| Food security and poverty in Australia—challenges for dietitians
Sue Booth and Alison Smith
Abstract The idea that many people in Australia may not have adequate access to ‘sufficient food for an active and healthy life’ is starting to be seriously considered by nutritionists. Food insecurity as a consequence of limited resources exists in Australia at a level likely to be over 5% of the general population and much higher among groups at risk. Groups known to suffer food insecurity include those in remote areas, indigenous people, homeless people, injecting drug users and those on low or insecure incomes. Young people, the elderly, single person households, unemployed people, disabled people and some immigrants and their families are therefore also likely to be at risk due to increased levels of relative poverty. Food insecurity has a high cost to individuals, families and society as a whole in terms of reduced physical, mental, spiritual and social health and wellbeing. Current research, practice and policy directions clearly indicate the need for comprehensive, intersectoral, integrated strategies that are based around community responses supported by state and national policy and funding directions. Strategies by which dietitians and nutritionists can help to prevent and ameliorate food insecurity include local and national level advocacy, policy making, education, research and community-based practice. The challenges for dietitians and their employing organisations to realise the mission of their professional organisation to achieve ‘better food, better health, better living for all’ are many. They include an examination of skills, competencies and practices; development of strategic alliances and partnerships with other organisations; and improvement of our effectiveness as advocates for change. (Aust J Nutr Diet 2001;58:150–156)
Development of a patient satisfaction survey with inpatient clinical nutrition services
Maree Ferguson, Sandra Capra, Judy Bauer and Merrilyn Banks
Abstract Although patient satisfaction has been an integral part of quality health care for a number of decades, there are few published papers on patient satisfaction with nutrition services. The aim of this study was to develop and evaluate a simple, reliable and valid tool to measure patient satisfaction with inpatient clinical nutrition services. Statements that were considered to represent specific attributes of clinical nutrition services were developed from the literature and professional opinion. Factor analysis was used to determine the dimensions of patient satisfaction with clinical nutrition services. Dimensions of patient satisfaction with clinical nutrition services included staff interpersonal skills, nutrition supplements, perceived health benefits of nutrition care, and staff presentation skills. The final satisfaction survey consisted of 15 statements relating to these dimensions and one statement relating to overall satisfaction with clinical nutrition services. Response options were based on a five-point Likert scale from ‘strongly agree’ to ‘strongly disagree’, except for the overall satisfaction statement where the scale ranged from ‘very good’ to ‘very poor’. The reliability and validity of the satisfaction survey was established for the general hospital population. Patient satisfaction can be used to measure the effectiveness of clinical nutrition services. (Aust J Nutr Diet 2001;58:157–163)
The effect of ‘Go and Grow with CF’ on nutrition and pancreatic enzyme knowledge of children with cystic fibrosis
Denise R. Stapleton, Lyle C. Gurrin, Stephen R. Zubrick, Sven R. Silburn, Jill L. Sherriff and Peter D. Sly
Abstract A randomised clinical trial was conducted to assess the impact of the ‘Go and Grow with CF’ intervention program on nutrition and pancreatic enzyme knowledge and self-management skills. Forty-two children with cystic fibrosis aged six to 11 years and 55 carers of two- to 11-year-old children participated in the program. Separate but similar validated questionnaires were used for face-to-face interviews with children with cystic fibrosis and for telephone interviews with carers on three occasions. The questionnaires were designed to assess nutrition and pancreatic enzyme knowledge and self-management skills. The improvement in knowledge of the children’s intervention group was significant immediately post-intervention (P = 0.001) but not at follow-up 12 months later. Children’s knowledge for both the intervention and control groups was associated with their appropriate self-management score immediately (P = 0.02 and P = 0.03, respectively) and 12 months post-intervention (P = 0.01 and P = 0.00, respectively). The home-based ‘Go and Grow with CF’ program was found to be effective in increasing children’s knowledge in the short-term. The absence of a long-term effect of the program on nutrition and pancreatic enzyme knowledge and behaviours may be due to the need for regular ongoing education and counselling. (Aust J Nutr Diet 2001;58:164–168)
A study of five-year retrospective data on breastfeeding practices and introduction of solids amongst Tasmanian children
Roger Hughes
