The benefits of virtual learning abroad programs for higher education students: A phenomenological research study.

BACKGROUND: Higher education institutions offer in-country learning abroad programs to provide healthcare students with the opportunity to gain the intercultural and global competencies they need to work in a globally interconnected world. During the Covid-19 pandemic, institutions offered virtual learning abroad programs as an alternative to the in-country programs, however, little is known about whether they provide comparable benefits to students. OBJECTIVES: The purpose of this study was to investigate, and identify, the benefits gained by higher education healthcare students through their participation in a virtual learning abroad program. DESIGN/METHODS: This research implemented a qualitative approach, conducting semi-structured interviews with four higher education students enrolled in the final year of their healthcare studies. Data were analyzed using interpretative phenomenological analysis. RESULTS: The results revealed that virtual programs provide a range of benefits students can use in their future careers. They also provide students with a positive learning experience and an opportunity for personal growth. However, although the benefits students gain from virtual learning abroad programs are similar to those they gain from in-country programs, they are not identical. While virtual learning abroad programs are a viable alternative for in-country programs and offer many benefits, they fail to replicate the intercultural and global competencies that in-country programs offer to students. CONCLUSION: This study focusses on virtual learning abroad programs and whether the benefits healthcare students gain from them are comparable to the traditional in-country programs. Students gain personal and professional benefits from these programs without the risks and costs associated with international travel. However, the identified lack of increased global awareness has implications for how the benefits of virtual learning abroad programs should be promoted to students.

The knowledge, attitudes, and behaviours of pregnant women regarding seafood consumption during the antenatal period: a qualitative study.

BACKGROUND: Maternal nutrition impacts fetal growth and development. The Food Standards Australia New Zealand (FSANZ) guidelines recommend pregnant women consume 2-3 servings (224-336 g) of fish/seafood per week to support intake of long chain omega 3 fatty acids, given adequate consumption supports numerous health benefits including reduced risk of preterm and early preterm birth. Evidence indicates that pregnant women purposely lower their fish/seafood intake, largely due to fears of methylmercury exposure. The aim of this study was to explore pregnant women's knowledge, attitudes, and behaviours regarding their fish/seafood consumption during the antenatal period. METHODS: Semi-structured interviews were conducted between October 2018 and December 2020 among a purposive sample of 12 pregnant women from the Australian Capital Territory (ACT). The interviews were recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach. Themes were developed on the women's lived experience related to fish/seafood knowledge, attitudes, and consumption behaviour. RESULTS: The most prominent finding was widespread non-adherence to fish/seafood consumption guidelines. This was largely owing to a lack of proactive health promotion related to the health benefits of fish/seafood throughout pregnancy, including the health promoting roles of long chain omega 3 fatty acids for fetal growth and development. Three themes were identified: nutrition knowledge; sources of health promotion; and barriers and enablers to fish/seafood consumption. CONCLUSIONS: To support adequate maternal consumption of fish/seafood throughout pregnancy, emphasis should be placed on the benefits of consuming this food group regularly. Additionally, pregnant women should receive education about the health promoting role of long chain omega 3 fatty acids. Dietitians are well placed to provide this information.

Alterations in gut microbiota caused by major depressive disorder or a low FODMAP diet and where they overlap.

Beneficial changes in microbiota observed in individuals with a major depressive disorder (MDD) may be initiated with a low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) elimination diet. Academic Search Ultimate, APA PsychINFO, Cochrane Library, MEDLINE, Scopus and Web of Science were searched for original research documenting differences in microbiota in MDD or changes with a low FODMAP diet in adults (age 18 years +). Studies with fecal microbiota, 16 s RNA sequencing and QIIME pipelines were included. Studies using antibiotics, probiotics, and medications such as antidepressants were excluded. Additionally, studies based on a single gender were excluded as gender impacts microbiota changes in MDD. Four studies addressed differences in microbiota with MDD and another four assessed shifts occurring with a low FODMAP diet. The abundance of Bacteroidetes, Bacteroidaceae and Bacteroides were lower in individuals with MDD but increased with a low FODMAP diet. Abundance of Ruminoccaceae was lower and Bilophila was higher with both a low FODMAP diet and MDD. These results provide preliminary evidence that a low FODMAP diet might drive changes in microbiota that also benefit people with MDD. Further research to assess whether a low FODMAP diet can treat MDD through modification of targeted microbiota is warranted.

