Medium-Chain Triglyceride Oil and Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: Dietary saturated fat raises total cholesterol and LDL cholesterol levels. It is unclear whether these effects differ by the fatty acid chain lengths of saturated fats; particularly, it is unclear whether medium-chain fatty acids increase lipid levels. OBJECTIVES: We conducted a systematic review to determine the effects of medium-chain triglyceride (MCT) oil, consisting almost exclusively of medium-chain fatty acids (6:0-10:0), on blood lipids. METHODS: We searched Medline and Embase through March 2020 for randomized trials with a minimum 2-week intervention period that compared MCT oil with another fat or oil. Outcomes were total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. Included studies were restricted to adults above 18 years of age. Studies conducted in populations receiving enteral or parenteral nutrition were excluded. Data were pooled using a random-effects meta-analysis. RESULTS: Seven articles were included in the meta-analysis; LDL cholesterol and HDL cholesterol were reported in 6 studies. MCT oil intake did not affect total cholesterol (0.04 mmol/L; 95% CI, -0.11 to 0.20; I2 = 33.6%), LDL cholesterol (0.02 mmol/L; 95% CI, -0.13 to 0.17; I2 = 28.7%), or HDL cholesterol (-0.01 mmol/L; 95% CI, -0.10 to 0.09; I2 = 74.1%) levels, but did increase triglycerides (0.14 mmol/L; 95% CI, 0.01-0.27; I2 = 42.8%). Subgroup analyses showed that the effects of MCT oil on total cholesterol and LDL cholesterol differed based on the fatty acid profile of the control oil (Pinteraction = 0.003 and 0.008, respectively), with MCT oil increasing total cholesterol and LDL cholesterol when compared to a comparator consisting predominantly of unsaturated fatty acids, and with some evidence for reductions when compared to longer-chain SFAs. CONCLUSIONS: MCT oil does not affect total cholesterol, LDL cholesterol, or HDL cholesterol levels, but does cause a small increase in triglycerides.

The role of complementary and alternative medicine practitioners in the information-seeking pathway of vaccine-hesitant parents in the Blue Mountains area, Australia.

While immunisation rates were 94.63% for the whole Nepean Blue Mountains region of New South Wales in 2017, coverage for 1 year olds in the upper Blue Mountains was under 80%. There is a known relationship between vaccine-hesitant parents and complementary and alternative medicine (CAM) use; however, little is known about how CAM practitioners fit within the information-seeking pathway of parents. This exploratory study sought to address this knowledge gap. Qualitative semi-structured interviews with vaccine-hesitant and vaccine rejecting parents and CAM practitioners purposively sampled from the Blue Mountains area revealed three sets of themes: 1) Parents' search for further information about immunisation; 2) Parents' use of CAM practitioners as an immunisation information source; and 3) CAM practitioners' engagement with parents about immunisation. CAM practitioners form a definite, if complex, part of vaccine-hesitant and vaccine-rejecting parents decision-making pathway in the Blue Mountains area. The notion of patient choice is crucial to vaccine discussions. Development of support materials, such as decision resources which give impartial and detailed information while acknowledging and supporting patient choice, are needed to support both CAM practitioners and parents in making informed vaccination decisions.

Exploring complementary medicine practitioners' attitudes towards the use of an immunization decision aid, and its potential acceptability for use with clients to reduce vaccine related decisional conflict.

While Australia boasts a high immunization rate, geographical pockets of low uptake still challenge herd immunity on a community level. For some parents, concerns about immunization lead to distrust of conventional sources of vaccine information and complementary medicine (CM) practitioners may be more readily trusted as a source of information about vaccines. Decision aids are common educational resources that are developed to support informed decision making. We interviewed CM practitioners to explore their attitudes to immunization decision aids in general and the acceptability of recommending this resource to parents with concerns or questions about immunization. While some practitioners felt that it might be biased towards immunizations, all said that they would recommend the resource to parents. CM practitioners are a trusted source of information, including immunization advice for some parents. CM practitioners were generally supportive of decision aids as a tool they could use in their practice to help parents with immunization questions, where a premium is often placed on patient choice.

Midwives' role in the provision of maternal and childhood immunisation information.

