Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study.

BACKGROUND: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults' risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. METHODS: Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the 'Eat well, feel well, stay well' intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. RESULTS: Participants' comments were generally positive. This paper focuses predominantly on participants' negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants' specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults' beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults' everyday activities, values and beliefs. CONCLUSIONS: Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults' engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.

Assessing the implementation of healthy eating and physical activity policies and practices in the family day care setting: A cross-sectional study.

ISSUE ADDRESSED: While the family day care setting provides a unique opportunity to improve child health, few studies have assessed obesity prevention practices of this setting. This study aimed to examine the (a) prevalence of implementation of evidence-based healthy eating and physical activity policies and practices among schemes (ie overarching governing agency) and educators in the family day care setting in Australia; and (b) associations between educator socio-demographic characteristics and implementation of healthy eating and physical activity practices. METHODS: Family day care schemes (n = 16) responsible for educators (n = 174) located in the Hunter New England region of NSW participated in a telephone survey in 2018, reporting their implementation of evidence-based healthy eating and physical activity policies and practices. Linear mixed regression analyses were used to determine whether educator characteristics were associated with higher percentages of implementation. RESULTS: Few schemes had comprehensive breastfeeding (0%) and screen time (19%) policies. However, the majority of educators (81%) communicated with families when lunchboxes were not consistent with guidelines. Educators implemented an average of 64.3% of practices assessed. Educators located in higher socioeconomic areas implemented a significantly higher percentage of practices than those in lower socioeconomic areas (P < .000). Educator years of experience was positively associated with percentage of implementation (P = .009). CONCLUSIONS: The implementation of obesity prevention policies and practices in the family day care setting is variable and associated with educator socio-demographic characteristics. SO WHAT?: There is a need to support family day care schemes to improve their obesity prevention environments, particularly those related to policies.

Importance of involving patients and public in health research in Bangladesh and Nepal.

Patient and public involvement/engagement (PPI/E) in public health research and health technology assessment (HTA) in high-income countries (HICs) have significantly increased over the past decade. PPI/E helps to improve research and HTA, ultimately benefitting patients and service users. PPI/E is a very new concept in many low- and middle-income countries (LMICs). This paper considers the importance of PPI in public health research and HTA in the development and implementation of technology in the health sector in South Asia. Currently, in this region, health technology is frequently adopted from HICs without local research and HTA. It also discusses the importance of local co-creation of technology to reflect the needs of users within a culturally appropriate setting. It is important for LMIC-based researchers to understand the potential of PPI/E and how it can contribute to it to improve health care and research, especially perhaps in the era of COVID-19.

Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial.

BACKGROUND: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. OBJECTIVE: This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. METHODS: A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. RESULTS: No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. CONCLUSIONS: Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx.

Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis.

BACKGROUND: Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. METHOD: A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. RESULTS: Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. CONCLUSION: The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. REVIEW REGISTRATIONS: PROSPERO: CRD42017071398 . The review protocol was registered retrospectively.

People with enteral tubes and their carers' views of living with a tube and managing associated problems: A qualitative interview study.

BACKGROUND: Nutrition by enteral tube is a complex therapy requiring significant management to ensure safe, timely delivery of nutrients and avoidance of complications. In the home setting, people with enteral tubes and their carers are required to self-manage the therapy, including the need to cope with problems that arise. Whilst previous studies have conveyed experiences of people with enteral tubes, few have described views on enteral tube problems. AIMS AND OBJECTIVES: Drawing on the findings of a previously reported study (Journal of Human Nutrition and Dietetics, 2019), this paper aims to describe in-depth the experiences of people with enteral tubes and their carers of living with the tube day to day and managing problems that arise. DESIGN: A qualitative descriptive design using semi-structured in-depth interviews was employed. METHODS: A purposive sample of 19 people with enteral tubes and 15 carers of people with tubes participated. Interviews were recorded and transcribed. Using a thematic analysis approach, codes were defined and applied; themes developed and refined. Five themes with associated subthemes were generated, of which one, "living with the tube," is reported in-depth. The COREQ checklist was used. RESULTS: Participants described the tube affecting both physical and psychosocial being and revealed it had resulted in significant changes to their daily living, necessitating adaptation to a new way of life. Participants reported spending much time and effort to manage tube problems, at times without support from healthcare practitioners knowledgeable in tube management. Discomfort associated with the tube was commonly described. CONCLUSIONS: Living with an enteral tube impacts significantly on daily life requiring adaptations to normal routine. People with tubes and their carers use a range of strategies to manage common complications. RELEVANCE TO CLINICAL PRACTICE: Knowledge and understanding of how people with enteral tubes live with their tube and manage issues as they arise will enable healthcare practitioners to provide better support.

Effectiveness of a dissemination strategy on the uptake of an online menu planning program: A controlled trial.

