Oral size perception and texture preferences for particle-containing foods in children aged 5-12.

Foods containing bits and pieces are often less liked by children; however, there is a limited understanding of how perceptions and preferences for foods with particles change during childhood. This study aimed to investigate preferences and perceptions of particle-containing foods in children aged 5-12 years. Children (n = 485) completed a forced-choice questionnaire on drawings of six pairs of foods, each available with or without particles. Additionally, children tasted yogurts added with muesli differing in particle size (median diameter: 3.9 or 7.5 mm) and evaluated their perception of particle size in mouth and their liking. The questionnaire results showed that children had a clear preference for foods without particles. The average probability of choosing the 'with-particle' foods was 28%, significantly below the midpoint of 50% (p < .0001). Preferences for particle-containing foods were lowest at age six and increased significantly with age (p = .0007). In the taste test, muesli particle size affected oral size perception (p < .0001) but not liking (p = .60). Older children were better able to differentiate particle size than younger children. However, there was no relationship between individual preferences for particle-containing foods and oral size perception of muesli particles. The observation that children's texture preferences changed with age highlights the role of increased experience in shaping preferences for foods with particles.

A multi-centre retrospective study of long-term outcomes of spinal re-irradiation with SABR.

INTRODUCTION: Stereotactic ablative body radiotherapy (SABR) is a highly conformal technique utilising a high dose per fraction commonly employed in the re-treatment of spinal metastases. This study sought to determine the safety and efficacy of re-irradiation with SABR to previously treated spinal metastases. METHODS: This was a retrospective analysis of patients at three Australian centres who have undergone spinal SABR after previous spinal radiotherapy to the same or immediately adjacent vertebral level. Efficacy was determined in terms of rates of local control, while safety was characterised by rates of serious complications. RESULTS: Thirty-three spinal segments were evaluated from 32 patients. Median follow-up for all patients was 2.6 years, and median overall survival was 4.3 years. Eleven of 33 (33.3%) treated spinal segments had local progression, with a local control rate at 12 months of 71.4% (95% C.I. 55.2%-92.4%). Four patients (16.7%) went on to develop cauda equina or spinal cord compression. Thirteen out of 32 patients (40.6%) experienced acute toxicity, of which 12 were grade 2 or less. Five out of 30 spinal (16.7%) segments with follow-up imaging had a radiation-induced vertebral compression fracture. There was one case of radiation myelitis which occurred in a patient who had mediastinal radiotherapy with a treatment field which overlapped their prior spinal radiation. CONCLUSION: The patients in this study experienced long median survival, durable tumour control and high rates of freedom from long-term sequelae of treatment. These results support the use of SABR in patients who progress in the spine despite previous radiotherapy.

Information processing style and institutional trust as factors of COVID vaccine hesitancy.

This study investigates the factors contributing to COVID vaccine hesitancy. Vaccine hesitancy has commonly been attributed to susceptibility to misinformation and linked to particular socio-demographic factors and personality traits. We present a new perspective, emphasizing the interplay between individual cognitive styles and perceptions of public health institutions. In January 2020, before the COVID-19 pandemic, 318 participants underwent a comprehensive assessment, including self-report measures of personality and clinical characteristics, as well as a behavioral task that assessed information processing styles. During 2021, attitudes towards vaccines, scientists, and the CDC were measured at three time points (February-October). Panel data analysis and structural equation modeling revealed nuanced relationships between these measures and information processing styles over time. Trust in public health institutions, authoritarian submission, and lower information processing capabilities together contribute to vaccine acceptance. Information processing capacities influenced vaccination decisions independently from the trust level, but their impact was partially mediated by authoritarian tendencies. These findings underscore the multifactorial nature of vaccine hesitancy, which emerges as a product of interactions between individual cognitive styles and perceptions of public health institutions. This novel perspective provides valuable insights into the underlying mechanisms that drive this complex phenomenon.

The impacts of an mHealth intervention targeting parents on health service usage and out-of-pocket costs in the first 9 months of life: The Growing healthy app.

