Influence of a structured, 1-year-long dietary intervention regarding body composition and cardiovascular risk (ARCTIC) in coeliac disease: a protocol of a multicentre randomised controlled trial.

INTRODUCTION: Coeliac disease (CD) affects 1% of the population worldwide. The only available evidence-based treatment is a strict gluten-free diet (GFD), which can readily lead to weight gain and unfavourable metabolic changes (eg, dyslipidaemia, fatty liver disease and insulin resistance) if followed without adequate dietary control. That can lead to increased cardiovascular risk (CV). We planned a randomised controlled trial to test the effect of a group-based, structured, 1-year, advanced dietary education, per the proposal of a Mediterranean diet vs standard of care, regarding the most relevant CV risk factors (eg, metabolic parameters and body composition) in CD patients. METHODS AND ANALYSIS: Randomisation will occur after the baseline dietary education and interview in a 1:1 allocation ratio. Outcomes include anthropometric parameters (body composition analysis including weight, Body Mass Index, fat mass, per cent body fat, skeletal muscle mass, visceral fat area and total body water) and CV risk-related metabolic parameters (eg, lipid profile, homocysteine, fasting glucose, haemoglobin A1c, Homeostatic Model Assessment Index, metabolic hormones, waist circumference, blood pressure, liver function tests, liver steatosis rate and diet composition). In this study, we aim to draw attention to a new aspect regarding managing CD: dietary education can lead to a better quality of the GFD, thereby reducing the risk of potential metabolic and CV complications. ETHICS AND DISSEMINATION: The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05530070.

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study.

INTRODUCTION: The majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This study aims to investigate the effectivity and feasibility of a co-created healthy school lunch in disadvantaged neighbourhoods of the city of Rotterdam, the Netherlands. METHODS AND ANALYSIS: This is a cluster randomised cross-over trial with five participating primary schools. Schools will be randomised to have an 18 week healthy school lunch the first or second half of the academic year. The other half of the academic year, children will bring their own lunch from home. A tailored lunch concept for each school will be co-created with school staff, parents, children and key-stakeholders.Primary outcome is the dietary content of children's lunches, assessed by observations for all children. Secondary outcomes include healthy lunch-related parameters, like general dietary behaviour, perceived health, taste preferences, concentration in class, and some feasibility outcomes, like satisfaction, implementation at school and affordability for parents. Secondary outcomes will be assessed by questionnaires for children (grades 5-8), parents and teachers. The observations and questionnaires for children and parents will be completed at baseline (September 2023), half way the academic year (January-February 2024) and at the end of the academic year (June-July 2024). Teachers will complete a monthly questionnaire starting in September 2023. ETHICS AND DISSEMINATION: This study obtained ethical approval from the Institutional research Review Board Erasmus MC of Rotterdam, the Netherlands. Informed consent will be collected from all participants (parents, teachers and children 12 years or older) and/or their parents (for children under the age of 16). The findings will be disseminated by conference presentations and publications in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT06058325.

Caregivers' perceptions of feeding practices and diet diversity among children aged 12-59 months in a rural district of South India: an analytical cross-sectional study.

OBJECTIVE: The primary objective of this study was to assess caregivers' perceptions of feeding practices (breastfeeding and complementary feeding) and diet diversity among children aged 12-59 months in a rural district of South India. The secondary objective was to identify potential predictors of these perceptions and diet diversity. DESIGN: An analytical cross-sectional study was performed from March 2023 to May 2023. SETTING: In a rural district of Tamil Nadu, South India. PARTICIPANTS: This study included 301 mothers/caregivers of children between 12 and 59 months of age in a rural district of Tamil Nadu. The research gathered demographic information from caregivers, including details such as age, educational background, occupation, relationship with the child and place of residence. Additionally, the caregivers' perspectives were evaluated through a questionnaire focused on breastfeeding/complementary feeding, and the diet diversity of the children was also assessed. OUTCOME MEASURES: The primary outcome was the perceptions of mothers/caregivers of children between 12 and 59 months of age about breastfeeding/complementary feeding practices, and the diet diversity of the children was measured. Additionally, predictors associated with these perceptions were evaluated through regression analysis. RESULTS: In the present study, 188 (62.5%) and 179 (59.5%) of the participants had good perceptions of breastfeeding practices and complementary feeding practices, respectively. This binomial regression revealed that subjects with unstable occupations (adjusted OR=2.24, 95% CI 1.25 to 4.01), schooling (7.71, 95% CI 2.73 to 8.9) and higher education (38.32, 95% CI 4.63 to 316.85) had increased chances of having good perceptions of breastfeeding practices. Subjects with unstable occupations (0.23, 95% CI 0.06 to 0.85), stable occupations (0.13, 95% CI 0.04 to 0.51), schooling (0.43, 95% CI 0.25 to 0.74), higher education (0.15, 95% CI 0.04 to 0.50) and increased birth weights (2.54, 95% CI 1.35 to 4.78) had increased chances of having good perceptions of complementary feeding practices (p<0.05). This study revealed that 86.4% of the children had adequate diet diversity. CONCLUSION: The study revealed that most caregivers, particularly mothers, possess a strong understanding of breastfeeding and complementary feeding practices, with education and occupation exerting a notable influence. However, there is a crucial necessity to translate this knowledge into practical applications to effectively obtain feeding indicators.

