ShopSmart 4 Health - protocol of a skills-based randomised controlled trial promoting fruit and vegetable consumption among socioeconomically disadvantaged women

BackgroundThere is a need for evidence on the most effective and cost-effective approaches for promoting healthy eating among groups that do not meet dietary recommendations for good health, such as those with low incomes or experiencing socioeconomic disadvantage. This paper describes the ShopSmart 4 Health study, a randomised controlled trial conducted by Deakin University, Coles Supermarkets and the Heart Foundation, to investigate the effectiveness and cost-effectiveness of a skill-building intervention for promoting increased purchasing and consumption of fruits and vegetables amongst women of low socioeconomic position (SEP).Methods/designShopSmart 4 Health employed a randomised controlled trial design. Women aged 18&ndash;60 years, holding a Coles store loyalty card, who shopped at Coles stores within socioeconomically disadvantaged neighbourhoods and met low-income eligibility criteria were invited to participate. Consenting women completed a baseline survey assessing food shopping and eating habits and food-related behaviours and attitudes. On receipt of their completed survey, women were randomised to either a skill-building intervention or a wait-list control condition. Intervention effects will be evaluated via self-completion surveys and using supermarket transaction sales data, collected at pre- and post-intervention and 6-month follow-up. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups. Process evaluation will be undertaken to identify perceived value and effects of intervention components.DiscussionThis study will provide data to address the currently limited evidence base regarding the effectiveness and cost-effectiveness of skill-building intervention strategies aimed at increasing fruit and vegetable consumption among socioeconomically disadvantaged women, a target group at high risk of poor diets.<br /

Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: The Australian and New Zealand Massive Transfusion Registry study methodology

Background: The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines. The MTR commenced in 2011. At each participating site, all eligible patients aged ≥18 years with CB from any clinical context receiving MT are included using a waived consent model. Patient information and clinical coding, transfusion history, and laboratory test results are extracted for each patient’s hospital admission at the episode level. Results: Thirty-two hospitals have enrolled and 3566 MT patients have been identified across Australia and New Zealand between 2011 and 2015. The majority of CB contexts are surgical, followed by trauma and gastrointestinal haemorrhage. Validation studies have verified that the definition of MT used in the registry correctly identifies 94 % of CB events, and that the median time of transfusion for the majority of fresh products is the ‘product event issue time’ from the hospital blood bank plus 20 min. Data linkage between the MTR and mortality databases in Australia and New Zealand will allow comparisons of risk-adjusted mortality estimates across different bleeding contexts, and between countries. Data extracts will be examined to determine if there are differences in patient outcomes according to transfusion practice. The ratios of blood components (e.g. FFP:RBC) used in different types of critical bleeding will also be investigated. Conclusions: The MTR is generating data with the potential to have an impact on management and policy decision-making in CB and MT and provide benchmarking and monitoring tools for immediate application

Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with further consideration of the unobserved factors and reports the population average effect. Adults with ST-elevation myocardial infarction admitted to one of the six registry participating hospitals in Australia were included in this study. The exposure variable was patient-level door-to-balloon time. Primary outcomes assessed included in-hospital and 30 days mortality. 4343 patients fulfilled the study criteria. 38.0% (1651) experienced a door-to-balloon delay of >90 minutes. The absolute risk differences for in-hospital and 30-day deaths between the two exposure subgroups with balanced covariates were 2.81 (95% CI 1.04, 4.58) and 3.37 (95% CI 1.49, 5.26) per 100 population. When unmeasured factors were taken into consideration, the risk difference were 20.7 (95% CI −2.6, 44.0) and 22.6 (95% CI −1.7, 47.0) per 100 population. Despite further adjustment of the observed and unobserved factors, this study suggests a directionally consistent linkage between longer door-to-balloon delay and higher risk of adverse outcomes at the population level. Greater uncertainties were observed when unmeasured factors were taken into consideration.https://doi.org/10.1038/s41598-019-56353-79pubpub

