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Chromosomal organization, scaling from the 147-base pair (bp) nucleosome to megabase-ranging domains encompassing multiple transcriptional units, including heritability loci for psychiatric traits, remains largely unexplored in the human brain. In this study, we constructed promoter- and enhancer-enriched nucleosomal histone modification landscapes for adult prefrontal cortex from H3-lysine 27 acetylation and H3-lysine 4 trimethylation profiles, generated from 388 controls and 351 individuals diagnosed with schizophrenia (SCZ) or bipolar disorder (BD) (n = 739). We mapped thousands of cis-regulatory domains (CRDs), revealing fine-grained, 104-106-bp chromosomal organization, firmly integrated into Hi-C topologically associating domain stratification by open/repressive chromosomal environments and nuclear topography. Large clusters of hyper-acetylated CRDs were enriched for SCZ heritability, with prominent representation of regulatory sequences governing fetal development and glutamatergic neuron signaling. Therefore, SCZ and BD brains show coordinated dysregulation of risk-associated regulatory sequences assembled into kilobase- to megabase-scaling chromosomal domains.

Refereed/Peer-reviewed Introduction: Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. Methods: We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians’ perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December 2021. Results: Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n = 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n = 907, 81%) and that abdominal strengthening exercises could be safely performed (n = 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Conclusion: Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.

Higher dietary intakes of Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have been linked to lower rates of preterm birth and preeclampsia. The aim of this analysis was to describe dietary intake and fractions of red blood cell (RBC) membrane LC-PUFAs during pregnancy in a cohort of Indigenous Australian women. Maternal dietary intake was assessed using two validated dietary assessment tools and quantified using the AUSNUT (Australian Food and Nutrient) 2011–2013 database. Analysis from a 3-month food frequency questionnaire indicated that 83% of this cohort met national n-3 LC-PUFA recommendations, with 59% meeting alpha-linolenic acid (ALA) recommendations. No nutritional supplements used by the women contained n-3 LC-PUFAs. Over 90% of women had no detectable level of ALA in their RBC membranes, and the median Omega-3 Index was 5.5%. This analysis appears to illustrate a decline in concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) across gestation in women who had preterm birth. However, there was no visible trend in LC-PUFA fractions in women who experienced hypertension during pregnancy. Further research is needed to better understand the link between dietary intake of n-3 LC-PUFA-rich foods and the role of fatty acids in preterm birth and preeclampsia.

Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

SUMMARYIsolates ofCryptococcus neoformans, a fungal pathogen that kills over 120,000 people each year, differ from a 19-megabase reference genome at a few thousand up to almost a million DNA sequence positions. We used bulked segregant analysis and association analysis, genetic methods that require no prior knowledge of sequence function, to address the key question of which naturally occurring sequence variants influence fungal virulence. We identified a region containing such variants, prioritized them, and engineered strains to test our findings in a mouse model of infection. At one locus we identified a 4-nt variant in thePDE2gene, which severely truncates its phosphodiesterase product and significantly alters virulence. Our studies demonstrate a powerful and unbiased strategy for identifying key genomic regions in the absence of prior information, suggest revisions to current assumptions about cAMP levels and about common laboratory strains, and provide significant sequence and strain resources to the community.

Rationale: Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may pla...

OBJECTIVE To describe the development of and key factors for sustaining a rural-based research team focussed on nutrition and dietetics. DESIGN A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub-units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. SETTING University of Newcastle Department of Rural Health across 4 rural sites. PARTICIPANTS Publicly available data sources from existing team members. MAIN OUTCOME MEASURES Staffing levels, research supervision, internal and external grant outcomes and peer-reviewed journal publications. RESULT Academic staffing has increased by 4 full-time equivalent positions over 18 years, with 6 current higher-degree research students. Key factors identified in the development of a discipline-specific research workforce included staff higher degree by research completions, longevity of staff in research-active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. CONCLUSION Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand.

Previous studies report an association between longer haemodialysis treatment sessions and improved survival. Worldwide, there is a trend to increasing age among prevalent patients receiving haemodialysis. This analysis aimed to determine whether the mortality benefit of longer haemodialysis treatment sessions diminishes with increasing age.This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest.Of 8224 people who commenced haemodialysis as their first treatment for kidney failure aged ≥65 years during this period, 4727 patients died. Longer dialysis hours per session was associated with a decreased risk of death in unadjusted analyses [hazard ratio, HR, for ≥5 h versus 4 to4.5 h: 0.81 (0.75-0.88, p .001)]. Patients having longer dialysis sessions were younger but had greater co-morbidity. In an adjusted model including age and other variables, the survival benefit of longer hours was only partially attenuated [HR for previous comparison: 0.75 (0.69-0.82, p .001)], and no interaction between age and hours was demonstrated (p = .89).The apparent survival benefit associated with longer haemodialysis session length appears to be preserved in patients 65 years or older. In practice, the benefit of longer dialysis hours should be carefully weighed against other factors in this patient group.