Dietary habit and lifestyle of postpartum women in South China: a mixed methods research.

OBJECTIVE: To investigate the dietary and hygiene behaviours and influencing factors of women during the puerperium in South China. DESIGN: A cross-sectional study. SETTING: Three tertiary hospitals in Guangdong Province, China PARTICIPANTS: From November 2022 to March 2023, 327 women with puerperal experience were enrolled using the purposive sampling method, with 323 valid questionnaires collected for data analysis. Semistructured interviews were conducted with six puerperium women and five primary caregivers. PRIMARY AND SECONDARY OUTCOME MEASURES: This study used a questionnaire survey to collect and analyse the current postpartum dietary and hygiene behaviours among women in the South China region, along with their influencing factors. RESULTS: Multinomial logistics regression revealed women residing in urban-rural fringe were more likely to use ventilated rooms (OR 4.496, 95% CI 2.363 to 8.552) and avoid hair washing (OR 0.345, 95% CI 0.159 to 0.749) compared with urban residents. Additionally, women who practiced Buddhism were more likely to wash their hair (OR 11.070, 95% CI 2.339 to 52.379) and take baths (OR 6.856, 95% CI 2.057 to 22.855) compared with those with no religious affiliation. Lastly, those whose primary caregiver was their husband were more likely to consume watermelon (OR 2.235, 95% CI 1.119 to 4.463), persimmon (OR 4.395, 95% CI 1.886 to 10.242) and longan (OR 2.612, 95% CI 1.362 to 5.010). The qualitative study identified five themes: dietary practices, hygiene habits, personal attitude, sources of information and support. CONCLUSION: The dietary and hygiene behaviours of puerperium women in South China are significantly influenced by the residen, primary caregivers and religious beliefs. Medical care providers should adopt a precision postpartum care strategy to improve the quality of care.

Market survey of food product indicators and their credibility as a healthy food product in Klang Valley, Malaysia.

INTRODUCTION: The presence of food product indicators may facilitate consumers in making informed healthy choices. However, it may also mislead consumers. This study aims to determine the prevalence of food products carrying food product indicators; the compliance of products bearing Malaysia's Healthier Choice Logo (HCL) and nutrition and health claims (NHC) towards the local regulations; and the credibility of the aforementioned products as healthy food products based on the international regulation in the Malaysian market. METHOD: This is a cross-sectional market survey conducted from February to May 2023 on 3428 products sold in Malaysian supermarkets. Product information including the brand, name, nutrition information panel, food product indicator (front-of-pack nutrition labelling, NHC, other claims), ingredients list and manufacturer or importer were collected. Compliance of products carrying NHC and HCL is evaluated against local guidelines. Credibility as a healthy product is evaluated against the WHO Nutrient Profile Model for the Western Pacific Region on a subsample (products with HCL and/or NHC). RESULTS: 53% of food products surveyed had food product indicators (n=1809). A total of 32% carried at least one NHC (n=1101), of which 47% had excellent overall compliance (n=522). Only 4% carried Malaysia's HCL (n=138), of which 48% had excellent nutrient compliance (n=66). Only 13% of the products carrying Malaysia's HCL and NHC could be identified as absolute healthy food products as defined by the WHO standard (n=147). CONCLUSION: Although half of the products surveyed had food product indicators, merely half of them had excellent compliance towards the standards. Only 13% of the subsample qualified as healthy food products. Voluntary application of the local HCL was low among food industries. Ensuring high standards of compliance and credibility of food products in the Malaysian market is crucial for food companies and government authorities.

