The Influence of Home and School Environments on Children's Diet and Physical Activity, and Body Mass Index: A Structural Equation Modelling Approach.

Introduction The home and school environments play important roles in influencing children's health behaviours. However, their simultaneous influence on childhood obesity has not yet been examined. We explore the relationship of the home and school environments with childhood obesity, to determine whether this relationship is mediated by children's fruit and vegetable intake and physical behaviours. Methods This study uses baseline data from 9 to 11 year old children, their parents and school principals (matched data n = 2466) from the Obesity Prevention and Lifestyle Project. Child-reported behaviours, parent-reported home environment and principal-reported school environment data were collected via questionnaires. Trained researchers measured children's height and weight, and Body Mass Index (BMI, kg/m2) was calculated. Structural equation modelling was used to assess the relationship of the home and school environments with children's fruit and vegetable intake, physical activity behaviours, and children's BMI. Result The home diet environment was positively associated with child diet (ß = 0.18, p < 0.001). The home physical activity environment had the largest inverse association with BMI (ß = - 0.11, p < 0.001), indirectly through child physical activity (ß = 0.28 ,p < 0.001). Schools' healthy eating policy implementation was significantly associated with child diet (ß = 0.52, p < 0.05), but physical activity policy was not associated with child activity (ß = - 0.007, p > 0.05). The school environment was not associated with child BMI. Discussion The home environment had a stronger association with healthier child behaviours, compared to the school environment. These findings suggest that future childhood obesity interventions targeting healthier home environments and supporting parents can promote healthier child eating and physical activity behaviours.

Macro and micro ethics in fetal and embryological collections: Exploring the paradigms of informed consent among Australian education-focused stakeholders.

The management of human fetal and embryological collections presents an ethical challenge that can be explored from different perspectives, particularly when considering informed consent. The "micro ethics" level focuses on parties engaged in giving and receiving human tissue while the "macro ethics" level focusses on the collective responsibility of the discipline and society. Additionally, adopting a framework, where ways of working are designed with relevant communities, requires understanding the perspectives of individuals, communities, and organizations. The aim of this study therefore was to assess the perceptions of education-focused Australian stakeholders. A survey collected the perspectives of 198 participants. The majority of participants (61.6%; n = 122/198) indicated that human fetal and embryological remains obtained prior to era of informed consent should be retained for use in education/research. It is likely that their perspective is based on the notion that if human fetal and embryological collections are used for good, then disposing of them would deny this benefit. Women (p < 0.001) indicated a preference for obtaining fetuses and embryos with informed consent for education and research (38.4%; n = 76/198). Majority were in favor of recording both maternal (MI) (59.6%; n = 118/198) and paternal information (PI) (58.1%; n = 115/198) with each donation. Majority (56.1%; n = 111/198) expressed that donations should be accepted from both parental sources. Consideration of stakeholder perspectives is important in developing guidelines regarding these collections. The results from this study demonstrate a level of discomfort with respect to collections without informed consent, which should be considered at the macro ethical and micro ethical level.

The efficacy and real-world effectiveness of a diet low in fermentable oligo-, di-, monosaccharides and polyols in irritable bowel syndrome: A systematic review and meta-analysis.

BACKGROUND & AIMS: A diet low in fermentable oligo-, di-, monosaccharides, and polyols (LFD) has been shown to effectively reduce irritable bowel syndrome (IBS) symptoms. Effects resulting from real-world studies may differ from those seen in efficacy studies because of the diversity of patients in real-world settings. This systematic review and meta-analysis aimed to compare the effect of the LFD on reducing IBS symptoms and improving the quality of life (QoL) in efficacy trials and real-world studies. METHODS: Major databases, trial registries, dissertations, and journals were systematically searched for studies on the LFD in adults with IBS. Meta-analysis was conducted using a random effects model with standardized mean differences (SMD) and 95% confidence intervals (CI). Outcomes of interest were all patient-reported: stool consistency, stool frequency, abdominal pain, overall symptoms, adequate symptom relief, IBS-specific QoL and adherence to the LFD. RESULTS: Eleven efficacy and 19 real-world studies were reviewed. The meta-analysis results for abdominal pain (SMD 0.35, 95% CI 0.16 to 0.54) and QoL (SMD 0.23, 95% CI -0.05 to 0.50) showed the LFD was beneficial in efficacy studies with no statistically significant results for stool frequency (SMD 0.71, 95% CI 0.34 to 1.07). Real-world studies found improvements in abdominal pain and QoL. Due to heterogeneity, no meta-analysis was done for stool consistency and overall symptoms. In these outcomes, results were mostly supportive of the LFD, but they were not always statistically significant. CONCLUSIONS: The results of this systematic review and meta-analysis suggest the LFD improves outcomes compared to a control diet (efficacy studies) or baseline data (real-world studies). Because of diverse study designs and heterogeneity of results, a clear superiority of the LFD over control diets could not be concluded. There are no indications of an efficacy-effectiveness gap for the LFD in adults with IBS.