Nurse practitioners (NP) have an expanded scope of practice beyond that of a registered nurse. In kidney care, nephrology NP can manage patients at various points along the chronic kidney disease (CKD) trajectory.To profile the characteristics, service patterns, and domains of practice of nephrology NP in Australia.A cross-sectional online secure survey.Nephrology NP (NP students) who were members of the Renal Society of Australasia and working in Australia (n = 73).Data collected were demographic and practice characteristics, and domains of practice (using the modified Strong Model of Advanced Practice). The survey also sought qualitative perspectives of the enablers and barriers to sustainability nurse practitioner healthcare delivery services.Nephrology NP (n = 45) primarily worked in adult services, managing those receiving haemodialysis, peritoneal dialysis, or patients with earlier grades of CKD. Providing direct comprehensive care was the dominant domain of advanced practice although administrative activities took up considerable time each week. Support from nurse leaders and medical colleagues was identified as key enablers for sustainability of these services whereas succession planning, and workload were the main barriers.This study found a highly qualified, experienced but older nephrology nurse practitioner workforce who provide an additional model of health service delivery which can meet the growing CKD burden. Internationally, this level of nurse provides an opportunity for a career pathway to maintain nurses in direct clinical roles and to expand the nephrology nursing workforce.

PURPOSE This study sought to determine current practice regarding nutrition care within cardiac rehabilitation (CR) programs, including perceived barriers and facilitators to providing nutrition care in this setting. METHODS A cross-sectional survey was conducted in October and November 2019. Potential participants were program coordinators, identified through the Australian Cardiovascular Health and Rehabilitation Association program directory and invited to participate via e-mail. RESULTS Forty-nine respondents (response rate: 13%) are included in this analysis. Programs provided group (n = 42, 86%) and/or individual (n = 25, 51%) nutrition education, and most were supported by a dietitian (63%). However, the availability of dietitians and nutrition care provided at CR was variable. For example, individual education was consistently provided at 13 programs and usually by health professionals other than dietitians. Eight programs (16%) used a formal behavior change framework for nutrition care. Generally, respondents were positive about the role of nutrition; CR coordinators perceived nutrition as a valuable component of the program, and that they had good nutrition knowledge. An identified barrier was the financial resources available to support the provision of nutrition care. CONCLUSIONS To ensure that patients receive the benefits of evidence-based nutrition care, program staff may require additional support, particularly regarding the use of evidence-based behavior change techniques. Key facilitators that may be leveraged to achieve this include the high value and priority that CR program coordinators place on nutrition care.

Objective Linking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements. Design Retrospective cohort data linkage. Setting Two Australian universities, Monash University and the University of Newcastle. Participants Students who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018. Interventions Location of origin, university and discipline of enrolment. Main outcome measure(s) Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio-economic indices for location of origin, and available placements. Results A total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care. Conclusions There is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non-rural students.

The Nutrition Dashboard is an interactive nutrition technology platform that displays food provision and intake data used to categorise the nutrition risk of hospitalised individuals. The present study aimed to investigate the Nutrition Dashboard's ability to identify malnutrition compared with a validated malnutrition screening tool (MST).A retrospective observational study at a 99-bed hospital was conducted using medical record and food intake data presented via the Nutrition Dashboard. Inter-Rater Reliability of food intake estimation between hospital catering staff and a dietitian reported good agreement across 912 food items (κ = 0.69, 95% confidence interval = 0.65-0.72, p 0.001). Default nutritional adequacy thresholds of 4500 kJ and 50 g protein were applied for Nutrition Dashboard categorisation of supply and intake. Generalised estimating equation regression models explored the association between the Nutrition Dashboard risk categories and the MST, with and without controlling for patient demographic characteristics.Analyses from 216 individuals (1783 hospital-stay days) found that those in the highest risk Nutrition Dashboard category were 1.93 times more likely to have a MST score indicating risk compared to the lowest Nutrition Dashboard category (unadjusted odds ratio = 1.93, 95% confidence interval = 1.17-3.19, p 0.01). When patient weight was added to the model, lower weight became the only significant predictor of MST ≥ 2 (p 0.01) CONCLUSIONS: The present study indicates a role for nutrition intake technology in malnutrition screening. Further adaptions that address the complexities of applying this technology could improve the use of the Nutrition Dashboard to support identification of malnutrition.

Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition. (Figure presented.). Refereed/Peer-reviewed

The diet quality of rural Australians is under researched. Characterising disparities in diet quality between rural and urban populations may inform targeted interventions in at- risk groups. A cross-sectional study aimed to determine the relationship between diet quality, rurality and sociodemographic characteristics in a sample of Australian adults. Participants were recruited at rural and regional events between 2017 and 2020, in New South Wales, Australia. Diet quality was measured using the Healthy Eating Quiz or Australian Eating Survey to generate an Australian Recommended Food Score (ARFS). ARFS was compared by rurality and sociodemographic characteristics using multivariate regression. Participants (n = 247, 53% female) had a mean ± SD ARFS of 34.5 ± 9.0. There was no significant effect of rurality on ARFS (β-coefficient = −0.4, 95%CI −3.0, 2.3). Compared to participants aged 18–30 years, higher ARFS was evident for those aged 31–50 (β = 5.4, 95%CI 0.3, 10.4), 51–70 (β = 4.4, 95%CI 0.3, 8.5) and &gt, 71 years (β = 6.5, 95% CI 1.6–11.4). Compared to those living alone, participants living with a partner (β = 5.2, 95%CI 2.0, 8.4) and families with children (β = 5.6, 95%CI 1.4, 9.8) had significantly higher ARFS. ARFS was significantly lower with each additional self-reported chronic health condition (β = −1.4, 95%CI −2.3, −0.4). Our results indicate that diet quality as defined by the ARFS was classified as ‘getting there’ and that age, living arrangements and chronic health conditions, but not rurality, influenced diet quality in a sample of Australian adults.

Introduction: Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data. Methods: By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location. Results: This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time. Conclusion: The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.

INTRODUCTION An optimal diet is imperative in preparing women for pregnancy and this may be influenced by socio-economic status (SES). This research aims to investigate the role of SES on the dietary energy density (ED) in Australian women of preconception age. METHODS A secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12 for females aged 18-39 years (n = 1617) was conducted. Dietary intake was assessed by 24-hr recalls and dietary ED by dietary energy per weight (kJ.g-1 ). ED was further categorised as ED of foods and beverages separately. SES was assessed by three variables: Socio-Economic Indexes for Areas (SEIFA), developed by the Australian Bureau of Statistics; income decile; and level of education. Linear mixed model regressions were used to identify associations between ED and SES. RESULTS The median ED for food, beverages and combined food and beverages was 9.38 kJ g-1 , 1.02 kJ g-1 and 7.11 kJ g-1 , respectively. No significant variation was explained by SES variables when analysing combined ED in the adjusted model or ED from foods. Income decile reduced ED of beverages, although with little effect (coefficient: -0.04, P = 0.002). Significant confounders included inactivity, which increased ED in both combined ED and ED foods (coefficient: 0.51, P = 0.001 and coefficient: 0.78, P

Introduction Pre-vocational placement experiences are known to considerably influence the career preferences of health graduates and are a key factor in growing the rural allied health workforce. This paper explores the rural placement experiences and future work intentions of students who attended a placement with the University of Newcastle Department of Rural Health. Methods Part of a larger longitudinal mixed methods study of students' placement experiences and subsequent career choices, this study explored students' placement evaluations responses. Following each placement, students were invited to complete an online survey which asked about their placement experiences and future work intentions. Counts and proportion tests were performed for frequencies of quantitative variables. Wilcoxon signed rank tests were conducted on the paired pre- and post-rural intent scores to determine any perceived differences in intent before and after placement for students both with and without a rural background. Qualitative data from short answer questions were analyzed thematically guided by qualitative content analysis. Data were comparatively analyzed for students of a rural or urban background. Results Four hundred and forty end of placement surveys were completed by 275 students (response rate 69.8%). There was a positive shift in intention to work rurally for students of both rural and urban background post-placement, but this was only statistically significant in the group from an urban background (p≤0.001). From the qualitative analysis three themes emerged: immersed rural supported placement experience, immersed interaction in rural life with other students, and immersed interaction in the rural community. Students from both rural and urban backgrounds indicated similar benefits and challenges. Conclusion While the positive impact of rural placement experiences and rural background on future rural practice is well known, this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.

