Journal of Human Nutrition and Dietetics, Feb 24, 2023
BackgroundThere is a clear need for food and nutrition research to lead to pragmatic and sustaina... more BackgroundThere is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens.MethodsQualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in‐depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches.ResultsFour themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples.ConclusionsSeveral challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.
Every year, the majority of Hong Kong young adults who graduate from secondary school progress on... more Every year, the majority of Hong Kong young adults who graduate from secondary school progress onto tertiary education. Poor eating patterns among young adults could lead to long-term health implications associated with overweight and obesity. Using the socio-ecological model as a theoretical framework, this paper reviews the current food-related policies in Hong Kong and proposes a comprehensive policy approach relevant to a variety of organizational contexts that has the potential to support positive eating patterns among young adults by enhancing the local food environment. Hong Kong has an unusual food supply in that more than 95% of food is imported, making it vulnerable to food insecurity. Education interventions commonly conducted in Hong Kong are unlikely to be helpful because young adults acquire nutrition-related knowledge when they attend secondary school. There is a need to change the food environment in Hong Kong so that young adults can easily translate their nutrition knowledge into making healthy food choices. Policy approaches might be among the most effective strategies for bringing positive changes in eating patterns because they have the potential to directly influence the food environment and context where an individual lives. A comprehensive suite of approaches that fill the policy gaps, remove barriers of healthy food consumption and create more healthy food choices is required to improve diet and health.
This study investigated one of the major causes of malnutrition, i.e. poor client satisfaction wi... more This study investigated one of the major causes of malnutrition, i.e. poor client satisfaction with institutional food, and developed a measurement instrument for the regular evaluation of client satisfaction with longer-stay foodservices. Following thorough development and pre-testing (n = 40), the pilot version of the Resident Foodservice Satisfaction Questionnaire was used to survey 313 respondents, in both longer-stay hospital and residential aged care settings. Ordered probit regression analyses indicated that foodservice satisfaction was significantly moderated by client age (p < 0.05). Marginal effects analysis on outcome probability estimates demonstrated that clients aged 75–84 years were more likely than those aged less than 65 years to rate overall foodservice satisfaction as “very good” (Pr = 0.23), and this positive association also occurred for clients aged 95 years or more (Pr = 0.27); however, clients aged 85–94 years were less likely to provide this overall rating (Pr = 0.19), suggesting a non-linear relationship between satisfaction and age. Furthermore, the results suggest that foodservice variables representing client autonomy and choice, appetite and perceived health status appear to exert a greater influence in the longer-stay setting than food quality per se. The results provide evidence for modifications to current menu planning and foodservice delivery methods, particularly regarding the reduction of the time-lapse between resident meal choice and consumption. In addition to these practical service delivery changes, the results may be applied to refine the food and nutrition components of the existing Aged Care Accreditation Standards to improve their applicability to clients of residential aged care facilities.
Recommended Dietary Intakes (RDIs) have been a key tool for nutrition practitioners for decades. ... more Recommended Dietary Intakes (RDIs) have been a key tool for nutrition practitioners for decades. After much debate within Australia about nutrient recommendations (Cobiac, Dreosti & Baghurst, 1998) the Nutrient Reference Values (NRVs) for Australia and New Zealand were released in 2006 (National Health & Medical Research Council, 2006). The term Nutrient Reference Values (NRVs) is an umbrella term, incorporating a variety of sets of values. They include not just RDIs as in the past, but a range of other references such as those for adequate intake (AI), estimated average requirements (EAR), upper limit of intake (UL) as well as suggested dietary targets (SDTs) for chronic disease risk reduction. This was the first review of the recommendations for nutrients for more than fifteen years and represents changes not just in the values themselves, but the number of nutrients to be considered. The issue now is interpretation of these values into meaningful messages for all members of our population, as people eat food, not nutrients. Food Standards Australia and New Zealand (FSANZ) will also have to determine the best value to use on food labels, given that there are now more than just the RDIs available for use. All nutrition educators need to be clear about how to use the NRVs in practice as consistency in nutrition messages is important.