Development of a diet quality score and adherence to the Swiss dietary recommendations for vegans.

BACKGROUND: Vegan diets have recently gained popularity in Switzerland as well as globally. The aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans. METHODS: The dataset included 52 healthy vegan adults. Dietary intake data were assessed by three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA). RESULTS: The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega-3-rich nuts, fats and oils, and iodized salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The sample overconsumed sweet-, salty-, fried foods, and alcohol. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus intakes (p's < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p's < 0.05). Two dietary patterns were derived from PCA: 1) refined grains and sweets and 2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (- 0.41, p = 0.004) and positive for the second dietary pattern (0.37, p = 0.01). The refined grains and sweets dietary pattern was inversely correlated with beta-carotene status (- 0.41, p = 0.004) and vitamin C status (r = - 0.51, p = 0.0002). CONCLUSION: The newly developed DQS-V provides a single score for estimating diet quality among vegan adults. Further validation studies examining the DQS-V in relation to an independent dietary assessment method and to biomarkers of nutritional intake and status are still needed before the general application of the DQS-V.

Dietary Exposure and Risk Assessment of Multi-Mycotoxins (AFB1, AFM1, OTA, OTB, DON, T-2 and HT-2) in the Lebanese Food Basket Consumed by Adults: Findings from the Updated Lebanese National Consumption Survey through a Total Diet Study Approach.

Mycotoxins have been linked to adverse health impacts, including liver cancer and kidney diseases. The objectives of the current study were to evaluate the dietary exposure of Lebanese adults to multi-mycotoxins (aflatoxin B1 (AFB1), aflatoxin M1 (AFM1), ochratoxin A (OTA), ochratoxin B (OTB), deoxynivalenol (DON), T-2 and HT-2) and to assess their associated health risks. Hence, a nationally representative sample of 449 participants aged 18-64 years old were interviewed to obtain their socio-demographic characteristics, food consumption data and exposure estimates. A food frequency questionnaire and 24 h-recall were used to collect data. The concentration of mycotoxins in all foods consumed by the participants was collected from previous national published studies. The estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) were calculated. The total exposure to AFB1, AFM1, OTA and DON was 1.26, 0.39, 4.10 and 411.18 ng/kg bw/day, respectively. The MOE to AFB1, AFM1, OTA and DON in the Lebanese food basket was 316, 1454, 3539 and 510, respectively, indicating high health-related risks. Per food items, the MOE to AFB1 was below 10,000 in cereals (466.5), mainly in rice (827.9) and Burgul (4868.5). Similarly, the MOE to OTA in cereals was 1439, in which bread (4022), rice (7589) and bulgur (7628) were considered unsafe. Moreover, the MOE to DON in cereals (605) is alarming, especially in bread (632) and manakesh (6879). The MOE to AFM1 in dairy products was 1454, indicating health-related risks with a focus on yogurt (9788) and labneh (8153). As for the herbs/spices group and traditional dishes, the MOE to AFB1 was relatively lower than 10,000 (3690 and 1625, respectively), with a focus on thyme (2624) and kishik (3297), respectively. It is noteworthy that the MOE to DON and the MOE to OTA in traditional foods and coffee were lower than 10,000 (8047 and 8867, respectively). All hazard quotient (HQ) values were below 1, except the HQ value of milk and dairy products (1.96). The intake of some food groups varied between age categories, corresponding to differences in EDI between them. Thus, it is essential to put control measures in place to decrease the contamination and exposure to mycotoxins by Lebanese consumers.

Home-based cooking intervention with a smartphone app to improve eating behaviors in children aged 7-9 years: a feasibility study.

