Tailored, iterative, printed dietary feedback is as effective as group education in improving dietary behaviours: results from a randomised control trial in middle-aged adults with cardiovascular risk factors

<p>Abstract</p> <p>Background</p> <p>Tailored nutrition interventions have been shown to be more effective than non-tailored materials in changing dietary behaviours, particularly fat intake and fruit and vegetable intake. But further research examining efficacy of tailored nutrition education in comparison to other nutrition education methods and across a wider range of dietary behaviours is needed. The Stages to Healthy Eating Patterns Study (STEPs) was an intervention study, in middle-aged adults with cardiovascular risk factors, to examine the effectiveness of printed, tailored, iterative dietary feedback delivered by mail in improving short-term dietary behaviour in the areas of saturated fat, fruit, vegetable and grain and cereal intake.</p> <p>Methods</p> <p>STEPs was a 3-month randomised controlled trial with a pre and post-test design. There were three experimental conditions: 1) tailored, iterative, printed dietary feedback (TF) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake, intention to change and assessment of self-adequacy of dietary intake. Tailoring for dietary intake was performed on data from a validated 63-item combination FFQ designed for the purpose 2) small group nutrition education sessions (GE): consisting of two 90-minute dietitian-led small group nutrition education sessions and 3) and a wait-listed control (C) group who completed the dietary measures and socio-demographic questionnaires at baseline and 3-months later. Dietary outcome measures in the areas of saturated fat intake (g), and the intake of fruit (serves), vegetables (serves), grain and cereals as total and wholegrain (serves) were collected using 7-day estimated dietary records. Descriptive statistics, paired t-tests and general linear models adjusted for baseline dietary intake, age and gender were used to examine the effectiveness of different nutrition interventions.</p> <p>Results</p> <p>The TF group reported a significantly greater increase in fruit intake (0.3 serves/d P = 0.031) in comparison to GE and the C group. All three intervention groups showed a reduction in total saturated fat intake. GE also had a within-group increase in mean vegetable intake after 3 months, but this increase was not different from changes in the other groups.</p> <p>Conclusions</p> <p>In this study, printed, tailored, iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour, and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors. This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance.</p

Perspectives and attitudes of breastfeeding women using herbal galactagogues during breastfeeding: a qualitative study

Some herbal galactagogues have gained reputation and recognition by the public and health professionals as alternative approaches to increase breast milk supply. This study explores the perspectives and attitudes of breastfeeding women towards the use of herbal galactagogues while breastfeeding, their experiences, and why and how they have chosen an alternative option over conventional treatments to enhance breastfeeding performance. This exploratory research was conducted through in-depth semi-structured interviews with women living in Perth, Western Australia, who were using one or more herbal galactagogues during breastfeeding. Purposeful and subsequent snowball sampling methods were employed to recruit participants. All interviews, facilitated by an interview guide, were audio-recorded, then transcribed verbatim. Thematic analysis was used to analyse qualitative data to construct themes and subthemes.The perspectives and attitudes of the 20 participants are classified under three main headings: i) use of herbal medicines during breastfeeding, ii) available herbal medicines resources, and iii) level of breastfeeding support received. Throughout the interviews, participants described how their perseverance and determination to breastfeed, as well as concerns over breastfed infants’ safety with conventional treatments, influenced their choice of therapy. A sense of self-efficacy and autonomy over their own health needs was seen as influential to their confidence level, supported self-empowerment and provided reassurance throughout the breastfeeding journey. There was also a desire for more evidence-based information and expectations of health professionals to provide credible and reliable information regarding the use of herbal medicines during breastfeeding. This study has enhanced our understanding of the perspectives and attitudes of breastfeeding women towards the use of herbal medicines, in particular galactagogues, while breastfeeding. The positive attitudes of breastfeeding women identified in this study highlight the need for further research into evaluating the safety and efficacy of commonly used herbal galactagogues, whilst the negative views on breastfeeding education should be taken into consideration when implementing or improving breastfeeding-related health policies