ISSUE ADDRESSED: Online systems offer opportunities to provide effective, ongoing support to childcare services to implement dietary guidelines. The study aimed to assess the effectiveness of a dissemination strategy on childcare service: (i) adoption; and (ii) use of an online menu planning program designed to increase compliance with dietary guidelines. METHODS: A nonrandomised controlled trial was conducted with long day care services across Australia. All services received an email invitation to access an online evidence-based menu planning program. Services in the intervention also received training, telephone contact and provision of a portable computer tablet to encourage program adoption and use. Outcomes were assessed at the 6-month follow-up using analytics data recorded by the online program. Outcomes included the proportion of services having accessed the program (adoption) and the proportion of services with a current menu entered in the program (use as intended). RESULTS: Twenty-seven interventions and 19 control services took part. At the 6-month follow-up, 100% vs 58% of services had adopted the online menu planning program (OR: 14.67, 95% CI: 2.43-infinity; P < 0.01) and 41% vs 5% of services had a current menu entered in the program (OR: 9.99, 95% CI: 1.01-534.57; P < 0.01) in the intervention and control arms respectively. CONCLUSIONS: This study highlights the need for strategies to support adoption and use of an online menu planning program in childcare services if the potential benefits of such a program are to be achieved. Future research should explore the effectiveness of differing strategies to increase adoption and use of online programs at scale. SO WHAT?: Strategies to support childcare service uptake and use of online programs are required in order for the potential public health benefits of such technologies to be realised.

Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study.

INTRODUCTION: Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care. AIMS AND OBJECTIVES: To explore hospital patients' perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation. DESIGN: A qualitative, explorative study design was employed. METHOD: An inductive content analysis of semi-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline. FINDINGS: Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits. CONCLUSION: Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care. RELEVANCE TO CLINICAL PRACTICE: This study illustrates that nurses caring for people who undergo lower extremity amputation need to recognise that nutritional care is an essential component of nursing and should focus on working in partnership with the patient.

Effectiveness of a pragmatic school-based universal intervention targeting student resilience protective factors in reducing mental health problems in adolescents.

Worldwide, 10-20% of adolescents experience mental health problems. Strategies aimed at strengthening resilience protective factors provide a potential approach for reducing mental health problems in adolescents. This study evaluated the effectiveness of a universal, school-based intervention targeting resilience protective factors in reducing mental health problems in adolescents. A cluster randomised controlled trial was conducted in 20 intervention and 12 control secondary schools located in socio-economically disadvantaged areas of NSW, Australia. Data were collected from 3115 students at baseline (Grade 7, 2011), of whom 2149 provided data at follow up (Grade 10, 2014; enrolments in Grades 7 to 10 typically aged 12-16 years; 50% male; 69.0% retention). There were no significant differences between groups at follow-up for three mental health outcomes: total SDQ, internalising problems, and prosocial behaviour. A small statistically significant difference in favour of the control group was found for externalising problems. Findings highlight the continued difficulties in developing effective, school-based prevention programs for mental health problems in adolescents. TRIAL REGISTRATION: ANZCTR (Ref no: ACTRN12611000606987).

The effect of caffeinated versus decaffeinated drinks on overactive bladder: a double-blind, randomized, crossover study.

PURPOSE: The primary aims of this study were to test the methodology for use in a future randomized control trial and to investigate the effect of drinking caffeinated versus decaffeinated fluids on symptoms of overactive bladder (OAB) in women. DESIGN: A double-blind, randomized, crossover study was conducted. METHODS: Fourteen community-dwelling women newly diagnosed with OAB and a history of caffeine consumption were randomly allocated to group A (14-day caffeinated drink period followed by 14-day decaffeinated drink period) or group B (14-day decaffeinated drink period followed by 14-day caffeinated drink period). The periods were preceded by a 14-day run-in period and interspersed with a 14-day washout period. Primary outcomes were episodes of urgency, frequency, volume per void, and incontinence obtained each period on 3-day bladder diaries. Secondary outcome measures were OAB symptom severity and health-related quality of life (QOL) recorded each period using International Consultation on Incontinence-Overactive Bladder Module (ICIQ-OAB) and ICIQ-OAB-Quality of Life (ICIQ-OABqol) tools. Effects of caffeine reduction were measured each day using visual analogue scales. RESULTS: Eleven participants completed the study. A significant reduction in urgency (P < .01) and frequency (P < .05) of urinary voids on day 3 of the diary, total ICIQ-OAB score (P < .01), and a non-significant directional change for the total ICIQ-OABqol score (P = .065) was found using sign tests for the period of decaffeinated compared to caffeinated drink intake. No significant differences were found for any caffeine withdrawal measures. CONCLUSIONS: Despite the small sample size, this pilot study demonstrated that reducing caffeine intake may alleviate the severity of some symptoms and health-related QOL factors associated with OAB. Furthermore, caffeine substitutes were well tolerated.