Mobile health (mHealth) interventions provide a low-cost, scalable approach to supporting parents with infant feeding advice with the potential to reduce health care visits and associated costs for infant feeding support. This Australian study examined the impact of the Growing healthy (GH) app on health service utilisation and out-of-pocket costs for families in the first 9 months of their infants life. A quasi-experimental study with a comparison group was conducted in 2015-2016 with an mHealth intervention group (GH app, n = 301) and a nonrandomized usual care group (n = 344). The GH app aimed to support parents of young infants with healthy infant feeding behaviours from birth to 9 months of age. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed surveys at baseline when infants were less than 3 months old (T1), at 6 months (T2) and 9 months (T3) of age. At T3, participants reported health services used and any out-of-pocket costs for advice on infant feeding, growth or activity. App users had lower odds (odds ratio: 0.38 95% confidence interval: 0.25, 0.59) of using one or more services and had lower number of visits to a general practitioner (1.0 vs. 1.5 visits, p = 0.003) and paediatrician (0.3 vs. 0.4 visits, p = 0.049) compared to the usual care group. There was no difference in out-of-pocket costs between groups. Provision of an evidenced-based infant feeding app may provide substantial savings to the health system and potentially to parents through fewer primary health care and paediatrician visits.

A Cross-Sectional Study of Sports Food Consumption Patterns, Experiences, and Perceptions amongst Non-Athletes in Australia.

Sports foods are designed for athletes, yet their availability, type, and sales have increased over the past decade, likely driven by non-athlete use. This could lead to detrimental health outcomes via over/misuse or unwanted side effects. The aim of this study was to describe sports food consumption patterns and associated drivers, consumption reasons, perception of risks, and side effects experienced amongst non-athletes in Australia. In 2022, n = 307 non-athlete Australian adults (18-65 years) completed an online cross-sectional survey including closed-ended (consumption patterns, factors, and exercise participation) and open-ended questions (reasons for consumption, risk perception, and side effects experienced). Descriptive statistics (frequency and percent) described the sample. Ordinal logistic regression was used for univariate associations and a multivariate model was used to determine relationships between sports food consumption proxy and significant univariate associations. The themes were analysed via inductive thematic analysis using NVivo 14. Females consumed sports foods most frequently, 65% of participants consumed three or more sports foods, and participants with higher sports food consumption/frequency were less likely to perceive risks or experience side effects. The main reason for consumption was protein intake, digestion/stomach issues were the main perceived risks, and the main side effect was bloating. Despite understanding the risks and side effects, non-athlete consumers continue to use numerous sports foods, which appear to be influenced by sociodemographic factors and packaging labels. Tighter regulation of packaging-label information would ensure safer and more informed consumption.

Visual communication design: a neglected factor in nutrition promotion via packaged food labels.

Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.

Australian Stakeholder Perspectives on Healthier Retail Food Environments for Toddlers-The Era of "Band Aids and Small Inroads".

Background: A healthy diet in young children is crucial for optimal growth and development. However, many toddlers (1-3 y) consume suboptimal diets, and as a result, are at a high risk of experiencing negative health outcomes. Moreover, minimal progress has been made to improve the healthiness of retail food environments for toddlers to date despite the potential and advocacy for the issue. Objectives: To gain insight into stakeholder perceptions and opinions on the healthiness of Australian retail food environments for toddlers, as well as perspectives on the options and barriers to improve their healthiness. Methods: Qualitative, online study utilizing semi-structured individual interviews with 27 key stakeholders from food industry, academia, nongovernment organizations, public health, and government in Australia. Results: Most stakeholders agreed that retail food environments for toddlers were not health promoting. Stakeholders identified that a multifaceted approach including nutrition education and strong government mandated regulation were essential to improve the healthiness of retail food environments for toddlers. Interviews also highlighted the main perceived barriers to progress, and reasons for policy inaction in this area are the food industry and government support. Many stakeholders were concerned that child health is being undermined due to the government favoring business needs over public health. Conclusions: Stakeholders in this study overwhelmingly agreed that there is more that can and should be done to create health promoting retail food environments for toddlers in Australia. Stakeholders identified a range of strategies that can be used to improve the healthiness of toddler food environments, but advocacy efforts are being undermined due to government inaction. Stakeholders believed that strong governance is required to create equitable, sustainable healthy retail food environments for young children. Improving the healthiness of retail food environments for young children will not only reduce diet related disease across the lifespan but will help to address financial and societal costs of a poor diet.