Objective: To develop and evaluate the feasibility of a mobile application in Swiss households and assess its impact on dietary behavior and food acceptability between children who cooked with limited parental support (intervention group) with children who were not involved in cooking (control group). Methods: A ten-week randomized controlled trial was conducted online in 2020. Parents were given access to a mobile-app with ten recipes. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Parents photographed and weighed the food components from the child's plate and reported whether their child liked the meal and target food. The main outcome measures were target food intake and acceptability analyzed through descriptive analysis for pre-post changes. Results: Of 24 parents who completed the baseline questionnaires, 18 parents and their children (median age: 8 years) completed the evaluation phase. Mean child baseline Brussel sprouts and whole-meal pasta intakes were 19.0 ± 24.2 g and 86.0 ± 69.7 g per meal, respectively. No meaningful differences in intake were found post-intervention or between groups. More children reported a neutral or positive liking towards the whole-meal pasta in the intervention group compared to those in the control group. No change was found for liking of Brussel sprouts. Conclusions for practice: The intervention was found to be feasible however more studies on larger samples are needed to validate feasibility. Integrating digital interventions in the home and promoting meal preparation may improve child reported acceptance of some healthy foods. Using such technology may save time for parents and engage families in consuming healthier meals.

A global perspective on embryological and fetal collections: Where to from here?

Human fetal and embryos collections (FECs) peaked in the late 19th century, an era before informed consent, and hence have unclear provenance. These collections are not only historical artifacts, but prized resources for education and research. This study aimed to determine, via a narrative review, the present location, status, and profile of reported human fetal and embryonic collections. Twenty-seven articles that reported on collections appropriate to the study were selected from an initial search pool of 120 articles. The reported collections were in: Australia (n = 1), Germany (n = 6), Japan (n = 1), Spain (n = 1), and the United States (n = 5). The largest collection is reported to contain 45,000 prenatal remains and the smallest, three remains. The purpose of establishing majority of the collections was for education and research. Eight collections contain both embryos and fetuses, one collection contained embryos, exclusively. Another collection contained only fetuses and one neonatal cadaver. The provenance, where mentioned, specified gynecologists and obstetricians as the main source of remains (n = 5). Except for the Kyoto Collection, information regarding informed consent from the next-of-kin was lacking. This paper draws upon the three themes of purpose, provenance, and profile and highlights the need to establish agreed international guidelines for the most appropriate ethical and sustainable practice with respect to establishment, procurement of remains, access, and maintenance of these collections. Nine domains for these guidelines are recommended: consent, privacy, commercial gain, digital and emerging technologies, commemorations and memorials, destruction and disposal, dignity of donors, global database and collaboration, and sustainability.

Aflatoxin B1 in Rice: Effects of Storage Duration, Grain Type and Size, Production Site, and Season.

ABSTRACT: Our study evaluated aflatoxin B1 (AFB1) levels in packed rice marketed in Lebanon and determined the exposure to this toxin from rice consumption. A total of 105 packed white, parboiled, and brown rice bags were collected. Enzyme-linked immunosorbent assay was used to measure AFB1. A comprehensive food frequency questionnaire was completed by 500 participants to determine patterns of rice consumption and, subsequently, the exposure levels to AFB1 from rice consumption in Lebanon. AFB1 was detected in all rice samples (100%). The average concentration ± standard deviation of AFB1 was 0.5 ± 0.3 µg/kg. Contamination ranged between 0.06 and 2.08 µg/kg. Moisture content in all rice samples was below the recommended percentage (14%). Only 1% of the samples had an AFB1 level above the European Union limit (2 µg/kg). Brown rice had a significantly higher AFB1 level than white and parboiled rice (P = 0.02), while a significant difference was found between both collections for the same brands (P = 0.016). Packing season, packing country, country of origin, presence of a food safety management certification, grain size, and time between packing and purchasing had no significant effect. Exposure to AFB1 from rice consumption in Lebanon was calculated as 0.1 to 2 ng/kg of body weight per day.

Pediatric Health Risk Assessment for Exposure to Aluminum from Infant Formulas and Children under the Age of Five's Food Products among Arab Infants: Experience from Lebanon.