To explore modular organization of chromosomes in schizophrenia (SCZ) and bipolar disorder (BD), we applied ‘population-scale’ correlational structuring of 739 histone H3-lysine 27 acetylation and H3-lysine 4 trimethylation profiles, generated from the prefrontal cortex (PFC) of 568 cases and controls. Neuronal histone acetylomes and methylomes assembled as thousands of cis-regulatory domains (CRDs), revealing fine-grained, kilo-to megabase scale chromatin organization at higher resolution but firmly integrated into Hi-C chromosomal conformations. Large clusters of domains that were hyperacetylated in disease shared spatial positioning within the nucleus, predominantly regulating PFC projection neuron function and excitatory neurotransmission. Hypoacetylated domains were linked to inhibitory interneuron- and myelination-relevant genes. Chromosomal modular architecture is affected in SCZ and BD, with hyperacetylated domains showing unexpectedly strong convergences defined by cell type, nuclear topography, genetic risk, and active chromatin state across a wide developmental window.

Adapting to living with coeliac disease requires individuals to learn about and follow a strict gluten-free diet. Utilising a qualitative inductive approach, this study aimed to explore the perspectives of adults diagnosed with coeliac disease who have accessed dietetic services in a rural outpatient setting. A purposive sample of adults with coeliac disease who had accessed dietetic services from two rural dietetic outpatient clinics were recruited. Semi-structured interviews were conducted by telephone. Data were thematically analysed. Six participants were recruited and interviewed. Three key themes emerged: (i) optimising individualised support and services, (ii) adapting to a gluten-free diet in a rural context, and (iii) managing a gluten-free diet within the context of interpersonal relationships. Key issues identified in the rural context were access to specialist services and the increased cost of gluten-free food in more remote areas. The findings of this study have highlighted the difficulties associated with coeliac disease management and how dietetic consultation has the potential to influence confidence in management and improve lifestyle outcomes. Further qualitative research is required to expand on the findings of this study and inform future dietetic practice that meets the expectations and individual needs of people with coeliac disease in rural settings.

Aim Water is critical for human survival, yet water intake equations may not reflect contemporary populations. This research aims to determine the total water intake of a representative Australian population, per kilogram of body weight (mL/kg) and stratified by age and sex. Methods A secondary analysis of the 2011 to 2013 National Nutrition and Physical Activity Survey (n = 10 146) was conducted. Dietary intake from food and beverages was assessed by a 24-hour recall, with respondent's weight objectively measured. Data were descriptively analysed, with multiple linear regressions used to identify the impact of demographic and physiologic factors on total water intake (mL/kg). Results The median (interquartile range) daily total water intake per kilogram of body weight for children (2-8 years), adolescents (9-18 years) and adults (19+ years) were 77.1 (57.4-100) mL/kg, 40.4 (29.3-53.4) mL/kg and 35.5 mL/kg (26.1-47.8), respectively. Increasing height and waist circumference were associated with reduced total water intake, with a change of -1.03 mL/kg (-1.43, -0.618) [coefficient (95% confidence interval)] in children for height and -0.448 mL/kg (-0.484, -0.412) in adults for waist circumference. Similarly, seasonality decreased intake, with greatest reductions in winter [adolescents: -4.11 mL/kg (-6.83, -1.40)]. In comparison, being male, living in rural areas and having a physical occupation were associated with greater intake, by 1.73 mL/kg (0.347, 3.10), 4.74 mL/kg (3.47, 6.00) and 2.82 (trade workers: 1.08, 4.59) in adults, respectively. Conclusions Total water intake (mL/kg) decreased with age in both sexes. The results highlight possibilities to incorporate other factors into water intake equations to improve their accuracy.

Combined, nursing and allied health constitute most of the Australian health workforce; yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice.Data linkage cohort study.Monash University and the University of Newcastle.Graduates who completed their degree in 2017 across seven disciplines.The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements.Of 1130 graduates, 51% were nurses, 81% females, 62% under 21 years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a 'Rural principal place of practice.' Compared to urban, rural origin graduates had 4.45 times higher odds ratio of 'Rural principal place of practice.' For graduates who had20 cumulative rural placement days, compared to zero the odds ratio of 'Rural principal place of practice' was the same (odds ratio = 1.10). For those who had 20-40 rural placement days, the odds ratio was 1.93, and for40 rural placement days, the odds ratio was 4.54).Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements.

AIMS To offer a rough guide to a quality rural/remote interprofessional educational activity. CONTEXT Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3-6 locations. APPROACH Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. CONCLUSION Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience.