Objective The aim of this study was to provide a detailed description of the flexible working arr... more Objective The aim of this study was to provide a detailed description of the flexible working arrangements (FWA) used by allied health professionals (AHP) on return from maternity leave. This is a crucial issue for staff management practices in a changing regulatory context. Methods A retrospective convenience sample of AHP employed by Queensland Health (QH) in 2006, using deidentified payroll data, was analysed descriptively to determine employment status on return from maternity leave in 2006 to December 2014. A qualitative study that surveyed managers of AHP departments was subsequently undertaken to complement the data from the payroll study. Twelve managers, across six allied health professions in three hospitals in south-east Queensland were surveyed for this component. Results The payroll study included 169 employees (138 full-time equivalent (FTE)), 61 of whom resigned over the study period. Of those who returned to work after the 2006 maternity event (n=152), 92% (n=140) initially returned part-time. At 31 December 2014, of the 108 staff working for QH, 77% (n=83) were part-time. In total, 75.4 FTE positions were released over the 8-year period through reduced working hours and resignations. The perceptions of surveyed managers were consistent with the data from the payroll study. Conclusion The study showed that most AHPs who took maternity leave returned to work part-time and remained part-time for an extended period. The data suggest that managers could permanently backfill a proportion of hours released due to FWA after maternity leave without major budgetary risk due to the need to accommodate existing employees’ entitlements. However, this would require a significant policy change. What is known about this topic? Current research on this topic has concentrated on the benefits of paid maternity leave, timing of return to work and use of FWA by employees on return to work after maternity leave. What does this paper add? This paper presents the first comprehensive data on patterns of return to work and part-time hours following maternity leave for AHP employees. Access to a unique payroll dataset provided the opportunity to describe this for a cohort of AHP employees over a period of 8 years following a maternity event. A survey of AHP managers’ experience with maternity leave and return to work arrangements supported the findings, underlining the associated difficulties with staff management. What are the implications for practitioners? The hours released through resignations or reduced hours over this period of study suggest that management could backfill a proportion of released hours permanently, or at least offer temporary staff longer-term contracts, once an employee returns from maternity leave on reduced hours
Lutein and zeaxanthin (L/Z), xanthophylls obtained from the diet, are deposited in the macula of ... more Lutein and zeaxanthin (L/Z), xanthophylls obtained from the diet, are deposited in the macula of the eye. The macular concentration of L/Z is quantifiable as macular pigment optical density (MPOD). The aim of this review was to critically appraise the effect on MPOD of increasing L/Z intake by dietary intervention in adults. Pubmed, Cochrane Library, Web of Science, and Cinahl were searched up to April 2020. Ten studies investigating populations with and without age-related macular degeneration were included. MPOD increased significantly in 2 of the 8 controlled studies. Studies varied largely in the prescribed dietary L/Z dosage, duration, and participant characteristics. No relationships between types of dietary L/Z interventions and MPOD response could be determined. Limited monitoring of habitual dietary L/Z intake was identified as a major limitation of all 10 studies. Habitual dietary L/Z intake should be closely monitored in future studies to account for their effects on MPOD...
This information on best practice examines the evidence on effective interventions for use with u... more This information on best practice examines the evidence on effective interventions for use with undernourished older patients in hospital. It is based on an evidence synthesis of research published by Blackwell Publishing Asia and conducted by the Australian Centre for Evidence Based Nutrition and Dietetics (Vanderkroft et al 2007). The article has been reproduced with the permission of the Joanna Briggs Institute (JBI). The primary references are available online at: www.blackwell-synergy.com and to members of the JBI via the website: www.joannabriggs.edu.au.
Focus on health professional education : a multi-disciplinary journal, Nov 27, 2017
Background: Nutrition and dietetics competencies in Australia have recently changed to incorporat... more Background: Nutrition and dietetics competencies in Australia have recently changed to incorporate greater emphasis on client-centredness, flexibility, marketing skills, advocacy and a systems-based approach to practice. This study examined the translation of the new competency standards into a series of entrustable professional activities (EPAs) to achieve authentic assessment practice. Methods: An iterative, multiple-methods approach was used. Two senior academic dietitian-nutritionists conceptualised key tasks for everyday practice and devised a list of 14 EPAs. Face validity of the 14 EPAs, new curriculum and assessment plans was established through expert review and presentation to four dietetics department directors and 10 clinical educators. Dietetics students trialled the new assessment procedure. Results: Each domain of competence was included in 9–10 EPAs. Each EPA included the demonstration of 12–21 key tasks/elements. The EPAs were positively received by expert reviewers and were considered a strong framework. Students considered the EPA assessment process easier than previous competency-based methods and reported a higher recognition of learning and skills development. Conclusions: EPAs are feasible for translating competency standards into a workplace-driven nutrition and dietetics curriculum and are an effective catalyst for curriculum and assessment modifications to drive the development of client-centred and entrepreneurial dietetics professionals.