Chronic dietary aluminum (Al) exposure can have various negative effects on health. The aim of our study is to (1) assess the contamination level of Al in infant formulas (n = 41) and baby food products (n = 76) available in the Lebanese market, and to (2) evaluate the margin of exposure of Al through the consumption of these foods among children under the age of five in Lebanon. Flame atomic absorption spectrometry (FAAS) was used to evaluate all of the samples. Al levels in all tested children's food items were below the limit of detection. The highest Al level was detected in cornflakes (0.361 ± 0.049 mg/kg) and pureed foods (0.362 ± 0.079 mg/kg). Among infants aged 0−23 months, the average Al exposure due to the daily intake of infant formulas and baby foods was 0.01 and 0.0104 mg/kg BW/day for males and females, respectively. Babies aged 8−10 and 3−5 months had the highest and lowest levels of Al exposure, respectively. Additionally, the toxicological contribution of Al exposure determined for several age groups to a provisional tolerated weekly intake (PTWI) set by JECFA was <6% and <7% for males and females, respectively. The total Al exposure through the consumption of infant formulas and complementary foods among all ages in both males and females was below the values of weekly tolerable intakes (2 mg/kg/BW/W) set by JECFA. However, the values of hazard quotient (HQ) exceeded 1 in both male and female Lebanese infants. As a result, the risk of infants being exposed to Al in baby foods needs to be continuously considered.

Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups.

Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.

Attitudes of Anatomy Students toward Commemorations for Body Donors: A Multicultural Perspective.

Many medical schools practice commemorative ceremonies to honor body donors. Attitudes of medical education stakeholders toward these ceremonies have not yet been fully investigated. The aim of this study was to explore anatomy students' attitudes toward commemorations at a multicultural institution which has not introduced these ceremonies yet. A survey was carried out on different groups of anatomy students that were exposed and not yet exposed to human remains. The survey was used to record basic demographic data from the respondents, ask if they would support the establishment of an anatomy commemoration and in which format. A total of 756 anatomy students participated in the survey (response rate 69.8%). The majority (76.3%) were in favor of introducing a commemoration for donors. The associations of students' gender, attitude toward body donation, and level of exposure to human remains with attitudes toward commemoration for donors were identified (P < 0.05), whereas ethnicity and religion seemed to have no influence on attitudes (P > 0.05). Most students believed that anatomy staff and students should organize the commemoration. There was a preference for the commemoration to be secular with revealed identities of donors, and not recorded for social media. The support for the establishment of commemorations transcended cultural and religious differences and confirmed students' respectful attitude toward donors. Anatomy commemorations seem to have potential not only to engage students with one another, and donor families, but also to pave the way for students to become life-long ethical and empathetic learners and practitioners.

Team-based learning in neuroanatomy.

OBJECTIVE: Team-based learning (TBL) is an active learning method in which student teams participate in individual work, teamwork, and the application of learned concepts to problem solving. It has been widely adopted in the education of health professions. The aim of this study was to assess whether TBL in tutorials would be beneficial to students' assessed knowledge and subjective sense of satisfaction as compared to traditional modes of teaching. METHODS: In 2018, TBL was introduced into the tutorials of a clinically oriented undergraduate course of neuroanatomy, and its benefits in improving student grades and satisfaction were assessed. The Welch 2 sample t test was used for group differences in continuous variables, and Pearson's χ2 test with Yates' continuity correction was used for group differences in dichotomous variables. Linear modeling was used to look for group differences while adjusting for significant baseline characteristics. RESULTS: Our study found that in comparison to more traditionally delivered teaching, TBL did not improve grades or alter overall satisfaction. A post hoc pairwise comparison of satisfaction among lectures, tutorials, and practical classes showed that students appeared to be most dissatisfied with the TBL. CONCLUSION: Analysis of our methods, results, student comments, and the literature indicate that the length of the tutorials, at 1 hour, was too short to conduct TBL to the standards required. In addition, there is an imperative to persist in preparing students for a different knowledge-transfer paradigm, and it takes a few iterations to improve the approach and application of this method of teaching.

Anatomy commemoration for body donors at Macquarie University, Sydney, Australia / Conmemoración de la anatomía para donantes de cuerpos en la Universidad Macquarie, Sydney, Australia

SUMMARY: Modern anatomy education is imbued with humanistic values which manifest primarily in the ethical acquisition of bodies for research and education, and respectful treatment of these bodies in anatomy laboratories. This humanistic approach is best embedded in the organisation of commemorative ceremonies for body donors. This paper presents experiences of preparation and implementation of a commemorative ceremony at Macquarie University, Sydney. Local cultural context and university infrastructure were considered when preparing the commemoration. It was decided that it will be introduced in stages, starting with a ceremony for anatomy students. Students were surveyed about the introduction of the ceremony and their attitudes about its format. The results of the survey influenced the format in which the commemoration was conducted. The commemoration was introduced in 2019, embedded in the first anatomy lecture. Such format was cost effective, caused little disturbance to a complex timetable and was aligned with learning outcomes and students' cultural preferences. It also enabled easy transition to the online modes of the delivery caused by the COVID-19 pandemic in Australia. In the next stage commemorative ceremony will be inclusive of donor family members as well as students.

