Objectives: UK policy priority is to support people with dementia (PLwD) to live at home for longer. Initial clinical assessment involves evaluating and managing risk to enable PLwD to live safely and well at home. Risk assessment scales are needed to identify, manage and reduce risk within contemporary dementia practice. The “Islington Dementia Navigator Risk Assessment Tool” (IDNRAT) is used by specialist and non-specialist staff to stratify the level of risk for PLwD and inform a risk management plan and the frequency of follow-up. We assessed whether IDNRAT enables risk detection and whether the risk intervention derived from it is implemented and improves the safety of people living at home with dementia.

Methods: A mixed Methods study to evaluate IDNRAT’s validity, and the feasibility and acceptability of the resulting risk management plan. We investigated the use of the IDNRAT to: (i) detect risk (concurrent validity) and measure the reliability of the tool; (ii) contribute to risk reduction (primary outcome was numbers of decisions implemented); (iii) explore patients’ and carers’ experience of risk stratification.

Results: We found risk stratification scores (n = 119) derived from IDNRAT and compared with gold standard clinical risk assessments showed concordance between clinicians’ ratings. Joint Dementia navigator and researcher interviews (n = 19) showed consistency between the different assessor scores demonstrating IDNRAT has good reliability. Care-plan data showed most participants (n = 275) scored in the low-risk band of IDNRAT (78.9%) at baseline assessment and risk severity ratings (red/amber/green) reduced over the 6–12-month time period. PLwD (n = 19) and family carers (n = 17) had differing perceptions about risk and the PLwD’s susceptibility to risk. Overall, participants found the risk assessment acceptable, were able to identify risks and felt included in decision-making processes.

Conclusions: We found that the IDNRAT used by non-specialist practitioners (dementia navigators) does enable people with dementia to live safely at home in terms of risk- identification, implemented risk enablement decisions and acceptability. IDNRAT is a valid risk assessment tool, which offers a tailored approach to the management of risk, and over 80% of care-plan decisions were implemented. This is consistent with best practice and the tool has potential for wider use.

Oceania is currently facing a substantial challenge: to provide sustainable and ethical food systems that support nutrition and health across land and water. The Nutrition Society of Australia and the Nutrition Society of New Zealand held a joint 2023 Annual Scientific Meeting on ‘Nutrition and Wellbeing in Oceania’ attended by 408 delegates. This was a timely conference focussing on nutrition challenges across the Pacific, emphasising the importance of nutrition across land and water, education settings, women’s health and gut health. Cutting-edge, multi-disciplinary and collaborative research was presented in a 4-day programme of keynote presentations, workshops, oral and poster sessions, breakfast and lunch symposiums and early career researcher sessions. The conference highlighted the importance of collaboration between nations to address the challenge facing nutrition and wellbeing across Oceania. A systems approach of collaboration among scientists, industry and government is vital for finding solutions to this challenge.

Between fifteen and twenty-five million Americans took to the streets in the summer of 2020 to march, mourn, occupy highways, clash with police, and be together in grief and rage. Municipal and state police forces responded with a national campaign of excessive force. Demonstrators were clubbed, tear gassed, sprayed with chemical agents, kettled and trampled, illegally detained, and mutilated by “less-than-lethal” munitions. Internal police reviews and municipal leaders blamed the violence on insufficient training but the scale and intensity of repression suggest a more profound democratic crisis surrounding the criminalization of dissent.