[Diet and diabetes: constantly evolving recommendations]. / Alimentation et diabète, des recommandations en constante évolution.

Diabetes management has evolved into a person-centered practice, where specific needs play a central role. Different types of diabetes have different dietary characteristics, depending on the patient's profile. With better access to information, patients are keen to adopt new diets. The needs expressed by each individual must be accommodated, in order to respect their autonomy and improve their quality of life.

Differences in the Use and Perception of Telehealth Across Four Mental Health Professions: Insights From a Secondary Analysis of Qualitative Data.

There is growing evidence that the uptake and use of telehealth is influenced by the distinct specialty area or type of healthcare service provided, with mental health services presenting particular challenges. However, little is known about how telehealth use differs between different mental health professions, and no qualitative research has explored variations in telehealth use and perspectives at the profession level within Australian mental health services. To address this gap, we analyzed transcripts from 19 semi-structured interviews conducted with mental healthcare professionals in a local health district within New South Wales, Australia. A secondary analysis of the data revealed the distinct ways in which different mental health professions perceive and engage with telehealth depending on their specific role and approach to practice. Application of a systems theory lens highlighted the challenges each profession faces at different levels of telehealth engagement, and the macro-systemic power dynamics and hierarchies that shape profession-specific differences in telehealth use.

Nutritional Properties of Wild Edible Plants with Traditional Use in the Catalan Linguistic Area: A First Step for Their Relevance in Food Security.

Wild food plants (WFPs) are crucial for the subsistence of many human populations. While there are at least 7000 edible plant species in the world, only approximately 420 are considered food crops. WFPs are often studied from the phytochemical and pharmacological point of view, because they include available food components with nutraceutical value. The present study aims to highlight the nutritional value of WFPs traditionally used in the Catalan linguistic area, providing detailed insights and discussing the significance of these properties. Information about the nutritional properties of 93 taxa, coming from ethnobotanical prospection, has been collected through an extensive bibliographic research. The results reveal that WFPs are rich in nutrients, especially micronutrients. Furthermore, in selected species, those for which nutritional information and a cultivated homologue are available, the nutrient content in wild taxa exceeds than of phylogenetically related crop plants with similar use. Traditional wild plant preparation forms for food and the nutritional value of a menu constituted by wild food plants are presented. This research represents a preliminary step toward selecting certain taxa that could be developed into new small- or large-scale crops or sustainably harvested in the wild, contributing to food security.

Assessing the effect of anthocyanins through diet and supplementation on cognitive function in older adults at risk for dementia: protocol for a randomised controlled trial.

INTRODUCTION: Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments. METHODS AND ANALYSIS: The 'Food for Thought' study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim is to investigate whether anthocyanin consumption, either through diet or supplementation, can prevent memory loss progression and improve inflammatory and cardiovascular health in older adults at risk for dementia. Eligible participants will include those aged 60-85 years with a diagnosis of amnestic mild cognitive impairment or with a self-referral of memory concerns and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment screening test. Participants will be randomised to one of three arms: High anthocyanin ('purple foods') diet (aiming for a target of 250 mg anthocyanins/day); freeze-dried product derived from blackcurrants (250 mg anthocyanins/day); or control (coloured maltose powder). The primary outcome is auditory anterograde memory functioning assessed by the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall. Secondary outcomes are additional cognitive functions including processing speed, working memory, aspects of executive functioning (attentional shifting and word generativity) and premorbid estimate as well as subjective memory problems and self-reported depression symptoms. Additional secondary outcomes are blood pressure, inflammatory biomarkers, brain-derived neurotrophic factor, fatty acid profile, apolipoprotein E and polyphenol metabolites, gut microbiota composition and function and vascular and microvascular endothelial function tests. Repeated measures analysis of variance and/or mixed linear modelling will evaluate changes over time, with the inclusion of covariates. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Greater Western Human Research Ethics Committee (2021/ETH12083). A Consumer Advisory Group was established to guide and review the protocol and dissemination strategy. The results of this trial are intended to be published in a peer-reviewed journal. TRIAL SPONSOR: National Health and Medical Research Centre Dementia Collaborative Research Centre.Start date of clinical trial: 02 September 2022.Expected end date: 11 October 2024. TRIAL REGISTRATION NUMBER: ACTRN12622000065796.