Journal of Human Nutrition and Dietetics, Feb 24, 2023
BackgroundThere is a clear need for food and nutrition research to lead to pragmatic and sustaina... more BackgroundThere is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens.MethodsQualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in‐depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches.ResultsFour themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples.ConclusionsSeveral challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.
Every year, the majority of Hong Kong young adults who graduate from secondary school progress on... more Every year, the majority of Hong Kong young adults who graduate from secondary school progress onto tertiary education. Poor eating patterns among young adults could lead to long-term health implications associated with overweight and obesity. Using the socio-ecological model as a theoretical framework, this paper reviews the current food-related policies in Hong Kong and proposes a comprehensive policy approach relevant to a variety of organizational contexts that has the potential to support positive eating patterns among young adults by enhancing the local food environment. Hong Kong has an unusual food supply in that more than 95% of food is imported, making it vulnerable to food insecurity. Education interventions commonly conducted in Hong Kong are unlikely to be helpful because young adults acquire nutrition-related knowledge when they attend secondary school. There is a need to change the food environment in Hong Kong so that young adults can easily translate their nutrition knowledge into making healthy food choices. Policy approaches might be among the most effective strategies for bringing positive changes in eating patterns because they have the potential to directly influence the food environment and context where an individual lives. A comprehensive suite of approaches that fill the policy gaps, remove barriers of healthy food consumption and create more healthy food choices is required to improve diet and health.
This study investigated one of the major causes of malnutrition, i.e. poor client satisfaction wi... more This study investigated one of the major causes of malnutrition, i.e. poor client satisfaction with institutional food, and developed a measurement instrument for the regular evaluation of client satisfaction with longer-stay foodservices. Following thorough development and pre-testing (n = 40), the pilot version of the Resident Foodservice Satisfaction Questionnaire was used to survey 313 respondents, in both longer-stay hospital and residential aged care settings. Ordered probit regression analyses indicated that foodservice satisfaction was significantly moderated by client age (p < 0.05). Marginal effects analysis on outcome probability estimates demonstrated that clients aged 75–84 years were more likely than those aged less than 65 years to rate overall foodservice satisfaction as “very good” (Pr = 0.23), and this positive association also occurred for clients aged 95 years or more (Pr = 0.27); however, clients aged 85–94 years were less likely to provide this overall rating (Pr = 0.19), suggesting a non-linear relationship between satisfaction and age. Furthermore, the results suggest that foodservice variables representing client autonomy and choice, appetite and perceived health status appear to exert a greater influence in the longer-stay setting than food quality per se. The results provide evidence for modifications to current menu planning and foodservice delivery methods, particularly regarding the reduction of the time-lapse between resident meal choice and consumption. In addition to these practical service delivery changes, the results may be applied to refine the food and nutrition components of the existing Aged Care Accreditation Standards to improve their applicability to clients of residential aged care facilities.
Recommended Dietary Intakes (RDIs) have been a key tool for nutrition practitioners for decades. ... more Recommended Dietary Intakes (RDIs) have been a key tool for nutrition practitioners for decades. After much debate within Australia about nutrient recommendations (Cobiac, Dreosti & Baghurst, 1998) the Nutrient Reference Values (NRVs) for Australia and New Zealand were released in 2006 (National Health & Medical Research Council, 2006). The term Nutrient Reference Values (NRVs) is an umbrella term, incorporating a variety of sets of values. They include not just RDIs as in the past, but a range of other references such as those for adequate intake (AI), estimated average requirements (EAR), upper limit of intake (UL) as well as suggested dietary targets (SDTs) for chronic disease risk reduction. This was the first review of the recommendations for nutrients for more than fifteen years and represents changes not just in the values themselves, but the number of nutrients to be considered. The issue now is interpretation of these values into meaningful messages for all members of our population, as people eat food, not nutrients. Food Standards Australia and New Zealand (FSANZ) will also have to determine the best value to use on food labels, given that there are now more than just the RDIs available for use. All nutrition educators need to be clear about how to use the NRVs in practice as consistency in nutrition messages is important.