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P>0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P>0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Mentoring is an established method of promoting networking, professional growth and learning, and career development in many health professions(1). For a non-vocational profession such as nutrition with a diverse scope of practice, the impact of mentoring remains unclear. In 2020, the Nutrition Society of Australia (NSA) developed and implemented a mentoring program for registered nutritionists. The individually matched mentoring facilitates a 12-month relationship between nutritionists who opted-in to the program. This qualitative case study research aimed to understand the conceptualisation and development of the NSA mentoring program and explore the experience from the viewpoints of both mentors and mentees in the program. First, a 60-minute focus group was conducted with the NSA program organising committee to explore the initial conceptualisation, objectives of the program, expected outcomes, and related training provided to mentors and mentees. Then, a 34-item questionnaire was sent to 63 participants from the first three program cohorts to collect their demographic information as well as expectations, perception and experience of the mentoring. Twenty-one questionnaire responses from 10 mentors and 11 mentees were collected. Participants were from a range of nutrition professions across NSW, VIC, QLD, and WA. Ten questionnaire participants (four mentors and six mentees) further participated in in-depth interviews to provide narratives of their experience. Thematic analysis was conducted with employment of theory-building structure within the case study(2). Our findings indicated that despite an explicit discussion of mentoring focus on employability skills, e.g. communication, professionalism, advocacy, etc., many mentees perceived mentoring as a gateway to employment and career pathway development. The perceived benefits of mentoring were highly dependent on matching of mentor/mentee, which was complicated by the diversity of practice within the profession, and unstated expectations of individual mentees. Regardless of the perceived quality of their mentoring experience, participants reported that the NSA mentoring program added value to the society’s membership and were supportive of program continuity. In conclusion, the NSA mentoring program was a value-adding strategy to the society membership and it could play an important role in career pathway support into the diverse areas of practice in the nutrition profession. More explicit discussion of expectations between mentors and mentees at the beginning of mentoring could enhance the mentoring experience.

Consumer interest in plant-based diets has increased, alongside significant growth in the availability of plant-based meat and dairy alternatives in supermarkets(1). The nutritional profile of these products is likely to vary due to the broad range of ingredients used(2). Food composition databases, such as the Australian Food Composition Database (AFCD), are used extensively in research, practice, and policy, including by nutrition and dietetics researchers and health professionals to identify the nutrient content of foods. However, it is unclear if, and to what extent, the AFCD data on plant-based alternatives reflects the current food supply. This study aimed to examine the range and composition of plant-based meat and dairy alternatives available in Australian supermarkets and compare this with the AFCD. Data on core plant-based meat and dairy alternatives were collected from eight Melbourne supermarkets between June and October 2022 using the CSIRO FoodTrackTM database methodology(3). Products were included if they were i) meat or dairy substitutes outlined in the AFCD; or ii) plant-based alternatives for core meat and dairy included in the Australian Dietary Guidelines. Product images were taken, and data was transcribed. Products collected in supermarkets were then ‘matched’ to the most appropriate reference item in the AFCD. In total, 455 meat alternatives (n = 219 legumes/pulses; n = 178 meat substitutes; n = 38 tofu/tempeh; n = 20 sausages) and 249 dairy alternatives (n = 157 milk; n = 52 cheese; n = 40 yoghurt) were identified. Over half of the plant-based meat substitutes (n = 102; 57%) were made from a soy/wheat/pea base protein. Of the dairy alternatives, just over half of the cheese substitutes had coconut as their main ingredient (n = 28; 54%), and almost two-thirds of yoghurts were coconut-based (n = 28; 70%). The majority of the 157 milks were oat-based (n = 57; 37%), followed by almond (n = 45; 29%), and soy (n = 27; 17%). Many supermarket products were not reflected in the AFCD, including over two-thirds of dairy alternatives (n = 159; 67%), and one-third of meat alternatives (n = 150; 33%). This was due to more product options within categories, such as the variety of canned beans/legumes (n = 96) and flavoured milk substitutes (n = 34) available in supermarkets, and a greater variety of main ingredients used, most notably for cheese substitutes (n = 52). This study highlights that the range of plant-based meat and dairy alternatives available in Australian supermarkets is diverse, with many different base ingredients used, and a great range of products available in-store than in the AFCD. Findings highlight the challenges of food composition databases in keeping up to date with the fast-growing plant-based sector. Outcomes from this study have implications for the monitoring of the food supply and population level dietary data.

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the ‘dimensions’). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally.