A lack of core food accessibility negatively affects diet quality, potentially increasing the prevalence of health risk factors such as obesity. The purpose of this study was to investigate core food access in an Australian regional center through the use of data visualization techniques.Supermarkets were used as a proxy for core food accessibility and were identified and mapped by town region with a combination of Google Maps and Stata/IC 15.1 software. A statistical analysis comparing the demographics of each town region was also completed using Stata.The maps generated suggest that there may be a disparity in core food accessibility between town regions. The analysis of demographics demonstrated that one town region had a greater proportion of disadvantaged residents, with statistically significant variation between regions.Data visualization and analysis may be a useful tool for clinicians to communicate accessibility information experienced by local residents. This need not be limited to food accessibility and extended to health services.

Objective To describe and compare body composition and fat distribution of Australian women 18-44 years from an urban and rural location. Design Cross-sectional survey and collection of anthropometric and body composition measurements. Setting Newcastle and Tamworth in New South Wales. Participants Convenience sample of women recruited through media and community. Main outcome measures Weight, height, waist and hip girths, visceral fat area, body fat (kg and %) and skeletal muscle mass. Results Of the total sample (n = 254), 53% resided in an urban area and the mean age was 28.0 (7.6) years. The mean age of rural women was significantly higher than for urban women. The majority of women (66.5%) had a Body Mass Index within the healthy range (18.5-24.9 kg m-2 ) and there was no significant difference in mean Body Mass Index between rural and urban women. Measures of central fat distribution, waist circumference and waist-to-hip ratio were significantly higher in rural residents. Visceral fat area was significantly higher among rural women. After adjustment for age, differences in waist circumference, waist-to-hip ratio and visceral fat area were no longer statistically significant. Conclusion While we did not find statistically significant differences in body composition among urban and rural women, these results highlight the dramatic effect of age on measures of central adiposity. Population surveillance needs to incorporate measures of excess central adiposity, particularly visceral fat area, to better investigate changes in body composition among women in their 20s and 30s.

There is no consensus if electronic nicotine delivery systems (ENDS) should be used to reduce harm among the smoking population. Physicians, who represent a trusted source of health communication, are exposed to a range of often conflicting ENDS information and this information may be relayed to patients looking to quit smoking. Previous studies have examined ENDS content of various sources of media but there is a lack of knowledge about ENDS content in medical journals. We analyzed 421 ENDS publications printed between 2012 and 2018 from PubMed&rsquo, s Core Clinical Journal list. Publications were analyzed based on publication type, journal type, study design, geographic focus, theme, terminology, outcomes, and positive/negative statements. The number of ENDS publications grew since 2012, and peaked in 2015. Across all years, negative statements about ENDS outnumbered positive statements, though this difference decreased over time. Over time, negative statements about &ldquo, toxins and carcinogens&rdquo, were made less frequently, while negative statements about &ldquo, gateway effects&rdquo, and &ldquo, youth appeal&rdquo, became more prevalent. UK journals had fewer negative statements relative to US journals. Only 12.6% of publications included guidance for healthcare professionals about ENDS. As published ENDS topics change over time, physicians&rsquo, communications with patients may be impacted.

AIM The aim was to support rich collaborative practice between two professions who frequently work together across both ordered and organic modes of collaboration. METHODS This study uses a qualitative research approach of collaborative dialogical inquiry to explore the question 'From the perspective of dietitians and speech pathologists, "what works well" for developing and maintaining collaborative practice?' We deliberately chose a context where collaborative practice is evident, University Department of Rural Health (UONDRH). Participants in the research were academics and clinicians from dietetics and speech pathology. Data were sourced from our research reflections and focus group transcriptions. Analysis was dialogical and iterative. RESULTS Beyond shared purpose, knowledge of roles and good communication, the notions of curiosity, willingness and momentum were at the core of 'what works well' for collaborative practice between dietitians and speech pathologists. Participant perspectives related to collaborative practice between these professions and beyond to other professions, and involved collaborative practice within and across healthcare organisations and a university setting. CONCLUSIONS Our interpreted themes of curiosity, willingness and momentum for developing and maintaining collaborative practice highlight the importance of paying attention to the less visible and difficult to measure aspects of patient-centred care. Questions for reflection are suggested to inform the ongoing process of developing and maintaining our and others' collaborative practice.

Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth’s purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.