Objective The aim of this study was to provide a detailed description of the flexible working arr... more Objective The aim of this study was to provide a detailed description of the flexible working arrangements (FWA) used by allied health professionals (AHP) on return from maternity leave. This is a crucial issue for staff management practices in a changing regulatory context. Methods A retrospective convenience sample of AHP employed by Queensland Health (QH) in 2006, using deidentified payroll data, was analysed descriptively to determine employment status on return from maternity leave in 2006 to December 2014. A qualitative study that surveyed managers of AHP departments was subsequently undertaken to complement the data from the payroll study. Twelve managers, across six allied health professions in three hospitals in south-east Queensland were surveyed for this component. Results The payroll study included 169 employees (138 full-time equivalent (FTE)), 61 of whom resigned over the study period. Of those who returned to work after the 2006 maternity event (n=152), 92% (n=140) initially returned part-time. At 31 December 2014, of the 108 staff working for QH, 77% (n=83) were part-time. In total, 75.4 FTE positions were released over the 8-year period through reduced working hours and resignations. The perceptions of surveyed managers were consistent with the data from the payroll study. Conclusion The study showed that most AHPs who took maternity leave returned to work part-time and remained part-time for an extended period. The data suggest that managers could permanently backfill a proportion of hours released due to FWA after maternity leave without major budgetary risk due to the need to accommodate existing employees’ entitlements. However, this would require a significant policy change. What is known about this topic? Current research on this topic has concentrated on the benefits of paid maternity leave, timing of return to work and use of FWA by employees on return to work after maternity leave. What does this paper add? This paper presents the first comprehensive data on patterns of return to work and part-time hours following maternity leave for AHP employees. Access to a unique payroll dataset provided the opportunity to describe this for a cohort of AHP employees over a period of 8 years following a maternity event. A survey of AHP managers’ experience with maternity leave and return to work arrangements supported the findings, underlining the associated difficulties with staff management. What are the implications for practitioners? The hours released through resignations or reduced hours over this period of study suggest that management could backfill a proportion of released hours permanently, or at least offer temporary staff longer-term contracts, once an employee returns from maternity leave on reduced hours
Lutein and zeaxanthin (L/Z), xanthophylls obtained from the diet, are deposited in the macula of ... more Lutein and zeaxanthin (L/Z), xanthophylls obtained from the diet, are deposited in the macula of the eye. The macular concentration of L/Z is quantifiable as macular pigment optical density (MPOD). The aim of this review was to critically appraise the effect on MPOD of increasing L/Z intake by dietary intervention in adults. Pubmed, Cochrane Library, Web of Science, and Cinahl were searched up to April 2020. Ten studies investigating populations with and without age-related macular degeneration were included. MPOD increased significantly in 2 of the 8 controlled studies. Studies varied largely in the prescribed dietary L/Z dosage, duration, and participant characteristics. No relationships between types of dietary L/Z interventions and MPOD response could be determined. Limited monitoring of habitual dietary L/Z intake was identified as a major limitation of all 10 studies. Habitual dietary L/Z intake should be closely monitored in future studies to account for their effects on MPOD...
This information on best practice examines the evidence on effective interventions for use with u... more This information on best practice examines the evidence on effective interventions for use with undernourished older patients in hospital. It is based on an evidence synthesis of research published by Blackwell Publishing Asia and conducted by the Australian Centre for Evidence Based Nutrition and Dietetics (Vanderkroft et al 2007). The article has been reproduced with the permission of the Joanna Briggs Institute (JBI). The primary references are available online at: www.blackwell-synergy.com and to members of the JBI via the website: www.joannabriggs.edu.au.
Focus on health professional education : a multi-disciplinary journal, Nov 27, 2017
Background: Nutrition and dietetics competencies in Australia have recently changed to incorporat... more Background: Nutrition and dietetics competencies in Australia have recently changed to incorporate greater emphasis on client-centredness, flexibility, marketing skills, advocacy and a systems-based approach to practice. This study examined the translation of the new competency standards into a series of entrustable professional activities (EPAs) to achieve authentic assessment practice. Methods: An iterative, multiple-methods approach was used. Two senior academic dietitian-nutritionists conceptualised key tasks for everyday practice and devised a list of 14 EPAs. Face validity of the 14 EPAs, new curriculum and assessment plans was established through expert review and presentation to four dietetics department directors and 10 clinical educators. Dietetics students trialled the new assessment procedure. Results: Each domain of competence was included in 9–10 EPAs. Each EPA included the demonstration of 12–21 key tasks/elements. The EPAs were positively received by expert reviewers and were considered a strong framework. Students considered the EPA assessment process easier than previous competency-based methods and reported a higher recognition of learning and skills development. Conclusions: EPAs are feasible for translating competency standards into a workplace-driven nutrition and dietetics curriculum and are an effective catalyst for curriculum and assessment modifications to drive the development of client-centred and entrepreneurial dietetics professionals.
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Papers by Sandra Capra