Couples-based behaviour change interventions to reduce metabolic syndrome risk. A systematic review.

BACKGROUND AND AIMS: Metabolic Syndrome (MetS), is a major risk factor for non-communicable diseases including type 2 diabetes mellitus, cardiovascular disease, and cancer. Although MetS risk is transferred via the epigenome from both biological parents, periconceptional lifestyle interventions are generally directed towards mothers. There is a need for interventions to reflect the shared nature of epigenetic MetS risk between both biological parents. Couples-based lifestyle interventions have previously been used to improve adherence to behaviour change in conditions with shared risk responsibility such as sexually transmitted diseases. This systematic literature review sought to answer the research question: Are couples-based interventions more effective than individual interventions to address overweight and obesity as the primary modifiable risk for MetS in addition to other associated factors. METHODS: Couples-based studies involving randomised controlled trials, published between 01/01/1990-31/12/2021, were identified in Medline, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, Cochrane, and Scopus. RESULTS: After screening 4742 articles, only five eligible trials remained. Statistically significant post-intervention maintenance of low glycaemic levels was observed in one study. Otherwise, no statistically significant group differences between couples' groups and control groups were observed in any of the five included studies. CONCLUSIONS: The included studies concluded that couple-based interventions can lead to weight reduction, maintenance, and adherence to modified health behaviours similar to interventions that target individuals. Overall, the findings indicate that, notwithstanding the paucity of authentic couples-based interventions, there is potential for such approaches to moderate MetS risk factors likely to flow onto epigenetic transmission of risk.

Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials.

This systematic literature review examined whole food or whole diet interventions to treat depression. The inclusion criteria encompassed adults, depression, a recognized depression scale and a whole food or diet intervention. APA PsychINFO, CINAHL, the Cochrance Central Register of Controlled Trails, MEDLINE and Scopus were searched for original research addressing diet as a treatment for depression in adult populations. The quality of the study was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Seven studies; with 49,156 participants; met the eligibility criteria. All these studies found positive outcomes with depression levels decreasing after dietary intervention. The calculated effect size varied from small (Cohen's d = 0.32) to very large (Cohen's d = 1.82). The inconsistent nature of the studies limited the synthesis of the data. Recommendations are provided to enhance future study design and measurement outcomes. Overall, the findings show a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods. No funding was provided for this review. The protocol for this review is registered with PROSPERO (CRD42020210426).

Evaluation of a specialist antenatal nutrition clinic for women with a body mass index ≥ 40kg/m2: A qualitative study.

OBJECTIVE: To explore the views of women who attended a specialist antenatal nutrition clinic that was specifically developed and piloted for pregnant women with a BMI ≥ 40 kg/m2. DESIGN: A phenomenological approach, using individual interviews, was employed. Discussions were audio recorded, transcribed verbatim and scrutinised using Interpretive Phenomenological Analysis. Themes were pinpointed and supported with direct quotes to demonstrate results. SETTING AND PARTICIPANTS: Eight women, with a BMI ≥ 40 kg/m2, receiving antenatal care at a tertiary hospital in south eastern Australia and who participated in a specialist antenatal nutrition service were interviewed. FINDINGS: Three main themes emerged: 1) Motivation to be Healthy; 2) Woman Centred Nutrition Care; 3) Conflicts, Confusion and Assumptions. KEY CONCLUSIONS: Pregnant women with a BMI ≥ 40kgm2 responded positively to incorporating dietitians in the antenatal care setting. The reinforcement and reassurance provided by the specialist dietetic team was highly valued. More effective communication regarding referrals, improved consistency in information provided by the entire antenatal service and continuity of dietetic support beyond birth would add value to future interventions.

Maternal body mass index and country of birth in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus in a retrospective cohort of Australian pregnant women.

