Advancing nutrition science to meet evolving global health needs.

Populations in crisis!A global overview of health challenges and policy efforts within the scope of current nutrition issues, from persistent forms of undernutrition, including micronutrient deficiency, to diet-related chronic diseases. Nutrition science has evolved from a therapeutic and prevention emphasis to include a focus on diets and food systems. Working and consensus definitions are needed, as well as guidance related to healthy diets and the emerging issues that require further research and consensus building. Between nutrient deficiency and chronic disease, nutrition has evolved from focusing exclusively on the extremes of overt nutrient deficiency and chronic disease prevention, to equipping bodies with the ability to cope with physiologic, metabolic, and psychological stress. Just what is 'optimal nutrition', is that a valid public health goal, and what terminology is being provided by the nutrition science community? Nutrition research on 'healthspan', resilience, and intrinsic capacity may provide evidence to support optimal nutrition. Finally, experts provide views on ongoing challenges of achieving consensus or acceptance of the various definitions and interventions for health promotion, and how these can inform government health policies.Nutrition topics that receive particular focus in these proceedings include choline, NAD-replenishment in neurodegenerative diseases, and xanthophyll carotenoids. Choline is a crucial nutrient essential for cellular metabolism, requiring consumption from foods or supplements due to inadequate endogenous synthesis. Maternal choline intake is vital for fetal and infant development to prevent neural tube defects. Neurodegenerative diseases pose a growing health challenge, lacking effective therapies. Nutrition, including NAD-replenishing nutrients, might aid prevention. Emerging research indicates xanthophyll carotenoids enhance vision and cognition, potentially impacting age-related diseases.

Facilitating caregiver-child interactions in home visiting: A qualitative observational study.

Facilitating parent-child interactions is a key component of evidence-based early childhood home visiting programs. Several observational measures have been created to effectively capture home visiting activities from an operationalized perspective. While the field has a reasonable understanding of what home visitors can do to facilitate developmentally supportive interactions, and why, the how remains elusive for many home visitors. This qualitative study used a modified grounded theory approach to examine the facilitation of caregiver-child interactions during home visits. Home visit video recordings previously coded using the Home Visit Rating Scale (HOVRS) A+ were selected based on facilitation quality. Sixteen home visits (8 lower- and 8 higher-quality facilitation scores) were examined for differences in home visitor behaviors that support parent-child interactions during visits. We identified contextual and specific behaviors that home visitors used to actively engage caregivers and children together in developmentally supportive interactions. Results revealed 11 home visitor behaviors that discriminated higher quality facilitation. These behaviors were categorized into four domains: environmental conditions, executing the activity, strengths-based focus, and caregiver responses. This qualitative study highlights specific behaviors and professional development areas to support more effective home visiting services for a diverse population of families with young children.

Facilitar las interacciones progenitor-niño es un componente clave de los programas de visita a casa en la temprana niñez con base en la evidencia. Varias medidas de observación se han creado para captar eficazmente las actividades de visita a casa desde una perspectiva operacional. A pesar de que el campo tiene una comprensión razonable de lo que los visitantes a casa pueden hacer para facilitar las interacciones de apoyo al desarrollo, y el por qué, el cómo permanece aún esquivo para muchos visitantes a casa. Este estudio cualitativo usó un bien fundado acercamiento teórico modificado para examinar la manera de facilitar las interacciones cuidador-niño durante las visitas a casa. Con base en la calidad del proceso facilitador, se seleccionaron grabaciones en video de visitas a casa previamente codificadas usando la Escala de Puntuación de Visitas a Casa (HOVRS) A+. Dieciséis visitas a casa (8 con puntajes del proceso facilitador de más baja calidad y 8 de más alta calidad) se examinaron en cuanto a las diferencias en el comportamiento del visitador a casa que apoya las interacciones progenitor-niño durante las visitas. Identificamos comportamientos contextuales y específicos que los visitadores a casa usaron para hacer que los cuidadores y los niños participaran juntos activamente en las interacciones de apoyo al desarrollo. Los resultados revelaron 11 comportamientos del visitador a casa en que se comprometía la más alta calidad del proceso facilitador. Se categorizaron estos comportamientos en cuatro dominios: condiciones ambientales, ejecución de la actividad, enfoque con base en los puntos fuertes, así como las respuestas del cuidador. Este estudio cualitativo resalta comportamientos específicos y áreas de desarrollo profesional para apoyar servicios de visita a casa más eficaces para un diverso grupo de población de familias con niños pequeños.