Effect of time restricted eating versus current practice in dietetics on glycaemic control and cardio-metabolic outcomes in individuals at risk of developing type 2 diabetes: Protocol for a multi-centre, parallel group, non-inferiority, randomised controlled trial.

BACKGROUND: Time restricted eating (TRE) is a dietary strategy that may improve metabolic health. However, no studies have compared TRE with current practice (CP) in dietetics. HYPOTHESIS: TRE will not be inferior to CP to improve glycaemic control in individuals at risk of type 2 diabetes (T2D). METHODS: This parallel group, randomised, non-inferiority, controlled trial randomised 247 participants by site and glycated haemoglobin (HbA1c) into TRE or CP (1:1) for 12 months. Participants were aged 35-70 years, with a body mass index (BMI) >25 but <45 kg/m2, and score ≥15 on the Australian type 2 diabetes risk (AUSDRISK) assessment, without a diagnosis of T2D. Study visits were balanced between groups and all participants received five consultations at 0, 0.5, 1, 2 and 3 months. TRE followed a self-selected 9 h eating window (≥0600 and ≤1900), whereas CP followed Australian dietary guidelines. OUTCOMES: The primary endpoint is the estimate of group mean difference (TRE vs CP) of HbA1c at 4 months in a covariate linear regression adjusting for stratification factors and sex. Secondary efficacy outcomes at 4 and 12 months are changes in fasting glucose, fasting insulin, HOMA-IR and nocturnal glucose by continuous glucose monitor incremental area under the curve and change in HbA1c at 12 months. Other endpoints are exploratory and will not be adjusted for multiplicity. CONCLUSIONS: We will determine whether TRE is an alternate strategy to current practice in dietetics to improve glucose control. TRIAL REGISTRATION: NCT04762251; 21 Feb 2021.

Effect of peanut butter supplementation on physical and cognitive functions in community-dwelling older adults: study protocol for a 6-month randomised controlled trial.

INTRODUCTION: Ageing is associated with physical and cognitive declines, which may be further exacerbated by poor nutrition. Nuts are energy and nutrient dense, and their consumption is associated with better physical and cognitive functions in older adults, but data from interventional studies are limited. This 6-month randomised controlled trial is designed to investigate the effects of consuming 43 g/day of peanut butter (equivalent to 1.5 servings of nuts) on physical function, including walking speed (primary outcome), standing and dynamic balance, upper and lower body strength, lower body power and endurance, and associated factors including muscle mass, cognitive function and DNA telomere length in community-dwelling older adults. METHOD AND ANALYSIS: A total of 120 participants aged ≥65 years will be recruited and randomly allocated (1:1 ratio) to either the intervention group (n=60) that will receive individually packaged sealed containers containing 43 g of peanut butter to be consumed once daily for 6 months alongside habitual diet, or the control group (n=60) that will maintain their habitual diet. Primary and secondary outcomes will be assessed at baseline and at 6 months. The primary outcome is walking speed assessed using the 4 m usual gait speed test. Secondary outcomes include other physical function assessments: standing balance, chair stand time, timed-up-and-go test and four-square step test; and hand grip and knee extensor muscle strength; cognitive function assessed using the Montreal Cognitive Assessment and trail making tests; body composition; nutritional status; and DNA telomere length from participants' buccal cell samples. Linear mixed models will be used to compare changes in outcomes between intervention and control groups. ETHICS AND DISSEMINATION: The study protocol is approved by the Deakin University Human Research Ethics Committee. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622001291774. The results will be disseminated through peer-reviewed journals, conference presentations and media. TRIAL REGISTRATION NUMBER: ANZCTR12622001291774.

Evaluation of frequency of consumption of cariogenic snacks by freshmen versus the senior dental students in Tehran and the related factors: a cross-sectional study.