Clinical Nurse Well-being Improved Through Transcendental Meditation: A Multimethod Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of Transcendental Meditation® (TM®) practice on the multidimensional well-being of nurse clinicians affected by the COVID-19 pandemic. BACKGROUND: The health of clinical nurses has substantial impact on both the availability of a nursing workforce and the quality and safety of patient care. TM improved health and coping strategies across many populations. METHODS: Clinical nurses were recruited from 3 Magnet®-designated hospitals during the COVID-19 pandemic. Well-being outcomes included flourishing, burnout, anxiety, and posttraumatic stress disorder. Participants were randomized following completion of baseline surveys into immediate (intervention) or delayed (control) TM instruction. Surveys were repeated at 1 and 3 months following baseline survey or TM instruction. Repeated-measures analysis of variance compared differences in groups over time. RESULTS: Across the 3 sites, there were 104 clinical nurse participants. Repeated-measures analysis of variance showed significant medium to large effects in improvement over time in well-being measures for the intervention group. CONCLUSIONS: TM improved multidimensional well-being of clinical nurses by reducing posttraumatic stress disorder, anxiety, and burnout and improving flourishing. TM is easy to practice anywhere. The benefits are immediate and cumulative. Organizations and individual nurses can use TM to support clinical nurses in the difficult and meaningful work of patient care, especially in challenging times. Future studies may consider the feasibility of integrating TM into clinical shifts and evaluating its impact on patient and organizational outcomes.

Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review.

OBJECTIVES: Acceptance and commitment therapy (ACT) is a relatively new type of psychotherapy effective for treating depression and anxiety amongst family care partners of persons living with dementia [PLWD]. However, care partner engagement in mental health services is low and specific guidelines for designing ACT programs for care partners of PLWD do not exist. The purpose of this scoping review was to examine patterns in care partner engagement in ACT programs to identify program factors potentially influencing engagement. METHODS: A comprehensive scoping review according to Arksey and O'Malley's framework was followed. Databases and grey literature were searched for primary studies of ACT programs with care partners of PLWD. Data were charted and synthesized. RESULTS: Ten studies met inclusion criteria and were analyzed. Amongst these, engagement was highest in three ACT programs that were delivered individually, remotely and were therapist-led or supported. Conversely, engagement was the lowest in two ACT programs that were self-directed, web-based and had minimal or no care partner-therapist interaction. Program factors perceived as influencing engagement included tailoring and personalization, mode of delivery and format, therapeutic support and connectedness, program duration and pace. CONCLUSION: Findings from this review suggest that care partners engagement may be promoted by designing ACT programs that focus on the therapeutic client-therapist relationship, are delivered remotely and individually. Future research should focus on evaluation of best implementation practices for engagement and effectiveness.

Bromodomain Factor 5 as a Target for Antileishmanial Drug Discovery.

Leishmaniases are a collection of neglected tropical diseases caused by kinetoplastid parasites in the genus Leishmania. Current chemotherapies are severely limited, and the need for new antileishmanials is of pressing international importance. Bromodomains are epigenetic reader domains that have shown promising therapeutic potential for cancer therapy and may also present an attractive target to treat parasitic diseases. Here, we investigate Leishmania donovani bromodomain factor 5 (LdBDF5) as a target for antileishmanial drug discovery. LdBDF5 contains a pair of bromodomains (BD5.1 and BD5.2) in an N-terminal tandem repeat. We purified recombinant bromodomains of L. donovani BDF5 and determined the structure of BD5.2 by X-ray crystallography. Using a histone peptide microarray and fluorescence polarization assay, we identified binding interactions of LdBDF5 bromodomains with acetylated peptides derived from histones H2B and H4. In orthogonal biophysical assays including thermal shift assays, fluorescence polarization, and NMR, we showed that BDF5 bromodomains bind to human bromodomain inhibitors SGC-CBP30, bromosporine, and I-BRD9; moreover, SGC-CBP30 exhibited activity against Leishmania promastigotes in cell viability assays. These findings exemplify the potential BDF5 holds as a possible drug target in Leishmania and provide a foundation for the future development of optimized antileishmanial compounds targeting this epigenetic reader protein.

Mothers' descriptions of their feeding strategies in response to fussy eating with children of different levels of trait fussiness.

