Determinants and sources of iron intakes of australian toddlers: Findings from the SMILE cohort study

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. The first two years of life is a period of rapid growth and development. During this time a lack of key nutrients, including iron, can have long-lasting effects on motor and cognitive performance. The purpose of this cross-sectional study was to determine intake and sources of iron in a cohort of 828 toddlers (mean age; 13.1 mo) participating in the Adelaide-based Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE), and to identify determinants of iron intake. At approximately 12 months of age, 3 non-consecutive days of dietary intake data were collected using a 24-h recall and 2-days food record. The Multiple Source Method was used to combine data from the 24-h recall and each day of the food record to estimate usual iron intake and descriptive statistics were used to report sources of iron. Linear regression was used to identify associations between iron intake and non-dietary determinants (maternal age, education, country of birth, BMI, socioeconomic position, parity, toddler sex) and primary milk feeding method at 12 months. The mean intake of iron was 7.0 (95% CI 6.7–7.2) mg/day and 18.2% of children had usual intakes below the estimated average requirement of 4 mg/day. The main sources of iron included infant and toddler cereals and formulas. Milk feeding method and parity were significantly associated with iron intake. Toddlers with siblings and those who received breast milk as their primary milk feed had significantly lower iron intakes than only children and those who received formula, respectively. The Australian Infant Feeding Guidelines promote the importance of iron-iron-rich complementary foods such as meat and meat alternatives. However, low intakes of this food group suggest that parents do not recognize the importance of these foods or understand the specific foods that toddlers should be eating

Rote learning: the ugly duckling of student paramedic education?

The intent of this commentary is to ask questions and stimulate discussion amongst academics and paramedic educators as to whether the inherent value of rote learning has simply been lost in the shadow of more recent learning and teaching practices

A Comparison by Milk Feeding Method of the Nutrient Intake of a Cohort of Australian Toddlers

Breastfeeding is recommended beyond 12 months of age, but little is known about the contribution of breastmilk and infant formula to the nutritional intake of toddlers as they transition to a family diet in the second year of life. This study is a cross-sectional analysis of data collected from a birth cohort study in Adelaide, Australia. Dietary intake data were collected when children were approximately 1 year of age by an interviewer-administered multi-pass 24 h recall and a mother-completed 2 days food diary. Children were categorized according to their milk feeding method, i.e., breastmilk, infant formula, combination or other, and their nutrient intakes compared with recommended nutrient reference values. Complete data were available for 832 children, of which 714 had plausible energy intakes. Breastmilk and formula made a substantial contribution to the nutrient intake of those toddlers, contributing 28% and 34% of total energy, and 16% and 26% of protein intake, respectively when not drunk in combination. In general, Australian toddlers transitioning to the family diet consumed nutritionally adequate diets, although almost one quarter of all children and half of breastfed children with plausible intakes had iron intakes below the estimated average requirement, placing them at risk of iron deficiency

Ambulance clinicians’ attitudes to older patients’ self‐determination when the patient has impaired decision‐making ability: A Delphi study

Abstract: Objective: The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision‐making ability is impaired. Self‐determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self‐determination in cases where patients have impaired decision‐making ability, and who are in urgent need of care. Materials and methods: An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five‐point Likert scale together with free‐text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. Results: Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. Conclusions: The findings highlight the complexity of ACs’ attitudes towards older patients’ self‐determination. The respect of older patients’ self‐determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self‐determination and shared decision‐making. AS have to provide continued ethical training, for example to increase the use of simulation‐based training or moral case deliberations in order to strengthen the ACs’ moral abilities within their professional practice. Implications for practice: Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation‐based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs’ abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.Peer reviewe

Working with young dynamos: the benefits of patient public involvement in research design [Abstract only]

This study examined the attitudes and perceptions towards continuous professional development (CPD) of Australasian paramedics working in private and state or territory ambulance services. For the purpose of the study, CPD is described as commitment to both formal and informal life-long learning (LLL) opportunities which are linked to clinical advancements, practitioner competence, professionalism, and the delivery of gold standard patient care. Constructivist grounded theory was used as the methodological framework for this study. Study participants (n = 10) completed their paramedic qualification through two main pathways, namely a postemployment in-house Vocational Education and Training (VET) diploma or a preemployment university degree and had worked as a paramedic for a minimum of 2 years. Ethical approval was obtained from the Queensland University of Technology, and the participants signed consent forms prior to participating in the study. Data were collected by semistructured interviews, which were recorded digitally for transcription and analysis purposes. The study found there was not a considerable step up for paramedics to engage in CPD and LLL, as this was already expected prior to professional registration for paramedics commencing late 2018. Some older paramedics expressed fear about keeping up to date with new technologies and a shift in the paramilitary paramedic culture was identified, where education is forming a new hierarchical stigmatisation. A framework of paramedic CPD has been created from the study’s findings and builds on the extant literature. The framework acknowledges professional, industrial, social, personal, political, organisational, and economic factors which influence or change engagement in CPD