RESUMEN: La educación en anatomía moderna está incentivada de valores humanistas que se manifiestan principalmente en la adquisición ética de cuerpos para la investigación y la educación, y en el trato respetuoso de estos cuerpos en los laboratorios de anatomía. Este enfoque humanista se integra mejor en la organización de ceremonias conmemorativas para donantes de cuerpos. Este documento presenta las experiencias de preparación e implementación de una ceremonia conmemorativa en la Universidad Macquarie, Sydney. Se tuvo en cuenta el contexto cultural local y la infraestructura universitaria al preparar la conmemoración. Se decidió que se presentará por etapas, comenzando con una ceremonia para estudiantes de anatomía. Los estudiantes fueron encuestados sobre la presentación de la ceremonia y sus actitudes sobre su formato. Los resultados de la encuesta influyeron en el formato en el que se llevó a cabo la conmemoración. La conmemoración se introdujo en 2019, como parte de la primera conferencia de anatomía. El formato era rentable, causaba pocas alteraciones en un horario complejo y estaba alineado con los resultados del aprendizaje y las preferencias culturales de los estudiantes. También permitió la transición a los modos en línea de la entrega causada por la pandemia de COVID-19 en Australia. En la siguiente etapa, la ceremonia conmemorativa incluirá a los miembros de la familia donante y a los estudiantes.

Students' perceptions and usage of short anatomy videos: a preliminary study / Percepciones de los estudiantes y el uso de videos cortos de anatomía: un estudio preliminar

The efficacy of videos in anatomy education is still being debated. It appears that one of the major factors discouraging learners to use videos has been their length. To counteract this, 24 short videos (the longest lasting 1 minute and 13 seconds), were created for a course on musculoskeletal anatomy. Videos focused on identification of muscles of the limbs and their relations by area. The aim of this preliminary study was to assess students' perception of value of the videos and their utilisation. The number of views for each video was recorded. A questionnaire based survey was carried out focusing on students' perception of the educational usefulness of the videos. On average, each video had 339.5 views. Out of 312 students enrolled in the course, 210 completed the survey (67.3 % response rate). A total of 181 respondents (86.2 %) watched the videos and a majority perceived them useful in: Learning about the anatomy of the limbs (68 %), preparation for the laboratory (56.9 %), post-laboratory revision (65.6 %) and preparation for the practical test (66.3 %). Asked for feedback, students requested an increase in the number of videos to include structures other than muscles. Students reported to perceive videos as a useful resource in their musculoskeletal anatomy course. The shortness of the videos made them easy to access and use repeatedly. Future, more in-depth studies, based on the utilisation of the existing and newly produced videos, might throw more light on their full educational potential.

Actualmente, aún se está debatiendo la eficacia de los videos en la educación de la anatomía. Posiblemente, uno de los principales factores que desalientan a los estudiantes a usar videos ha sido el tiempo de duración. Para contrarrestar esto, se crearon 24 videos cortos (el más duradero de 1 minuto y 13 segundos) para un curso sobre anatomía musculoesquelética. Los videos se enfocaron en la identificación de los músculos de los miembros y sus relaciones por área. El objetivo de este estudio preliminar fue evaluar la percepción de los estudiantes sobre el valor de los videos y su utilización. Se registró el número de visitas para cada video. Se llevó a cabo una encuesta basada en cuestionarios que se centraron en la percepción de los estudiantes de la utilidad educativa de los videos. En promedio, cada video tuvo 339,5 visitas. De los 312 estudiantes matriculados en el curso, 210 completaron la encuesta (67,3 % de índice de respuesta). Un total de 181 encuestados (86,2 %) vieron los videos y la mayoría los percibieron útiles en: Aprender sobre la anatomía de los miembros (68 %), preparación para el laboratorio (56,9 %), revisión posterior al laboratorio (65,7 %) y preparación para la prueba práctica (66,3 %). Cuando se les pidió retroalimentación, los estudiantes solicitaron un aumento en la cantidad de videos para incluir estructuras distintas de los músculos. Los estudiantes informaron que perciben a los videos como un recurso útil en el curso de anatomía musculoesquelética. La brevedad de los videos los hizo de fácil acceso y posibles de utilizar repetidamente. Estudios más amplios a futuro, basados en la utilización de los videos existentes, como también aquellos producidos recientemente, podrían arrojar más luz sobre su total potencial educativo.