Parent feeding practices influence a child's dietary intake. Many studies examining how parents react to children's fussy eating behaviours have been limited to questionnaire measures, which assess a limited number of feeding practices. There is a lack of research exploring the range of strategies parents use when their child is being fussy and/or refusing to eat. Therefore, the aims of this study are to describe the strategies used by mothers when their child is being fussy or refusing to eat, and to assess differences in the strategies depending on the child's trait fussiness levels. In 2018, 1504 mothers of children aged 2-5 years completed an online survey. Trait fussiness was assessed using the Children's Eating Behaviour Questionnaire. Mothers were also asked the open-ended question "What are the strategies you use when your child is being fussy or refusing to eat?". Inductive thematic analysis was conducted using NVivo. Themes were compared by child trait fussiness levels. Seven main themes were identified: child-led feeding/trust in child's appetite, spectrum of pressure, home or family strategies, different types of food offerings, communication, avoid certain strategies, and never or rarely fussy. Mothers of children with severe trait fussiness levels reported more pressuring or persuasive strategies. This study provides novel information regarding the diverse range of feeding practices parents use in response to children's fussy eating behaviours. Mothers used more feeding strategies typically associated with unhealthy dietary intake for children of high levels of trait fussiness. It is important that future interventions tailor the information to provide support to parents of children with high levels of trait fussiness regarding the use of feeding practices recommended to support healthy dietary intake.

Sports foods are not all they shake up to be. An audit of formulated supplementary sports food products and packaging in Australian retail environments.

Objective: To determine store availability, total number of products, and types of Formulated Supplementary Sports Foods in Australia, along with their stated nutrition content, sweeteners added, total number, and type of claims displayed on the packaging. Design: A cross-sectional, visual product audit of mainstream retailers. Setting: Supermarkets, pharmacies, health food stores, and gym/fitness centres. Results: A total of 558 products were captured in the audit, 275 of which displayed the correct mandatory packaging attributes. Three categories of products were identified, based on the dominant nutrient. Only 184 products appeared to display the correct energy value based on the listed macronutrient content (protein, fat, carbohydrate, dietary fibre). The stated nutrient content was highly variable across all product subcategories. Nineteen different sweeteners were identified, with most foods containing only one (38.2%) or two (34.9%) types. The predominant sweetener was stevia glycosides. Packages displayed multiple claims, with a maximum of 67 and minimum of 2 claims. Nutrition content claims were most frequently displayed (on 98.5% of products). Claims included regulated, minimally regulated and marketing statements. Conclusion: Sports food consumers should be provided with accurate and detailed on pack nutrition information, to ensure informed choices are made. However, this audit showed multiple products which did not conform to current standards, appeared to provide inaccurate nutrition information, contained multiple sweeteners, and displayed an overwhelming number of on-pack claims. The increase in sales, availability, and products available in mainstream retail environments, could be impacting both intended consumers (athletes), and general non-athlete population. The results indicate underperformance in manufacturing practices which preference marketing over quality and stronger regulatory approaches are needed to protect consumer health and safety, and to prevent misleading consumers.

Children's eating behaviours and related constructs: conceptual and theoretical foundations and their implications.

BACKGROUND: There is a substantial body of research on children's eating behaviours (e.g., food responsiveness and fussiness) and related constructs (e.g., eating in the absence of hunger, appetite self-regulation). This research provides a foundation for understanding children's dietary intakes and healthy eating behaviours, as well as efforts at intervention, whether in relation to food avoidance, overeating and/or trajectories to excess weight gain. The success of these efforts and their associated outcomes is dependent on the theoretical foundation and conceptual clarity of the behaviours and constructs. This, in turn contributes to the coherence and precision of the definitions and measurement of these behaviours and constructs. Limited clarity in these areas ultimately creates uncertainty around the interpretation of findings from research studies and intervention programs. At present there does not appear to be an overarching theoretical framework of children's eating behaviours and associated constructs, or for separate domains of children's eating behaviours/constructs. The main purpose of the present review was to examine the possible theoretical foundations of some of the main current questionnaire and behavioural measures of children's eating behaviours and related constructs. METHODS: We reviewed the literature on the most prominent measures of children's eating behaviours for use with children aged ~ 0-12 years. We focused on the explanations and justifications for the original design of the measures and whether these included theoretical perspectives, as well as current theoretical interpretations (and difficulties) of the behaviours and constructs. RESULTS: We found that the most commonly used measures had their foundations in relatively applied or practical concerns rather than theoretical perspectives. CONCLUSIONS: We concluded, consistent with Lumeng & Fisher (1), that although existing measures have served the field well, to advance the field as a science, and better contribute to knowledge development, increased attention should be directed to the conceptual and theoretical foundations of children's eating behaviours and related constructs. Suggestions for future directions are outlined.