La facilitation des interactions parent-enfant est une composante clé des programmes de visite à domicile de le petite enfance, fondés sur des données probantes. Plusieurs mesures d'observation ont été créées afin de capturer efficacement les activités de visite à domicile du point de vue de l'opération. Le domaine a une compréhension raisonnable de ce que les visiteurs à domicile peuvent faire pour facilité des interactions qui soutiennent le développement mais le pourquoi et le comment demeurent insaisissables pour bien des visiteurs à domicile. Cette étude qualitative a utilisé une approche théorique fondée modifiée pour faciliter les interactions personne prenant soin de l'enfant - enfant durant les visites à domicile. Des enregistrements vidéo de visite à domicile, préalablement codés en utilisant l'Echelle d'Evaluation de Visite à Domicile (HOVRS en anglais), A+ ont été sélectionnées basé sur la qualité de la facilitation. Seize visites à domicile (8 de scores de plus faible qualité et 8 de scores de la meilleure qualité de facilitation) ont été examinées pour leurs différences dans les comportements du visiteur à domicile qui soutiennent les interactions parent-enfant durant ces visites. Nous avons identifié des comportements contextuels et spécifiques que les visiteurs à domicile ont utilisés afin d'engager activement les personnes prenant soin des enfants et les enfants ensemble dans des interactions soutenant le développement. Les résultats ont révélé 11 comportements de visiteur à domicile qui dans la facilitation distinguant la facilitation de haute qualité. Ces comportements ont été catégorisés en quatre domaines: conditions environnementales, exécuter l'activité, attention mise sur les forces, et réponses de la personne prenant soin de l'enfant. Cette étude qualitative met en lumière des comportements spécifiques et des domaines de développement professionnel pour soutenir des services efficaces de visite à domicile pour une population diverse de familles avec de jeunes enfants.

Case-Based Questions for Teaching Emergency Medicine Pharmacotherapy.

Audience: This pharmacotherapy curriculum is designed for emergency medicine residents of all postgraduate years and could also be given to rotating medical students during clerkships. Length of Curriculum: Curriculum is to run monthly for an 18-month general curriculum cycle. Introduction: Pharmacotherapy is a critical part of day-to-day practice of Emergency Medicine (EM). The purpose of this innovation is to give this subject specific dedicated instruction time. We introduced a dedicated pharmacotherapy curriculum as part of our conference time through a series of case-based question sets that mirrored our educational blocks. Educational Goals: Our goals were to teach residents clinical applications of EM pharmacotherapy including drug selection and consideration of alternatives, interactions, and adverse effects, as well as to prepare them for pharmacotherapy questions on board examinations. Educational Methods: The educational strategies used in this curriculum include: case-based vignettes, multiple choice assessments, and guided review explanation and discussion. Questions and explanations are written by resident physicians using a variety of textbooks and online resources and are then reviewed, edited, and expanded upon by attending physicians and an EM pharmacist. Research Methods: This curriculum was implemented in the University of Pittsburgh Emergency Medicine residency program. Curriculum is ongoing and initial data covers a 4-month pilot period. Survey questionnaires were given before and after, using the 7-point Likert scale (1 strongly agree to 7 strongly disagree) for self-assessed knowledge and satisfaction with the curriculum. Primary measure was resident agreement with the statement, "I am confident in overall knowledge of EM pharmacotherapy." We also surveyed readiness for independent practice, knowledge appropriate for training level, board exam preparedness, and satisfaction with curriculum. Results: On the whole residents did feel their pharmacology knowledge improved. Our primary marker was response to a survey question, "I am confident in my overall knowledge of EM pharmacotherapy." In our sample of 30 residents, this question received a pretest score of 3.7 on a 7-point Likert scale (1 strongly agree, 7 strongly disagree). On post intervention surveys this score had improved to 2.6 (p = .00008). In general, residents appreciated this change in curriculum structure. Resident assessment of their improvement during the curriculum was 2.1, aligning with "agree." Satisfaction also improved from a 3.8 on initial survey to a 3.1, with statistical significance (p =.023). Discussion: We had success in our primary outcome of self-assessed resident learning as above. Satisfaction also improved. Residents assessed self-improvement in knowledge relative to year of training, clinical practice ability, and independent practice ability by statistically significant amounts. In addition, the assessments provided the residency clinical competency committee with objective knowledge of pharmacotherapy-based topics. We feel this easy to implement and effective curriculum would be generalizable across programs looking to add options for teaching EM pharmacotherapy, or to other programs looking to add a formal instruction and evaluation component to traditionally informal curriculum. Topics: Emergency Medicine, education, pharmacotherapy, case based, questions, milestones.