BACKGROUND: Senior dental students are more aware of the harmful effects of cariogenic snacks and are expected to better watch their diet compared with freshmen dental students. This study aimed to compare the frequency of consumption of cariogenic snacks by senior and freshmen dental students of Tehran city and the related factors. METHODS: This cross-sectional study evaluated the senior and freshmen dental students attending dental schools in Tehran in 2018, who were selected by census sampling. A cariogenic snack record form was used to collect information regarding the frequency of consumption of cariogenic snacks both prospectively (within the upcoming week) and retrospectively (previous 24 hours). We also collected information on the demographic characteristics of the participants. The plaque-producing and decay-producing potential of the diet (PAP) index was calculated for each dental student. Data were analysed by the backward regression model using SPSS. RESULTS: A total of 294 dental students with a mean age of 22±2.85 years participated in this study. The mean PAP score was 76.48±49.91 for the freshmen and 89.87±49.41 for the senior dental students with a significant difference between them (p=0.023). Older dental students (p=0.008) and those not living with their parents (p=0.001) acquired a higher PAP score. CONCLUSION: The mean PAP score of freshmen and senior dental students in Tehran was slightly higher than the optimal level. So the instructional techniques of dental curricula are better to be revised to improve the performance of dental students to cut down the consumption of cariogenic snacks.

Effect of ketogenic diets on lipid metabolism in adults: protocol for a systematic review.

INTRODUCTION: The ketogenic diet is a very low carbohydrate diet known for its ability to reduce weight and counteract hyperglycaemia. However, ketogenic diets recommend an increased intake of fats, raising concerns about cardiometabolic risk in adults. Due to the higher intake of fats in the ketogenic diet, there is significant variability in outcomes of lipid metabolism in the population. Interventions have reported improvements in lipid profile while other studies did not find changes, and there are reports of increased low density lipoprotein (LDL) and triglyceride values. Hence, this is a protocol for a systematic review of the published literature and a summary of the effect of ketogenic diets on lipid metabolism in adults. METHODS AND ANALYSIS: Five databases (PubMed, Embase, Scopus, Cochrane Library and Web of Science) will be searched for studies on ketogenic diets in adult populations. Studies will be included if they report results from ketogenic diet interventions among adults. Exclusion is populations with diagnosed neurological disorders. Two reviewers will independently screen retrieved citations, extract data and appraise the risk of bias. Quantitative estimates (eg, standardised mean difference) measuring the change in the total cholesterol, LDL and triglyceride concentration will be pooled using random effects meta-analysis to produce one summarised weighted estimate. Sources of heterogeneity will be explored using subgroup analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols (PRISMA), and the final review will be reported following the PRISMA 2020 guidelines. ETHICS AND DISSEMINATION: The present protocol and the systematic review to be carried out do not require ethics clearance. The data source will be published studies. This review will provide estimates to inform the public about the effect of ketogenic diets on lipid metabolism and the possible peril of increasing cardiometabolic risk. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022309665.

Determination of appropriate policy targets to reduce the prevalence of stunting in children under five years of age in urban-poor communities in Indonesia: a secondary data analysis of the 2022 Indonesian national nutritional status survey.

OBJECTIVE: Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia. DESIGN: A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey. SETTING AND PARTICIPANTS: At the national level, Indonesia encompassed 43 284 toddlers. INTERVENTIONS: Non-intervention study. PRIMARY AND SECONDARY OUTCOMES: The study's eight independent factors were the mother's age, education, marital status, employment, wealth, antenatal care (ANC), children's age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam. RESULTS: Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0-11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105). CONCLUSION: The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids.

Nutritional Considerations of Plant-Based Diets for People With Food Allergy.

Plant-based diets (PBD) have been reported throughout history, but are increasingly common in current times, likely in part due to considerable emphasis on climate change and human health and wellness. Many dietary organisations around the world endorse well-planned, nutritionally adequate PBD, which exclude some or all forms of animal-based foods. However, special attention must be given to patients who follow PBD and also have food allergy (FA), as avoidance may increase the risk of developing nutritional deficiencies, including poor growth in children, weight loss in adults and vitamin and mineral deficiencies. Given the increasing prevalence of both PBD and food allergen avoidance diets, healthcare providers are likely to counsel patients with FA who also follow a PBD. In this review, an overview of PBD in patients with FA is provided, including recent trends, macro- and micronutrient needs, and growth for children and weight gain considerations for adults. With regard to a PBD, special attention should be given to ensure adequate fat and protein intake and improving the bioavailability of several minerals such as iron, zinc, iodine, calcium and magnesium, and vitamins such as A, B2, B12 and D. Although the collective data on growth amongst children following a PBD are varied in outcome and may be influenced in part by the type of PBD, growth must be regularly monitored and in adults weight gain assessed as part of any clinical assessment in those people with FA.

Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice.

Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.

The intersection of systems thinking and structural empowerment in the work of public health dietitians.

BACKGROUND: Public health dietitians navigate complex professional landscapes amid dwindling resources, organisational disruptions and limited advancement opportunities. Cultivating systems thinking and structural empowerment competencies may enable this workforce to address multifaceted public health challenges more effectively. This study explored the extent to which public health dietitians apply systems thinking and perceive access to structural empowerment and the relationship between these constructs. METHODS: A quantitative online survey incorporating the systems thinking scale (STS) and conditions for work effectiveness questionnaire-II (CWEQ-II) was conducted among US public health dietitians who worked in governmental public health. Data were collected from September 2022 to October 2022. Descriptive and inferential statistical analyses were conducted. RESULTS: Among 216 respondents, 98% demonstrated moderate-to-high systems thinking competency (mean STS score = 60.3 ± 8.74, range 28-78). Over 88% reported moderate-to-high perceived structural empowerment (mean CWEQ-II score = 18.3 ± 0.96, range 8-29). Higher systems thinking scores were associated with greater decision-making authority (p = 0.01) but not budget oversight. Higher structural empowerment scores correlated with increased job responsibilities and decision-making authority (p < 0.001). A significant positive correlation existed between systems thinking and structural empowerment (r = 0.24, p < 0.001). Public health dietitians exhibited substantial systems thinking capabilities and perceived access to organisational power structures. CONCLUSIONS: This study offers baseline understanding of systems thinking and structural empowerment among public health dietitians. The positive interplay between these constructs underscores their potential to drive systems-level change and influence population health outcomes. Integrating systems thinking and structural empowerment into dietetic education and professional development may enhance the workforce's preparedness for navigating complexities.

Embedding Multimodal Rehabilitation Within Routine Cancer Care in Sheffield-The Active Together Service Evaluation Protocol.

BACKGROUND: Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes. METHODS: This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the service and compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. CONCLUSIONS: Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer.

Exploring Dietitians' Perspectives Toward Current Practices and Services in Relation to Irritable Bowel Syndrome Management in Clinical Settings Across the United Kingdom: A Qualitative Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition that negatively impacts quality of life. Dietary triggers are common and dietary management is central to the IBS treatment pathway, and dietitians are the main education providers for patients. OBJECTIVE: The aim of this study was to explore dietitians' perspectives on current practices and services in relation to IBS management in clinical settings across the United Kingdom. DESIGN: Qualitative semi-structured interviews were undertaken from May to October 2021 via videoconferencing software. Eligible participants were dietitians specializing in gastroenterology and working in National Health Service (NHS) Trusts in the United Kingdom. Interviews were audio recorded and transcribed following intelligent transcription. Template analysis guided by naïve realism and its underlying epistemological assumptions was used. PARTICIPANTS/SETTING: Dietitians (N = 13) working in various NHS Trusts across the United Kingdom with at least 1 year of clinical experience in IBS management were included. QUALITATIVE DATA ANALYSIS: Template analysis, a form of thematic analysis with hierarchical coding, was used to explore dietitians' perspectives of IBS practices. RESULTS: Participating dietitians were mostly female (92.3%), of White race (84.6%), working in various NHS Trusts across the United Kingdom, and had more than 5 years of clinical experience (69.2%). The following 3 main themes emerged: 1) dietetics services as part of IBS referral pathways; 2) practices in relation to dietetics services; and 3) patients' expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist dietitians were reported, along with the use of digital innovation to facilitate practice and access to dietetic care. The use of internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centered approach to dietary counseling and recognize the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations. CONCLUSIONS: The study identified areas and practices that can facilitate access to dietetic services and patient-centered care in IBS management, as outlined in UK-based guidelines.