| Prevalence and predictors of dietary supplement use in an older Australian population
Xue Q. Yu, Wayne Smith, Karen Webb, Paul Mitchell and Stephen R. Leeder
Abstract This study assessed the prevalence of supplement use and investigated the characteristics of regular supplement users in an Australian population. A questionnaire about vitamin supplement use was completed by 90% of 3654 residents (aged 49 years and over) in a defined geographic area west of Sydney, Australia, from 1992 to 1994. Detailed demographic data, dietary intakes, risk factors, disease histories and clinical measures of blood pressure, height and weight were also collected. Thirty-two per cent of men and 42% of women reported regular supplement use over the two months prior to the study. Typical supplement users were younger (49 to 70 years) rather than older (more than 70 years), female, unmarried, highly educated, those with occupation of clerk or sales person, more physically active during leisure time and less likely to be overweight. Those with hypertension were less likely to take supplements. This study found 37.4% of the respondents reported consuming some form of supplements regularly. Age, sex, socioeconomic status and body mass index were associated with supplement use in this population. Supplement users tended to be more health conscious than non-users. (Aust J Nutr Diet 1999;56:69-75).
Nutrition education in outpatient cardiac rehabilitation programs
Fay L. Paxton, Madeleine Ball, Stephen Bunker and Catherine Cooper
Abstract Dietary change plays an important role in reducing the risk of coronary heart disease, and nutrition education is regarded as an important component of cardiac rehabilitation programs. The aim of this study was to investigate current activities in nutrition education in outpatient cardiac rehabilitation programs in Victoria and to compare the findings to National Heart Foundation (NHF) recommendations by conducting a postal survey of all coordinators. There was a 100% response rate. Results showed considerable variation amongst the 56 hospital-based and 18 community health centre-based programs. All programs included nutrition education, but the total time devoted to it ranged from half an hour to nine hours (median 1.83 hours) and ranged from 1% to 33% of total program time. Dietary fat was covered in all programs, food labelling in 84%, recipe modification in 68%, and behaviour change skills in 4%. Few programs had non-English speaking participants or the resources to cater for them. Two-thirds evaluated nutrition education, usually by questionnaire. Reported barriers to the delivery of nutrition education included the venue, varying participants’ needs, lack of funding and time limitations. Suggestions for assistance included provision of free patient literature, evaluation instruments and professional papers. Nutrition education generally conformed to NHF recommendations but most programs appeared to concentrate on knowledge-based objectives rather than those related to behaviour change skills. (Aust J Nutr Diet 1999;56:76-80).
Restructuring to improve access to dietetic services at no extra cost
Marianna Milosavljevic and Craig Patch
Abstract This paper discusses how the traditional layers of hierarchy seen in our department contributed to poor communication by promoting the local interpretation of policy and procedures. It examines how we addressed the problem of poor communication by using the principles of contemporary management theory. We adopted an organisational structure that reduced the layers of management within the dietetic department. The new structure afforded dietitians the opportunity to examine historical work practices and review every practice in the light of contemporary clinical dietetics. As a result of implementing the new structure we were able to streamline technical tasks, and with the surplus resources in this area, reinvest in clinical services. The restructure improved the communication between technical support staff and the dietitians and had the added benefit of increasing clinical services. (Aust J Nutr Diet 1999;56:81-85).
Dietitian-nutritionists in the Australian food industry: an educational needs assessment
Linda Tapsell and Renate H. M. de Groot
Abstract With the shift to a greater focus on nutrition in Australian food production, the role of dietitians and nutritionists employed in this sector, and their educational preparation, deserve attention. This paper presents the findings of qualitative research aimed at describing the current work practices and educational needs of dietitians employed within the food industry. Open-ended questions were asked of twelve dietitians including those employed by Australia’s major food companies. The outcomes of this research were that: industry-based dietitians had a population perspective to nutrition practice and a keen sense of career development; descriptions of work practices indicated a distinctive career structure for dietitians in this area, which can be supported with appropriate continuing education; and entry level practitioners would benefit from industry placements in their qualifying program. The educational implications of this study are that with increasing industry experience, short courses in management and communications would be of benefit, followed by higher qualifications in management and research. The implications for the profession include a review of competency standards and requirements for accredited programs and more generally, the development of a broad framework for recognising specialist practice in a range of workplace contexts. (Aust J Nutr Diet 1999;56:86-90).