Introduction Previous reviews of family-based interventions for childhood obesity treatment found that studies were of low methodological quality with inadequate details reported, especially related to intervention fidelity. The evaluation of fidelity is crucial to inform interpretation of the intervention outcomes. This study aimed to summarise intervention fidelity, participants’ acceptability and satisfaction with a 12-week family-focused technology-based child nutrition and weight management intervention. Methods Families with children aged 4–11 years participated in a telehealth intervention with complementary components: website, Facebook group and text messages. Intervention fidelity was reported using National Institutes of Health Treatment Fidelity Framework. Delivery was measured using a dietitian-reported evaluation survey. Google Analytics and Bitly platform were used to objectively track data on frequency and pattern of intervention use. Participants’ acceptability and satisfaction were measured using a process evaluation survey. Results Telehealth consultations delivered by trained dietitians had good adherence (≥83%) to the structured content. Process evaluation results indicated that parents ( n = 30; mean age 41 years, 97% were female, body mass index 30 kg/m2) found the intervention components easy to use/understand (87–100%), the programme had improved their family/child eating habits (93%), and they wanted to continue using telehealth and the website, as well as recommending it to other parents (90–91%). Discussion In summary, a family-focused technology-based child nutrition and weight management intervention using telehealth, website, Facebook and SMS can be delivered by trained dietitians with good fidelity and attain high acceptability and satisfaction among families with primary-school-aged children in New South Wales, Australia.

Introduction Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers. Methods Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet. Results Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI −21.99 to −0.03%E; p = .038) and increased percentage energy from healthy core food (95% CI −0.21 to 21.89%E; p = .045) compared to Waitlist control. Discussion A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.

Objective To determine sources of key nutrients contributing towards nutritional adequacy during pregnancy (fibre, calcium, iron, zinc and folate) in a cohort of women carrying an Indigenous child. Design Analysis of cross-sectional data from a prospective longitudinal cohort study that followed Indigenous women through pregnancy. Setting Women recruited via antenatal clinics in regional and remote locations in NSW, Australia as part of the Gomeroi gaaynggal project. Participants One hundred and fifty-two pregnant Australian women who identified as Indigenous or carrying an Indigenous child. Measurements and Findings Measurement outcomes included demographic information, smoking status, anthropometrics (weight and height,), self-reported pre-pregnancy weight, health conditions and dietary information (24-hour food recall). Findings indicate the inadequate intake of key pregnancy nutrients in this cohort. Supplements contributed to the nutrient adequacy of the cohort with 53% reporting use. As expected, predominant sources of fibre were from core food groups, whereas calcium was attained from a range of sources including food and beverages, with small amounts from supplementation. Importantly, supplements contributed significant amounts of iron, zinc and folate. Key Conclusions There is limited literature on Indigenous Australian maternal nutrition. This study highlights the key dietary contributors of nutritional adequacy during pregnancy for the cohort and that supplementation may be considered a viable source of nutrients during pregnancy for these women. Few women met national nutrient recommendations. The findings present an opportunity to optimise nutrient intakes of Indigenous pregnant women. Implications for practice Culturally appropriate targeted interventions to optimise dietary intakes of Indigenous Australian pregnant women is required. Collaborative support of health workers, Indigenous Australian communities, dietitians, and researchers to raise awareness of nutrition during pregnancy is imperative to achieving nutrient targets and optimising pregnancy outcomes. Targeted interventions provide positive opportunities to achieve improvements.

BACKGROUND: Genomic dysregulation is likely to contribute to neuronal dysfunction in prefrontal cortex (PFC) and other brain regions affected in schizophrenia (SCZ), but genome-scale mapping of neuronal transcriptomes and epigenomes has not been conducted in larger cohorts. We have shown recently that the genomic landscape of open chromatin-associated histone modifications, including histone H3-acetyl-lysine 27 (H3K27ac), show in neurons significant associations with the genetic risk architecture of schizophrenia. METHODS: We conducted H3K4me3 (H3K27ac) chromatin immunoprecipitation sequencing (ChIP-seq) on fluorescence-activated cell sorted (FACS) nuclei from dorsolateral PFC of 250 postmortem samples from SCZ and 280 matched control brains, generating altogether ~7(11) billion reads representing H3K4me3 (H3K27ac)-tagged nucleosomal DNA from PFC neurons. In addition, genotyping for the entire cohort of 530 brains was performed. RESULTS: Enrichment of differentially modified regions across schizophrenia cases and controls in calcium and potassium signaling pathways. This finding was replicated in differentially modified regions across cases and controls obtained from independent cohort. In addition to this, enrichment of schizophrenia GWAS loci was observed in differentially modified regions across cases and controls. DISCUSSION: Our dataset will provide unique insights into non-coding variants associated with neuronal dysfunction in schizophrenia. Our PsychENCODE sponsored resource highlights the critical role of cell-type specific signatures at regulatory and disease-associated non-coding sequences in the human frontal lobe. This is the first histone methylation and acetylation ChIP-seq datasets generated from prefrontal cortex brain region of 250 schizophrenia cases and 280 controls, postmortem human brain samples. As of now, this is the largest, yet unpublished ChIP-seq dataset from schizophrenia and control brains.