PROBLEM: Inactivated influenza vaccine and diphtheria-tetanus acellular pertussis vaccine are routinely recommended during pregnancy to protect women and their babies from infection. Additionally, the hepatitis B vaccine is recommended for infants within the first week of life; however, little is known about midwives' experiences of recommending and delivering these immunisations. BACKGROUND: Midwives are a trusted source of vaccine information for parents and the confident provision of information about immunisation during antenatal clinic visits has been found to increase the uptake of antenatal and childhood vaccines. AIM: This study aims to explore midwives' experiences of discussing maternal and childhood immunisation with women and their partners and their confidence in answering parent's questions. METHODS: We conducted 23 semi-structured interviews with registered Australian midwives working in public and private hospital settings, and in private practice. FINDINGS: Midwives find negotiating the requirement to recommend immunisation within a women-centred framework challenging at times. The vast majority of midwives described their education on immunisation as inadequate and workplace issues, such as time pressure, were identified as further barriers to effective communication about immunisation. DISCUSSION/CONCLUSION: The provision of immunisation training within midwifery education and continued professional development is critical. Appropriately resourcing midwives with the necessary infrastructure, education and resources to fully inform parents about immunisation may have a positive impact on vaccine uptake.

Midwives' knowledge, attitudes and confidence in discussing maternal and childhood immunisation with parents: A national study.

INTRODUCTION: Despite the enormous benefits of childhood and maternal immunisation to individual and population health, the uptake of maternal vaccines during pregnancy remains suboptimal. Midwives are a trusted information source for parents and play an important role in the provision of immunisation information. Understanding midwives' attitudes and vaccine knowledge, along with their confidence to discuss maternal and childhood immunisation with parents, is key to reducing parental decisional conflict and achieving immunisation goals. METHODS: An online study was conducted to investigate midwives' knowledge and attitudes towards maternal and childhood vaccination along with their confidence to answer parents' vaccine-related questions. Midwives were recruited by email via the midwifery peek body, the Australian College of Midwives. RESULTS: A total of 359 midwives completed the online survey. The majority of midwives supported maternal (influenza 83%, pertussis 90.5%) and childhood immunisation (85.8%); however, 69.4% of respondents wanted further training about immunisation. Midwives who felt their midwifery education adequately covered immunisation were more confident advising parents about maternal (p = 0.007) and childhood immunisation (p < 0.001). Similarly, Midwives were significantly more likely to confidently advise parents about maternal (p < 0.001) and childhood immunisations (p < 0.001) if they had completed a specific immunisation training course outside of their midwifery course. CONCLUSION: Most midwives working in Australia support vaccination. However, access to contemporary, culturally appropriate education that enables midwives to engage confidently with parents about immunisation is lacking. Education based on a women-centred approach within the pre-registration curriculum along with continuing professional development programs could enable midwives to reduce the evidence to practice gap by increasing vaccine uptake.

Subjective wellbeing in the Indian general population: a validation study of the Personal Wellbeing Index.

PURPOSE: The Personal Wellbeing Index (PWI) is a commonly used measure of life satisfaction that reflects a person's level of subjective wellbeing (SWB). The present study aimed to establish the validity and reliability of the PWI in a large sample of Indian adults and describe their SWB. METHODS: 2004 Indian adults completed a cross-sectional online survey, which was presented in English and included the PWI and demographic questions. The sample was split to assess the psychometric properties of the 7-item (n = 981) and 8-item (n = 937) versions of the PWI. RESULTS: Both the 7- and 8-item versions of the PWI demonstrated adequate internal consistency (α = .89 and .88, respectively). The global means for both versions of the PWI (7-item = 74.43, 8-item = 73.82) were within the normative range for Western countries. Achieving in life had the lowest domain scores for both the 7-item (M = 70.51) and 8-item (M = 68.37) versions; the spirituality or religion domain had the highest domain score in the 8-item version (M = 78.84). CONCLUSION: The findings suggest that both the 7- and 8-item versions of the PWI are valid and reliable measures of life satisfaction for use in India. The global mean scores for both versions of the PWI were within the normative range for Western countries. In this study, Indians reported high levels of satisfaction with their spirituality or religion, suggesting this domain may be an important contributor of SWB; however, more research is needed to determine this.