Home enteral nutrition: organisation of services.

This article discusses how services for people receiving enteral nutrition via a nasogastric or gastrostomy tube at home are organised. The home enteral nutrition team's role is also explored. The National Institute for Health and Care Excellence outlines the need for nutritional support in adults to be high quality and cost effective. It is important therefore that local services are able to provide people receiving enteral nutrition with safe and effective care that they consider satisfactory. The discussion is pertinent to nurses caring for older people because gastrostomy tube placement is increasingly common in people aged over 60. A gastrostomy tube is the usual route by which enteral nutrition is given in the community.

A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings.

AIMS AND OBJECTIVES: The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings. BACKGROUND: Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition. DESIGN: A systematic review of the literature was undertaken. METHOD: Key words were identified and used separately and in combination to search the electronic databases MEDLINE, CINHAL, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010. RESULTS: Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified. CONCLUSIONS: There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported. Relevance to clinical practice. This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings.

Audit of antipsychotic prescribing in dementia: Cambridgeshire results and lessons learnt.

BACKGROUND: Behavioural and psychological symptoms in dementia (BPSD) are common and distressing. Anti psychotic medication has been shown to have modest efficacy but is associated with well documented risks including excess cardiovascular events and increased mortality. The current NICE recommendations are that antipsychotics should only be prescribed to those with severe BPSD after exploring other possible interventions. There should be adequate counselling of the patient/family, an explicit risk-benefit analysis and regular review. METHODS: As part of the POMH-UK National Audit on antipsychotic prescribing in dementia we reviewed the notes of 67 patients in the Cambridgeshire area who had a diagnosis of dementia. RESULTS: Of the 67 patients reviewed, only 9 (13.4%) were currently being prescribed antipsychotics for BPSD. Of these patients, all were living in their own homes and were experiencing multiple distressing target symptoms. 5 had been prescribed an antipsychotic for less than 3 months and only 1 had a total duration of treatment of more than 1 year. There was good evidence in all cases that alternative diagnoses and management strategies had been explored before prescribing an antipsychotic. However, in none was the full range of potential causes or interventions explored. In 6 cases a risk/benefit analysis for use of antipsychotic medicine was recorded and in 5 cases there was documented discussion of this with family or carers. Of the four patients who had been prescribed an antipsychotic for more than 3 months, three had had two or more medication reviews. The fourth patient had had a trial of stopping the medication. Prescribing of other psychotropic medication was also reviewed. Benzodiazepines were used sparingly (7.5%). Of note a significant minority of patients (10.4%) were prescribed 3 or more different psychotropic medications. CONCLUSION: These results suggest that within this service antipsychotics are being used appropriately to enable patients with distressing and difficult behaviour to continue to remain at home. They were generally prescribed for a short time and reviewed. Areas for improvement include a documented discussion of risk in all cases and ensuring that all possible causes of BPSD have been ruled out. Regular review of efficacy and tolerability is essential for all pharmacological treatments for BPSD particularly for those prescribed multiple psychotropic medications.

Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review.

Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed.

How Do People Who Are Homeless Find Out about Local Health and Social Care Services: A Mixed Method Study.

BACKGROUND: There are significant numbers of people experiencing homelessness both in the UK and internationally. People who are homeless are much more likely to die prematurely and, therefore, need strong access to ongoing health and social care support if we hope to address the health disparity they face. OBJECTIVES: The aim of the research was to explore how people who are homeless identify and locate appropriate health and social care services. DESIGN: A mixed methods research study was applied on people who are currently homeless or had previously experienced homelessness. SETTINGS: The research study was based in an urban area in the southwest of England. The area was chosen as it was identified to be in the top 24 local authorities for the number of homeless individuals. PARTICIPANTS: A hundred individuals participated in the survey, of those 32% were living on the streets whilst 68% were living in temporary accommodation such as a charity home, shelter or a hotel paid for by the local authority. In addition, 16 participated in either a focus group or one-to-one interview Methods: The quantitative component consisted of a paper-based questionnaire whilst the qualitative aspect was focus groups/one-to-one interviews. The COREQ criteria were used in the report of the qualitative aspects of the study. RESULTS: Quantitative data identified poor health in 90% of the sample. Access to both healthcare and wider wellbeing services (housing and food) was problematic and support for this was largely through third sector charity organisations. Qualitative data identified numerous systemic, individual and cultural obstacles, leaving difficulty for people in terms of knowing who to contact and how to access services, largely relying on word of mouth of other people who are homeless. CONCLUSIONS: In order to address health inequities experienced by people who are homeless, there is a need to review how information regarding local health and wider wellbeing services is provided in local communities.

Use of Technology to Promote Health and Wellbeing of People Who Are Homeless: A Systematic Review.