BACKGROUND: The prevalence of gestational diabetes mellitus in Australia has been rising in line with the increased incidence of maternal overweight and obesity. Women with gestational diabetes mellitus, high body mass index or both are at an elevated risk of birthing a large for gestational age infant. The aim was to explore the relationship between country of birth, maternal body mass index with large for gestational age, and gestational diabetes mellitus. In addition to provide additional information for clinicians when making a risk assessment for large for gestational age babies. METHOD: A retrospective cohort study of 27,814 women residing in Australia but born in other countries, who gave birth to a singleton infant between 2008 and 2017 was undertaken. Logistic regression analysis was used to examine the association between the aforementioned variables. RESULTS: A significantly higher proportion of large for gestational age infants was born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women residing in Australia, with a body mass index of ≥40 kg/m2, had an adjusted odds ratio of 9.926 (3.859-25.535) for birthing a large for gestational age infant. Conversely, Australian-born women with a body mass index of ≥40 kg/m2 had an adjusted odds ratio of 2.661 (2.256-3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin-requiring gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational age infant, in either the diet controlled, or insulin requiring gestational diabetes mellitus groups. CONCLUSIONS: Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period to reduce their risk of adverse outcomes.

Living with type 2 diabetes mellitus in the Kingdom of Tonga: a qualitative investigation of the barriers and enablers to lifestyle management.

BACKGROUND: Despite the increasing prevalence of Type 2 Diabetes Mellitus (T2DM) in the Kingdom of Tonga, little is known of non-communicable disease experiences among adults living in this location. This investigation aimed to explore the barriers and enablers to healthy lifestyle in a group of men and women living with T2DM residing in this Pacific Island nation. METHODS: This qualitative study consisted of three semi-structured focus groups (n = 16), conducted at the only Tongan Public Hospital located at Nuku'alofa, capital of Tonga (north coast of the island of Tongatapu). Discussions were audio-recorded, transcribed, cross-checked for consistency, and entered into a word processing document for analysis. Thematic analysis was employed to synthesise results. RESULTS: Four main themes were identified: (1) Knowledge and Support; (2) Fear and Motivation; 3) Physical and Psychological Environment; and (4) Faith and Culture. CONCLUSIONS: The qualitative findings from this study will assist the future development and information dissemination of culturally appropriate lifestyle-related for men and women living with T2DM in the Kingdom of Tonga. The need for collaboration between practitioners at the hospital, the church, family members, and local traditional healers is important if the lifestyle-related needs and wants of this group of people are to be met.

The relationship between maternal pre-pregnancy body mass index and exclusive breastfeeding initiation: Findings from an Australian obstetric cohort.

BACKGROUND: To assess the type of infant nutrition at initiation of first feed in association with increasing maternal pre-pregnancy Body Mass Index in an Australian obstetric population. METHODS: A retrospective cohort study from 2008 to 2013 was undertaken. Body Mass Index was available for 12,347 women categorised into groups according to: underweight (≤18 kg/m2); normal weight (19-24 kg/m2); overweight (25-29 kg/m2); obese class I (30-34 kg/m2); obese class II (35-39/kg2) and obese class III (40+ kg/m2). Type and initiation of infant feeding is routinely recorded in the study hospital's birthing outcomes system. Six body mass index categories and mode of infant feeding were examined using logistic regression. Confounding factors that were controlled for included smoking status, parity, country of birth and maternal age. RESULTS: Within this cohort, 609 (4.93%) women were underweight, 6235 (50.50%) had a normal BMI, 3116 (25.24%) were overweight, 1314 (10.64%) were obese class I, 596 (4.83%) were obese class II and 477 (3.86%) were obese class III. In adjusted models', as BMI rose, women were significantly less likely to initiate exclusive breastfeeding and more likely to exclusively formula feed. Women with a BMI of 40+ kg/m2 had an AOR of 2.91(CI 1.94-4.25) for initiating exclusive formula at the time of their infant's first feed. CONCLUSIONS: Women who are overweight or obese are significantly less likely to initiate exclusive breastfeeding and more likely to give exclusive formula at the time of their newborn infants first feed. Effective breastfeeding interventions are required for these high-risk groups in the days leading up to and within the first hours after birth.

The Association Between Pre-Pregnancy Body Mass Index, Perinatal Depression and Maternal Vitamin D Status: Findings from an Australian Cohort Study.