Supermarket Healthy Eating for Life (SHELf): protocol of a randomised controlled trial promoting healthy food and beverage consumption through price reduction and skill-building strategies

Background: In the context of rising food prices, there is a need for evidence on the most effective approaches for promoting healthy eating. Individually-targeted behavioural interventions for increasing food-related skills show promise, but are unlikely to be effective in the absence of structural supports. Fiscal policies have been advocated as a means of promoting healthy eating and reducing obesity and nutrition-related disease, but there is little empirical evidence of their effectiveness. This paper describes the Supermarket Healthy Eating for LiFe (SHELf) study, a randomised controlled trial to investigate effectiveness and cost-effectiveness of a tailored skill-building intervention and a price reduction intervention, separately and in combination, against a control condition for promoting purchase and consumption of healthy foods and beverages in women from high and low socioeconomic groups.Methods/design: SHELf comprises a randomised controlled trial design, with participants randomised to receive either (1) a skill-building intervention; (2) price reductions on fruits, vegetables and low-joule soft drink beverages and water; (3) a combination of skill-building and price reductions; or (4) a control condition. Five hundred women from high and low socioeconomic areas will be recruited through a store loyalty card program and local media. Randomisation will occur on receipt of informed consent and baseline questionnaire. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups.Discussion: This study will build on a pivotal partnership with a major national supermarket chain and the Heart Foundation to investigate the effectiveness of intervention strategies aimed at increasing women&rsquo;s purchasing and consumption of fruits and vegetables and decreased purchasing and consumption of sugar-sweetened beverages. It will be among the first internationally to examine the effects of two promising approaches - skill-building and price reductions - on diet amongst women.<br /

Is dog ownership or dog walking associated with weight status in children and their parents?

Issue addressed: Several studies have shown that dog owners do more physical activity than non-owners; however, associations with weight status are unknown. This study examined associations between dog ownership, frequency of dog walking and weight status among children and their parents. Methods: Height and weight were measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent reported their own and their partner\u27s height and weight (n=1,108), dog ownership, usual frequency their child walks a dog, and usual frequency of walking the dog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups. Nearly one in four 5-6 year-olds and 37% of 10-12 year- olds walked a dog at least once/week. Weekly dog walking as a family was reported by 24-28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% CI 0.3-0.8) and higher among mothers whose family walked the dog together (OR--1.3, 95% CI 1.0-1.7). Conclusions: Dog ownership may offer some protection from overweight among young children. It is important that families with a dog are encouraged to walk or play with it regularly. Associations with weight status may depend on the type of dog owned, length of ownership and the nature of walks or interaction.<br /

Children\u27s fruit and vegetable intake : Associations with the neighbourhood food environment

Objective : To examine associations between availability of different types of food outlets and children\u27s fruit and vegetable intake.Method : Parents of 340 5&ndash;6 and 461 10&ndash;12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, caf&eacute;s and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit &ge; 2 times/day and vegetables &ge; 3 times/day, according to access to food outlets.Results : Overall, 62.5% of children ate fruit &ge; 2 times/day and 46.4% ate vegetables &ge; 3 times/day. The more fast food outlets (OR = 0.82, 95%CI = 0.67&ndash;0.99) and convenience stores (OR = 0.84, 95%CI = 0.73&ndash;0.98) close to home, the lower the likelihood of consuming fruit &ge; 2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables &ge; 3 times/day (OR = 0.84, 95%CI = 0.74&ndash;0.95). The likelihood of consuming vegetables &ge; 3 times/day was greater the farther children lived from a supermarket (OR = 1.27, 95%CI = 1.07&ndash;1.51) or a fast food outlet (OR = 1.19, 95%CI = 1.06&ndash;1.35).Conclusion : Availability of fast food outlets and convenience stores close to home may have a negative effect on children\u27s fruit and vegetable intake.<br /