breastfeeding provides the healthiest start to life, but breastfeeding rates amongst Aboriginal and Torres Strait Islanders is lower than non-Indigenous women., Aim: To assess the accuracy, quality and appropriate presentation of online breastfeeding information for Aboriginal and Torres Strait Islander women in Australia., Methods: An online search conducted in Google, Bing and Yahoo search engines to identify any breastfeeding websites that provided information for Aboriginal and Torres Strait Islander women. Relevant websites were evaluated against: a) National Health and Medical Research Council clinical guidelines, b) the quality of health information on the Internet by using DISCERN instrument, and c) appropriate key design features for Aboriginal and Torres Strait Islander women., Results: The search located 348 sites with 31 being eligible for inclusion. Websites from governmental organizations had the highest accuracy while YouTube videos had the lowest accuracy. Three quarters (74%, n=23) of sites incorporated the national clinical guidelines adequately, and most of the sites (77.8%, n=24) were considered high quality. Only 23% (n=7) of sites had sufficient key design features appropriate for Aboriginal and Torres Strait Islander women. Four websites were considered exemplary for their accuracy, quality and cultural appropriateness of information for Aboriginal and Torres Strait Islander women., Conclusion: Some websites are tailored to provide breastfeeding information and support to Aboriginal and Torres Strait Islander women. However, only a few contain culturally appropriate key design features. Further participatory action research is required to design online platforms for women from different cultural backgrounds that take into account cultural principles, beliefs and values., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: In response to the COVID-19 pandemic, a national lockdown was introduced on 23 March 2020. In the following weeks, emergency departments in the UK reported a reduction in attendances. We aimed to explore the incidence of emergency calls across North East England, as well as the number of out-of-hospital cardiac arrest (OHCA) deaths., Methods: Data were collected for all patients who contacted North East Ambulance Service between 4 March 2019-2 June 2019 and 2 March 2020-31 May 2020 suffering stroke, ST elevation myocardial infarction, allergy, asthma, chronic obstructive pulmonary disease, falls, intoxication, seizure, sepsis, acute coronary syndrome and OHCA., Results: There were a reduction in incidence of calls, excluding OHCA, resulting in ambulance activation during the pandemic compared with same period in 2019, 16 743 versus 19 639, respectively (-14.74%). The decline in calls was partially reversed by the end of May 2020. Incidence of OHCA at the time of the national lockdown had increased by 13.79% with a peak increase of 73.56% in the second week in April 2020. OHCA deaths peaked in the first 2 weeks in April 2020, 95.65% and 90.07%, respectively, but by the end May 2020, incidence of OHCA and OHCA deaths had returned to prelockdown levels., Conclusion: Incidence of emergency calls were reduced during the pandemic compared with 2019. There was a rise in incidence of OHCA and OHCA deaths during the same period; however, these changes appear transient. Further research is required to understand patient behaviour towards seeking help during the pandemic and the long-term consequences of not doing so., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)