Within rural Australia, only 47% and 9% of adults meet recommendations for fruit and vegetable intake, respectively, which is a leading contributor to the increased risk of non-communicable disease. Previous literature has identified barriers and facilitators to increasing fruit and vegetable intake in rural Australian settings, such as having greater access to fresh produce(1). However, this literature is limited by observing fruit and vegetables as a single food group and small sample sizes. This study aimed to determine the barriers and facilitators to meeting fruit and vegetable recommendations (as separate food groups) in rural Australian adults. It was hypothesised that barriers and facilitators to consumption of fruits and vegetables would be identified at the individual, social-environmental and physical-environmental levels of a socio-ecological framework and these would differ between fruit and vegetables(2). Data from the 2019 Active Living Census were used, completed in the Loddon Campaspe region of north-west Victoria, Australia. Data were available at the level of the individual (socio-demographic characteristics, health behaviours, education level, financial stability), social-environment (household size), and physical-environment (use of community gardens). Information on fruit and vegetable consumption was collected using two open-ended questions asking how many serves were consumed each day. Survey weighting was used to account for the survey design. Descriptive statistics were reported for continuous (mean and standard errors [SE]) and categorical (frequencies) data. Multivariate logistic regression analyses were used to determine odds ratios (OR) and 95% confidence intervals (CI) for meeting fruit and vegetables recommendations according to barriers and facilitators at the individual, social-environmental and physical-environmental level. A total of 13,464 adults with complete data were included in the analysis (51% female; mean age 48 (0.17) years). Mean fruit intake was 2.85 (0.02) serves per day and mean vegetable intake was 1.56 (0.01) serves per day. A total of 48% of participants consumed the recommended two serves of fruit daily, while 19% consumed the recommended five serves for vegetables. Multivariate analyses determined distinct barriers and facilitators to consumption between fruit and vegetables. For example, a larger household size facilitated meeting vegetable recommendations (OR: 1.41; 95% CI: 1.22, 1.63), but not fruit, and greater alcohol consumption was a barrier to meeting fruit recommendations (OR: 1.47; 95% CI: 1.31, 1.64), but not vegetables. Common facilitators across both fruit and vegetables included higher age, lower BMI, being a non-smoker, and engaging in more vigorous activity. The results of this research will help inform future policies to increase both fruit and vegetable intake in rural communities, therefore contributing to efforts to improve the health of rural Australians.

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically-refractory ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Whilst quality of life is generally good, as many as 83% of patients associate dietary factors with the onset of symptoms(1) and around two-thirds employ some form of dietary restriction post-pouch creation(2,3). There is growing interest to understand the role of diet (as a whole) on pouch function and how it can be used therapeutically. It is imperative that we know the dietary characteristics of pouch patients before attempting to introduce strategies altering their food choice. Since there is good rationale to assess overall diet quality to identify potential avenues for targeting dietary strategies, this study aimed to examine the frequency of perceived food intolerances and diet quality in patients with an ileoanal pouch and the relationship between these two indices. In this cross-sectional study, patients with an ileoanal pouch completed a food intolerance questionnaire and a validated 297-item semi-quantitative food frequency questionnaire (Monash Comprehensive Nutritional Assessment Questionnaire). Dietary data was used to score diet quality using the 2013 Dietary Guidelines Index (DGI), a scoring system which compares how closely an individual’s dietary intake aligns with the Australian Dietary Guidelines (ADG). The DGI also comprises of 11 subcomponents (scored out of 10 respectively) based on each of the ADG guidelines and provides a total score of 110, with higher scores reflecting greater compliance to the ADG. In order to determine if perceived dietary intolerances was negatively associated with the intake of specific dietary factors, univariable and multivariable linear regression analysis of the correlation of intolerance and diet quality was performed. Of the 58 (10 FAP and 48 UC) patients studied, 81% of UC and 80% of FAP patients reported dietary intolerances. Mean total DGI score was 78 (95% CI: 74-80) of 110 in the overall pouch cohort with no differences across pouch sub-groups. However, only 5% of patients achieved a full score for food variety. Both uni- [OR −0.94 (−1.7,-0.10); p = 0.02] and multivariable analysis (adjusting for age and sex) showed that only intolerances to dairy products were associated with reduced intake of lactose-containing dairy [OR −0.29 (−1.8,-0.08); p=0.03]. No other significant correlations were found for overall or subcomponents of DGI scores. High rates of perceived food intolerances were observed in patients with an ileoanal pouch. However, only those with perceived dairy intolerances restricted their intake of lactose-containing dairy products. Additionally, patients with ileoanal pouch scored highly for overall diet quality but specific gaps in achieving better diet quality, particularly for diet variety were observed. These results provide some starting points for targeted dietary counselling to optimise nutritional health and potentially to improve pouch function these patients.

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.