BACKGROUND: People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: 'what mobile health (mHealth) related technology is used by homeless populations' and 'what is the health impact of mobile technology for homeless populations'? METHODS: An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. RESULTS: Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. CONCLUSION: It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.

Child-level evaluation of a web-based intervention to improve dietary guideline implementation in childcare centers: a cluster-randomized controlled trial.

BACKGROUND: Although it is recommended that childcare centers provide foods consistent with dietary guidelines, the impact of implementing sector-specific guidelines on child outcomes is largely unknown. OBJECTIVES: This study aims to examine the impact of a web-based program and support to implement dietary guidelines in childcare centers on children's 1) diet; 2) BMI z scores; and 3) child health-related quality of life (HRQoL). METHODS: This study was a cluster-randomized controlled trial utilizing a Type-3 Hybrid implementation-effectiveness design conducted between October 2016 and March 2018. This study reports on child outcomes. Fifty-four childcare centers in New South Wales, Australia were randomly assigned to the intervention (a web-based menu-planning tool and support) or control group (usual care). The intervention was designed to address barriers and enablers to dietary guideline implementation according to the Theoretical Domains Framework. A quota of 35 consenting childcare centers undertook child-level evaluation of dietary intake where 522 parents consented to completing ≥1 component of data collection for their child. Child consumption of core and discretionary (unhealthy) foods while in care was assessed via dietary observations by blinded research assistants, childcare diet quality was assessed via educator-completed questionnaires, BMI z scores were assessed via measured weight and height, and child HRQoL was assessed via parent report at baseline and 12-mo follow-up. RESULTS: There was a significant increase in mean child consumption of fruit (0.39 servings; 95% CI: 0.12, 0.65 servings) and dairy foods (0.38 servings; 95% CI: 0.19, 0.57 servings) and a significant reduction in consumption of discretionary foods (-0.40 servings; 95% CI: -0.64, -0.16 servings) in care in the intervention group, relative to control at 12-mo follow-up. No significant differences were observed in diet quality, BMI z scores, or HRQoL. CONCLUSIONS: A web-based intervention to support planning of childcare menus consistent with dietary guidelines can improve child consumption of healthier foods in daycare. This trial was registered at www.anzctr.org.au as ACTRN12616000974404.

Older people playing ball: What is the risk of falling and injury?

Increasing physical activity amongst seniors is important for public health, yet guidance is needed to minimise injury risks. To describe the incidence of falls/injuries in a walking team ball game (Lifeball) designed for seniors, a prospective cohort study was undertaken amongst community dwelling Lifeball participants in Australia. Players completed a telephone survey soon after commencing Lifeball (2004) and 12 months later (2005). Attendance and incident records were audited for the period. Subjects joined a Lifeball group with opportunity to play at least once per week. Baseline was completed by 284 players aged between 40 and 96 years (mean 67 years), with most (83.8%, 238/284) female. Of 263 followed up, the average attendances was 25, with 19.3% attending on fewer than 4 occasions and 14.3% attending 52 or more times. Most (93.9%) reported no injuries requiring medical attention. However, 16 (6.1%) had injuries requiring medical attention and their 27 injuries represent an injury rate of 3.3 per 1000hours of participation. Twenty participants (7.6%) had a Lifeball fall equating to a fall rate of 2.8 per 1000hours of participation. Falls in Lifeball were not associated with measured predictors (age, gender, falls history, perceived falls risk or hours played). Incident records showed a trip/stumble involving rushing, walking backwards, or overextending (all against rules) as common falling causes. Lifeball is not 'risk free' however due to a lack of comparative data it is difficult to compare injury rate to relevant activities. Prevention of injury should concentrate on enforcing safety rules.

Promoting a team ball game (Lifeball) to older people: who does this game attract and who continues?

ISSUE ADDRESSED: To describe the demographic and health-related characteristics (physical activity, self-reported health status, quality of life and falls history) of older people who enrol in a team-based game, Lifeball, and examine associations between continuation and participant characteristics. Reasons for stopping, participants' perceptions of the game and changes in health-related characteristics over 12 months were examined. METHODS: Telephone surveys were conducted with a cohort of Lifeball players at: baseline, soon after commencing playing and 12 months later. RESULTS: At baseline, participants were aged 40 to 96 years (mean 67). Most were female (84%), in good to excellent health (86%) and reported being sufficiently (>150 minutes per week) physically active (69%). Almost half (43%) were still playing 12 months later (continuers). Continuers were more likely to perceive Lifeball had helped them to: feel fitter and healthier (91%); improve their social life (73%); and be more active (53%). No significant changes in continuers' physical activity, self-reported health status and quality of life measures were reported. The main reason for stopping playing was illness/injury unrelated to Lifeball. CONCLUSIONS: Lifeball mainly appealed to healthy, active older people.