Music Therapy for Neuropsychiatric Symptoms in the General Hospital: A Systematic Literature Review

Dementia and delirium are common in medical and surgical inpatients. Neuropsychiatric symptoms can be challenging to manage. Non-pharmacological interventions such as music therapy have been used to manage symptoms in psychiatric hospitals and nursing homes but are not routine in general hospitals. We performed a systematic literature review to establish whether music therapy improves neuropsychiatric symptoms in adults with dementia and/or delirium in the general hospital. We searched CINAHL, Medline and PsycINFO in November 2015. Search terms included music therapy, dementia, delirium. We screened 5054 titles, and read 142 full text articles. None of these met inclusion criteria for our review. To inform future research in music in general hospitals for people with dementia and/or delirium, we qualitatively reviewed 8 articles involving 239 patients. Music delivery was feasible and had a positive effect on some aspects of neuropsychiatric symptoms in various settings, but the studies were generally small, at high risk of bias, and did not use recognized frameworks for evaluating complex interventions. We found no robust published evidence for the use of music therapy in the treatment of neuropsychiatric symptoms in patients with dementia and/or delirium in the general hospital. Well-designed studies of this promising intervention are needed. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Variation in fat lactose and protein in human milk over 24h and throughout the first year of lactation

Fat in human milk is extremely variable and can represent up to 50 % of infant energy intake. To accurately determine milk composition and infant intake at 1 (n 17), 2 (n 17), 4 (n 17), 6 (n 15), 9 (n 6) and 12 (n 5) months of lactation, samples of fore- and hind-milk were collected from each breast at each feed over 24 h periods from an initial group of seventeen women. The content of fat in milk varied over 24 h, with a mean CV of 47·6 (SE 2·1) % (N 76) AND 46·7 (se 1·7) % (n 76) for left and right breasts respectively. The 24 h amounts of fat, lactose and protein in milk differed between women (P=0·0001), but were consistent between left and right breasts. Daily milk production differed between breasts (P=0·0001) and women (P=0·0001). Accordingly, amounts of fat (P=0·0008), lactose (P=0·0385) and protein (P=0·0173) delivered to the infant over 24 h also differed between breasts and women (P=0·0001). The energy content of milk and the amount of energy delivered to the infant over 24 h were the same between breasts, but differed between women (P=0·0001). The growth rate of a group of only six infants in the present study was not related to either the concentrations or amounts of fat, lactose, protein and energy in milk over the first 6 months of life. These results show the individuality of milk composition and suggest that only a rigorous sampling routine that takes into account all levels of variation will allow the accurate determination of infant intake of fat, lactose, protein and energy

Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation

Objective: The most common reason given for discontinuation of exclusive breastfeeding is perceived insufficient milk supply. Breastfed infants show more variation in feeding frequency than bottle-fed infants, and this may lead to a mother lacking confidence in her milk supply if the frequency of breastfeeding sessions does not match expectations based on bottle feeding. We aimed to assist clinicians in supporting breastfeeding mothers by providing evidence-based information on expected changes in breastfeeding patterns and milk intake during exclusive breastfeeding for 6 months.Subjects and Methods: Mothers and their healthy infants who were exclusively breastfeeding (total 24-hour milk intake within the normal range) were studied during two to five 24-hour periods between 1 and 6 months of lactation.Results: Between 1 and 3 months of lactation, the frequency of breastfeeding sessions decreased, whereas both the median and maximum breastmilk intakes during each breastfeeding session increased. These parameters remained constant between 3 and 6 months. The duration of each breastfeeding session decreased steadily from 1 to 6 months, but the total 24-hour milk intake remained constant.Conclusions: Breastfeeding becomes more efficient between 1 and 3 months of lactation, although milk intake remains constant. Clinicians can give mothers confidence that these changes in breastfeeding behavior do not indicate insufficient milk supply, but may be a result of the increase in the stomach capacity of the infants and are an expected outcome of a healthy, normal breastfeeding relationship