Abstract Infant feeding research in Tasmania in the 1970s, the 1980s and the late 1990s has highlighted the lower rates of breastfeeding compared with levels in other Australian states. The objective of this pilot study was to contribute to the development of an infant feeding minimum data set for Tasmania with a survey using an established data collection system. A retrospective survey using an existing school entry data collection system was initiated, focusing on breastfeeding and introduction of solids amongst Tasmanian infants. A five-item questionnaire based on questions from the 1995 National Health Survey was distributed through Tasmanian schools to parents of year 1 children during the 1997 school year. Questions were attached to the existing annual Family and Child Health Service year 1 school health survey. A total of 5732 completed questionnaires were returned from an estimated population of 7062 Tasmanian six-year-olds in 1997, representing an 80% participation rate. Just over 80% of parents reported that their child had been breastfed and 76% were breastfeeding on discharge from hospital. This estimate was within 3% of the breastfeeding initiation rate determined prospectively by perinatal data collections in the year of this samples’ birth (1992). Of the children in this population reported to be breastfeeding on discharge, 71%, 63%, 52% and 40% were still breastfeeding at two weeks, six weeks, three months and six months, respectively. About one-third (34.3%) of all parents indicated introducing solids before four months of infant age. About three-quarters (77%) had introduced solids before six months, 93% had introduced solids by six months and over 95% by seven months. Given the need for statewide infant nutrition monitoring and surveillance data, this data collection method has potential as an efficient data collection system to support nutrition program planning and evaluation. Although limitations exist with respect to the limited data of demographic confounders and the precision of retrospective surveys of this nature, results confirm the relatively low breastfeeding initiation rates in Tasmania and highlight a need for interventions addressing the high prevalence of premature introduction of solids to infants. (Aust J Nutr Diet 2001;58:169–173)
A cross-sectional study of weight- and shape-related beliefs, behaviours and concerns of north Queensland adolescents
Madeleine Nowak, David Crawford and Petra Büttner
Abstract The purpose of this study was to examine differences in weight- and shape-related beliefs, behaviours and concerns across a high school population. Data were collected by questionnaire from 902 high school students from private schools in Townsville. Concerns about weight and shape were more apparent in students from the higher school years. More girls in higher than lower school years were dissatisfied with their bodies, concerned that many parts of their bodies were too fat and more of them attempted weight loss. More boys in higher than lower school years were satisfied with their bodies but they wanted to ‘bulk up’. Societal expectations of weight and shape may adversely affect both males and females but in different ways. Thus, interventions aiming to promote the maintenance of a healthy body weight may need to account for the desire of the majority of young women to be thinner, while the majority of young men would like to be larger. (Aust J Nutr Diet 2001;58:174–180,185)
Managing constipation in elderly orthopaedic patients using either pear juice or a high fibre supplement
Robyn E. Stumm, Maureen Spence Thomas, Judith Coombes, Jennene Greenhill and John Hay
Abstract
Objective: The aim of the study was to compare two different dietary interventions, pear juice and a fibre supplement, on laxative requirement and bowel function in elderly orthopaedic patients.
Design: A randomised controlled trial with patients assigned to control, pear juice (150 mL bd) or fibre supplement (5 g fibre bd) group for duration of their hospital admission. Bowel opening, fluid and dietary fibre intake, laxative and opiate use were monitored daily.
Subjects: Elderly patients (n = 111) admitted for elective orthopaedic surgery or traumatic fracture requiring bed rest. Eighty-nine patients completed the study.
Setting: Two 32-bed orthopaedic wards in a metropolitan teaching hospital.
Main outcome measures: Bowel function, laxative requirement, oral fluid and dietary fibre intake.
Statistical analysis: Differences between treatments for bowel function, laxative requirement, oral fluid, and dietary fibre intake were analysed using analysis of variance (ANOVA) and Kruskal-Wallis H test. The c2 test of association was used to test associations between categorical variables of interest.
Results: Neither pear juice nor fibre supplement impacted on the day the bowels first opened, overall rate of bowel opening or requirement for laxatives. However, pear juice had a significant effect on increasing rate of bowel opening seven days after admission (P = 0.045). Most patients consumed less than 20 g of fibre per day and less than 1500 mL of fluid per day.
Conclusions: These results confirm previous reports that elderly orthopaedic patients consume low fibre diets and have poor oral fluid intake while hospitalised, and that attempts to improve fibre intake are met with limited success. Supplementation with pear juice may be beneficial in normalising long-term bowel function.
Aust J Nutr Diet 2001;58:181–185
Vitamin A deficiency, fruit and vegetable consumption, and nutrition education: villagers’ perceptions in Nepal
Netra B. Khadka
Abstract Proper utilisation and consumption of available food resources have a pivotal role to play in the fight against hunger and malnutrition in the world. However, this role is highly affected by social and cultural factors within the relevant community and these often result in a lack of appropriate understanding of the value of available food resources for maintaining people’s health. This study examines the perceptions of rural Nepalese concerning the importance of the consumption of vegetables and fruits in alleviating vitamin A deficiency in their villages. The main message to emerge from the study is that, despite being strongly influenced by their own cultural and traditional practices, the villagers prefer to have appropriate nutrition education so that they can better understand the value of vegetables and fruits in alleviating the vitamin A deficiency in their villages. They asserted that such education should be based on an information-sharing process rather than a one-way, prescriptive method of information dissemination. (Aust J Nutr Diet 2001;58:186–191) |
Australian Journal of Nutrition and Dietetics, Volume 58, Number 3, September 2001