Factors impacting the decision-making processes of qualified paramedics moving to a specialist role in community paramedicine

Community paramedicine continues to evolve as a stream of paramedic specialisation. However, little is known about the transition from a 'traditional' role to that of an Extended Care Paramedic (ECP) or Community Paramedic (CP). Moreover, few studies have explicitly examined the rationale for the articulation of an experienced practitioner to an advanced practice role. This research illuminated the events or circumstances participants identified as necessary prior to the active engagement in the transition process. Methods ECPs (n=25) from two Australian jurisdictions and CPs (n=11) from a Canadian provincial health service, participated in a qualitative study exploring their experiences of transition. The data from the three study sites was pooled and interpreted using constructivist grounded theory methodology. Results Qualified Paramedics entered a junctional point in their careers in which the reasons for pursuing a career in community paramedicine were rationalised. The decision-making process involved satisfying two career 'wants': seeking new career options and improving patient outcomes. Subsequently, the paramedic’s perception of the community paramedicine role determined whether the paramedic entered the active phases of transition. Conclusion This study is the first of its kind to qualitatively examine the transition from one clinical specialist stream to another. The findings of this study have the potential to inform the selection criteria of prospective ECP/CP candidates and be utilised as a workforce recruitment tool for community paramedicine programs

Pairwise approach for analysis and reporting of child’s free sugars intake from a birth cohort study

Objectives: The prospective cohort design is an important research design, but a common challenge is missing data. The purpose of this study is to compare three approaches to managing missing data, the pairwise (n = 1386 children), the partial or modified pairwise (n = 1019) and the listwise (n = 546), to characterize the trajectories of children's free sugars intake (FSI) across early childhood. Methods: By applying the Group-based Trajectory Model Technique to three waves of data collected from a prospective cohort study of South Australian children, this study examined the three approaches in managing missing data to validate and discuss children's FSI trajectories. Results: Each approach identified three distinct trajectories of child's FSI from 1 to 5 years of age: (1) ‘low and fast increasing’, (2) ‘moderate and increasing’ and (3) ‘high and increasing’. The trajectory memberships were consistent across the three approaches, and were for the pairwise scenario (1) 15.1%, (2) 68.3% and (3) 16.6%; the partial or modified pairwise (1) 15.9%, (2) 64.1% and (3) 20.0%; and the listwise (1) 14.9%, (2) 64.9% and (3) 20.2% of children. Conclusions: Given the comparability of the findings across the analytical approaches and the samples' characteristics between baseline and across different data collection waves, it is recommended that the pairwise approach be used in future analyses to optimize the sample size and statistical power when examining the relationship between FSI in the first years of life and health outcome such as dental caries

Paramedic students working in snow resort medical clinics: a non-traditional interprofessional clinical placement model

This study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through Queensland University of Technology, Brisbane Australia. Data were collected via individual face-to-face interviews and analysed using holistic and focused coding. The analysed results indicated the presence of three main categories, namely Pre-Placement, Intra-Placement and Post-Placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included perceived improvement in maturity levels, the acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced during traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports

Common risk factor approach to address socioeconomic inequality in the oral health of preschool children – a prospective cohort study

Background: Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences.Methods/Design: This investigation will apply an observational prospective study design to a cohort ofsocioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers’ general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted.Discussion: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.Discussion: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an to examine the relationship between oral health and childhood overweight

Measurement of the open-charm contribution to the diffractive proton structure function

Production of D*+/-(2010) mesons in diffractive deep inelastic scattering has been measured with the ZEUS detector at HERA using an integrated luminosity of 82 pb^{-1}. Diffractive events were identified by the presence of a large rapidity gap in the final state. Differential cross sections have been measured in the kinematic region 1.5 < Q^2 < 200 GeV^2, 0.02 < y < 0.7, x_{IP} < 0.035, beta 1.5 GeV and |\eta(D*+/-)| < 1.5. The measured cross sections are compared to theoretical predictions. The results are presented in terms of the open-charm contribution to the diffractive proton structure function. The data demonstrate a strong sensitivity to the diffractive parton densities.Comment: 35 pages, 11 figures, 6 table