Issue addressed Undergraduate dietetic students are required to demonstrate cultural awareness and culturally respectful communication to meet national competencies, but exposure to practical experiences may be limited. The Gomeroi gaaynggal ArtsHealth Centre was established in 2009 after community consultation with the Indigenous community in Tamworth, New South Wales. The Centre provides a safe and welcoming space where women can create art while discussing health issues with visiting health professionals and students. The present study aimed to evaluate the cultural experiences of student and new-graduate dietitians visiting an Aboriginal ArtsHealth centre through a quality assurance project. Methods Six student and new-graduate dietitians were invited to provide feedback on their experiences for this report. A generic inductive approach was used for qualitative data analysis. Results Key qualitative themes of ‘building rapport’ and ‘developing cultural understanding’ were identified. Four of the participants interviewed felt they gained a deeper understanding of the context around health disparity for Indigenous Australians through their experiences. Key ways to build rapport with community members were identified. Conclusions Results suggest that first-hand experiences working in an Aboriginal ArtsHealth centre are effective in building cultural competency skills for student and new-graduate dietitians. These experiences could be better supported through improved preparation for the cultural setting, and ongoing monitoring of participant experiences is recommended. So what? The authors encourage undergraduate dietetic programs and students to seek out opportunities for further development of cultural awareness through increased practical experiences working with Indigenous communities.

Electronic cigarettes are at the center of a public health policy debate which leverages scientific publications. This study characterizes e-cigarette publication trends over the past 15 years via a bibliometric analysis. Scopus was searched for &ldquo, electronic cigarette&rdquo, &ldquo, e-cig&rdquo, e-cigarette&rdquo, vape&rdquo, vaping&rdquo, juul&rdquo, or &ldquo, electronic nicotine delivery system&rdquo, between 2003&ndash, 2018. Data included Hirsch index, document type and frequency, and publications by institution, journal, and country. VOSviewer was used to visualize authorship network maps. A total of 4490 e-cigarette publications were identified, most (62.8%) being articles. After 2009, the annual growth rate for e-cigarette publications was the largest in 2014. The annual growth rate was nearly flat in 2017 but increased in 2018. The U.S. produced 51.6% of publications. Annual National Institutes of Health NIH funding for tobacco research mapped closely with the annual volume of e-cigarette publications. Author network analyses illustrated investigator collaborative patterns. The frequency of e-cigarette publications increased significantly in the past decade. A strong relationship of NIH funding for tobacco research and e-cigarette publications demonstrates the importance of e-cigarettes in tobacco research.

To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice.Pragmatic randomized controlled trial.People aged ≥70 years with advanced kidney disease (eGFR ≤20 ml/min/1.73mThere were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants' knowledge score in the intervention group. There were no observable differences between groups for health-related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision.OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision-making with older adults with advanced stages of kidney disease.Strategies to improve shared decision-making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention- OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence-based approach to support shared decision-making for this population.ACTRN 12614001090606 Registered 14/10/2014.目的: 评估决策支持干预(备选项)在帮助晚期肾病患者做出治疗选择方面的有效性。 研究设计: 实用随机对照试验。 方法: 2015年三月至2016年三月之间,招募年龄≥70岁未决定治疗方案且不符合肾移植条件的晚期肾病患者(表皮生长因子受体(eGFR)≤20 ml/min/1.73m2)。随机分配实验对象接受备选项(N = 16)或标准护理(N = 21)。备选项是一个4周的护理干预。主要结果是决策冲突和决策后悔,次要结果则是透析和健康相关的生活质量的风险和益处的知识,还评估了备选项的有用性。 结果: 就干预和标准护理组而言基线两者并没有太大区别。尽管干预组T2决策冲突较低,T1干预组的决策冲突和决策后悔仍然没有显著差异。决策支持干预显著提高了干预组实验对象的知识得分。备选项有助于帮助实验对象准备好做出治疗决策。。 结论: 备选项,即决策支持干预,增加了人们对透析的好处及风险的了解并能帮助肾病晚期的老年患者共享决策。 影响: 改进肾病晚期的老年患者及他们的临床医生共同决策的策略对于患者的自主性至关重要,因为这个做法并不常见。 试验注册号: ACTRN 12614001090606 注册于 14/10/2014。.