Clinical practice guidelines
Implementing the Australian pancreatic enzyme replacement therapy guidelines for cystic fibrosis
Denise R. Stapleton, Helen Anthony, Clare E. Collins, Elizabeth B. Powell, Susannah J. King and Catherine F. Mews
Abstract The Australian pancreatic enzyme replacement therapy (PERT) guidelines have been developed to maximise fat absorption and to improve the nutritional status of individuals with cystic fibrosis-related pancreatic insufficiency. These clinical practice guidelines provide detailed information to assist health care professionals in implementing the PERT guidelines. Issues regarding pancreatic enzyme distribution, administration, storage, adherence and structured education are discussed. Guidance for determining fat-based doses and matching pancreatic enzymes to dietary fat at meals and snacks and with enteral tube feeds are provided. Lastly, recommendations for monitoring effectiveness (using faecal fat balance studies), prescribing adjunctive therapies, minimising excessive doses and evaluating the guidelines are discussed. (Aust J Nutr Diet 1999;56:91-96).
Viewpoint
Morbidity mortality paradox’ of Greek-born Australians: possible dietary contributors
Antigone Kouris-Blazos, Mark L. Wahlqvist and Naiyana Wattanapenpaiboon
Abstract First generation Greek-born Australians (GA) are one of the longest lived populations in the world, despite unfavourable cardiovascular disease (CVD) risk factors, poor self-rated health and functional disabilities. The purpose of this paper is two-fold: to draw attention to the morbidity mortality dissociation using national health and mortality statistics along with supporting data from smaller studies; and to formulate a ‘morbidity mortality paradox’ hypothesis by re-examining recent and distant past food intake data and lifestyle habits from a study of 104 Greeks in rural Greece, 189 GA and 140 Anglo-Celtic Australians aged 70 years and over. The analysis suggests that the more frequent use of energy dense foods such as sweets and animal foods high in saturated fat (especially in the first 20 years in Australia), plus changes to meal patterns, serving sizes, cooking practices, physical activity and siesta habits may have had a significant impact on the development of obesity, diabetes and CVD in GA. Possible dietary factors contributing to the longevity of GA include: the proportionately high intake and variety of plant foods relative to animal foods; the tendency to return to the traditional Greek food pattern in old age; and the continued high intake of mono-unsaturated fats, n-3 fatty acids and phytochemicals (e.g. lycopene and flavonoids) from the wide variety of plant foods consumed. In particular, the retention of certain putatively protective foods (e.g. fish, legumes, leafy greens, onions, garlic, tomatoes, melons, herbs, olive oil, grapes and wine) may have helped to make the CVD risk factors ‘benign’. The influence of Greek cuisine (e.g. vegetables cooked or served with olive oil) on the bio-availability of certain phytochemicals requires further investigation. Possible mechanisms are briefly examined since further studies are needed to substantiate the hypothesis formulated. (Aust J Nutr Diet 1999;56:97-107).
Insight
Use of a social marketing strategy to promote community acceptance of breastfeeding in public
Roger Hughes
Abstract A lack of societal support for breastfeeding may be a significant barrier for breastfeeding promotion. Prompted by local and interstate reports of breastfeeding mothers being ejected from public facilities whilst breastfeeding, a project to increase community acceptance and support for breastfeeding in public was developed as the first of many initiatives of a local breastfeeding support coalition. Key components of social marketing, such as audience analysis and segmentation, formative research, channel analysis and the development of a marketing mix were used. Implementation of this marketing mix led to internal bus poster advertising on all of Hobart’s metropolitan buses over a two-month period during 1997. Project outcomes and experiences demonstrate the potential of applying social marketing techniques to increasing public awareness of breastfeeding issues, and as support for other breastfeeding promotion initiatives at a local community level. Results also indicate that internal bus advertising has useful applications as a medium for targeted message delivery at a local community level. (Aust J Nutr Diet 1999;56:108-110).
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Australian Journal of Nutrition and Dietetics, Volume 56, Number 2, June 1999