PURPOSE: This study aimed to assess the relationship between early-pregnancy Body Mass Index (BMI), perinatal depression risk and maternal vitamin D status. PATIENTS AND METHODS: A retrospective cohort study from 2013 to 2017 was undertaken involving 16,528 birth events in the Australian Capital Territory. Multivariate binary logistic regression was conducted using the forced entry method. Mediation of the association between maternal early-pregnancy BMI and perinatal depression risk by vitamin D status was also tested. RESULTS: Adjusted logistic regression models found that high maternal early-pregnancy BMI was associated with increased risk of developing perinatal depression (AOR 1.421; 95% CI, 1.191, 1.696) as well as increased odds of being vitamin D deficient (AOR 1.950; 95% CI; 1.735, 2.191). In comparison to women with low perinatal depression risk, women with high perinatal depression risk had increased odds of being vitamin D deficient (AOR 1.321; 95% CI, 1.105, 1.579). Maternal early-pregnancy BMI was a weak significant predictor of perinatal depression risk after including vitamin D as a mediator, consistent with partial mediation, Path C: B=0.016 (95% CI 1.003, 1.030), p= 0.02. Path C´: B=0.014 (95% CI 1.001, 1.028), p= 0.04. CONCLUSION: In line with current Australian recommendations, women with high early-pregnancy BMI should be screened for both perinatal depression risk and vitamin D deficiency, with referral to relevant support services when indicated.

The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study.

BACKGROUND: The prevalence of high body mass index is increasing amongst women of child bearing age. High maternal body mass index has ramifications for both mother and baby including increased health risks from gestational diabetes mellitus, caesarean section and stillbirth. Despite the increasing prevalence of high maternal body mass index little is known of the experiences of these women regarding nutrition information access and use during the antenatal period. METHODS: A qualitative study using individual interviews was undertaken at a tertiary hospital in south-eastern Australia. Twenty-Eight women with a body mass index ≥30kg/m2 participated. Interviews were audio recorded, transcribed, cross-checked for consistency and entered into a word processing document for further scrutiny. Data was analysed using interpretative phenomenological analysis (IPA). In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences. FINDINGS: Three major themes emerged: (1) Nutrition-related information attainment; (2) Nutrition-related information management; (3) Nutrition-related information needs and wants. CONCLUSION: The findings from this study may assist the future development and dissemination of nutrition-related information for pregnant women with a high body mass index. Women want more individualised support regarding nutritional requirements during pregnancy.

Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study.

OBJECTIVE: To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. METHODS: A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m(2)); normal weight (19-24 kg/m(2)); overweight (25-29 kg/m(2)); obese class I (30-34 kg/m(2)); obese class II (35-39 kg/m(2)) and obese class III (40+ kg/m(2)). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. RESULTS: Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). CONCLUSIONS: Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.

The perspectives of obese women receiving antenatal care: A qualitative study of women's experiences.

BACKGROUND: The prevalence of overweight and obesity is increasing amongst women of child bearing age. Maternal obesity has implications for both mother and baby including increased health risks from gestational hypertensive disorders, caesarean section and stillbirth. Despite the increasing prevalence of maternal obesity little is known of the experiences of these women within the health care system. The aim of this research was to investigate the perspectives of pregnant women with a body mass index (BMI) of ≥30kg/m(2) receiving antenatal care. METHODS: A qualitative study using individual interviews was undertaken. Sixteen pregnant women with a BMI ≥30kg/m(2) participated. Interviews were audio recorded, transcribed, cross checked for consistency and then entered into a word processing document for analysis. Data was analysed using Interpretative Phenomenological Analysis. In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences. FINDINGS: Four major themes emerged: (1) obese during pregnancy as part of a long history of obesity; (2) lack of knowledge of the key complications of obesity for both mother and child; (3) communication about weight and gestational weight gain can be conflicting, confusing and judgmental; (4) most women are motivated to eat well during pregnancy and want help to do so. CONCLUSION: Specialist lifestyle interventions for obese women should be a priority in antenatal care. Extra support is required to assist obese women in pregnancy achieve recommended nutritional and weight goals. Health professionals should approach the issue of maternal obesity in an informative but non-judgmental way.