The aim was to support rich collaborative practice between two professions who frequently work together across both ordered and organic modes of collaboration.This study uses a qualitative research approach of collaborative dialogical inquiry to explore the question 'From the perspective of dietitians and speech pathologists, "what works well" for developing and maintaining collaborative practice?' We deliberately chose a context where collaborative practice is evident, University Department of Rural Health (UONDRH). Participants in the research were academics and clinicians from dietetics and speech pathology. Data were sourced from our research reflections and focus group transcriptions. Analysis was dialogical and iterative.Beyond shared purpose, knowledge of roles and good communication, the notions of curiosity, willingness and momentum were at the core of 'what works well' for collaborative practice between dietitians and speech pathologists. Participant perspectives related to collaborative practice between these professions and beyond to other professions, and involved collaborative practice within and across healthcare organisations and a university setting.Our interpreted themes of curiosity, willingness and momentum for developing and maintaining collaborative practice highlight the importance of paying attention to the less visible and difficult to measure aspects of patient-centred care. Questions for reflection are suggested to inform the ongoing process of developing and maintaining our and others' collaborative practice.

Risk variants for schizophrenia affect more than 100 genomic loci, yet cell- and tissue-specific roles underlying disease liability remain poorly characterized. We have generated for two cortical areas implicated in psychosis, the dorsolateral prefrontal cortex and anterior cingulate cortex, 157 reference maps from neuronal, neuron-depleted and bulk tissue chromatin for two histone marks associated with active promoters and enhancers, H3-trimethyl-Lys4 (H3K4me3) and H3-acetyl-Lys27 (H3K27ac). Differences between neuronal and neuron-depleted chromatin states were the major axis of variation in histone modification profiles, followed by substantial variability across subjects and cortical areas. Thousands of significant histone quantitative trait loci were identified in neuronal and neuron-depleted samples. Risk variants for schizophrenia, depressive symptoms and neuroticism were significantly over-represented in neuronal H3K4me3 and H3K27ac landscapes. Our Resource, sponsored by PsychENCODE and CommonMind, highlights the critical role of cell-type-specific signatures at regulatory and disease-associated noncoding sequences in the human frontal lobe.

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

Interprofessional collaboration is an important aspect of delivering healthcare. However, helping students learn to work with other health professions continues to pose challenges. Students’ interprofessional relationships are an important aspect of learning to work with other professions. The complexity of educators’ interprofessional relationships is less easily recognised. Existing relationships between educators were the intentional foundation underpinning the development and implementation of a recent interprofessional workplace learning initiative over 18 months involving undergraduate students from speech pathology (n = 12) and nutrition and dietetics (n = 18) programs. As part of a larger collaborative inquiry, educators involved in the initiative explored the nature of interprofessional relationships involved in developing, delivering and participating in the initiative. The aim was to develop a deeper understanding of such interprofessional relationships in order to provide guidance for ongoing development of students’ and educators’ collaborative practice. Transcripts of five focus groups undertaken with students (n = 5), academic educators (n = 4) and clinical educators (n = 4) were compiled into a text set and interpreted using tools of philosophical hermeneutics. Findings of this study were iteratively dialogued with earlier findings of the collaborative dialogical inquiry to ensure “fusion of horizons” between studies. The three interpreted themes transcended professional affiliations: facilitating interprofessional mutuality, appreciating the multifaceted nature of “respect” and considering the visibility of interprofessional relationships. The themes highlighted the importance of educators’ ongoing development and understanding of interprofessional relationships as they help students learn to work with other professions. Based on a practice-based education framework, we pose reflective questions for educators to inform their ongoing development. We conclude that it is important for all those involved in healthcare education to embrace the responsibility of developing interprofessional relationships in an ongoing manner and not view the development of interprofessional relationships solely as the domain of students.

This study aimed to evaluate dietetic practices for patients with celiac disease and knowledge of celiac disease amongst rural dietitians. This study comprised of two parts: 1) a retrospective file audit of patients with celiac disease attending a rural dietetic outpatient clinic in NSW, Australia from 2007 to 2014 and 2) a cross-sectional survey of 25 dietitians within a rural Local Health District in NSW. Celiac disease related knowledge and diet therapy practices were assessed. Data were reported using descriptive statistics. The patient file audit (n = 17) indicated that the majority of patients (59%) had no follow-up with a dietitian. Education topics provided by dietitians included gluten-free food options (53%) and label reading (41%). Dietitians (n = 18, 72% response rate) achieved a mean score of 73% (range 48% - 90%) for celiac disease related food knowledge and 69% (range 50% - 90%) for screening and diagnosis knowledge. Perceived barriers for compliance with a gluten-free diet included limited access to dietitians, as well as limited availability and cost of gluten-free products. Current practices of rural-based dietitians in NSW are variable for patients with celiac disease, suggesting that evidence-based guidelines and continuing education are needed for rural-based dietitians in the specialized area of celiac disease.