Plastic pollution in riverbeds fundamentally affects natural sand transport processes.

Over the past 50 years, rivers have become increasingly important vectors for plastic pollution. Lowland riverbeds exhibit coherent morphological features including ripple and dune bedforms, which transport sediment downstream via well-understood processes, yet the impact of plastic on sediment transport mechanics is largely unknown. Here we use flume tank experiments to show that when plastic particles are introduced to sandy riverbeds, even at relatively low concentrations, novel bedform morphologies and altered processes emerge, including irregular bedform stoss erosion and dune "washout", causing topographic bedform amplitudes to decline. We detail (i) new mechanisms of plastic incorporation and transport in riverbed dunes, and (ii) how sedimentary processes are fundamentally influenced. Our laboratory flume tank experiments suggest that plastic is not a passive component of river systems but directly affects bed topography and locally increases the proportion of sand suspended in the water column, which at larger scales, has the potential to impact river ecosystems and wider landscapes. The resulting plastic distribution in the sediment is heterogeneous, highlighting the challenge of representatively sampling plastic concentrations in river sediments. Our insights are part of an ongoing suite of efforts contributing to the establishment of a new branch of process sedimentology: plastic - riverbed sand interactions.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study.

BACKGROUND: Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz. METHODS: Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz. RESULTS: There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach. CONCLUSION: This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.

Informing Infant Nutrition: Timing of Infant Formula Advice, Infant Formula Choice and Preparation in the First 6 Months of Life.

OBJECTIVE: To examine the sources and timing of advice formula feeding parents receive and how this and other factors influence the choice of formula product and formula preparation. DESIGN: Components of a cross-sectional survey. SETTING: A child and family health service in New South Wales, Australia. PARTICIPANTS: Parents (n = 153) who were fully or partially formula feeding infants aged 0-6 months and who visited the service's facilities or its social media site. VARIABLES MEASURED: Type of formula, preparation of formula, and use and sources of formula feeding advice. ANALYSIS: Descriptive statistics, Mann-Whitney U or Pearson's chi-square tests, and inductive content analysis. RESULTS: The most common source of formula feeding advice was the formula tin/packet (96.6%). Although 79.2% received advice from a health professional, only 18.9% reported receiving this advice before using formula. Approximately half (48.0%) of the parents chose a standard cow's milk-based formula. The most common reason for their choice of formula type/brand was a personal recommendation (53.0%). Parents' responses indicated that nearly half (46.3%) incorrectly prepared the formula. CONCLUSION AND IMPLICATIONS: Although health professional advice was widely received, this was rarely before starting formula. Despite the current national infant feeding regulations, parents who were not exclusively breastfeeding their infants did not always receive timely, health professional advice about formula feeding.

How to interpret spirometry in a child with suspected asthma.

Asthma is one of the most common chronic disorders of childhood. The typical symptoms are a result of reversible airway obstruction. There is no 'gold-standard' test to diagnose asthma, but the most commonly used investigation to help with a diagnosis is spirometry. This article outlines some of the technical aspects of spirometry together with how the forced expiration manoeuver and bronchodilator responsiveness testing can be performed and interpreted in a child with suspected asthma.

Barriers to Providing Smoking Cessation Intervention by Nursing Students: What is the Solution in Nursing Education?

AIM: This study aimed to explore the barriers that hinder nursing students from providing comprehensive smoking cessation interventions for their clients. METHOD: A mixed method study combining a self-administered questionnaire and one open-ended question were used to collect data from 152 nursing students at the university in Canada. Data were analyzed using descriptive statistics and thematic analysis. The Health Belief Model was the theoretical underpinning for this study. RESULTS: Participants showed positive attitudes toward smoking cessation interventions as being a part of their future work. However, students faced many barriers that hindered them from providing smoking cessation interventions to their clients. The participants identified the following seven themes/barriers: the lack of knowledge, training, resources, and time; the willingness of patients to quit; lack of students' self-confidence; students' level of comfort; smoking cessation being covered by other members of the health care team; patients already being knowledgeable about smoking cessation; and protecting therapeutic relationships with patients. CONCLUSION: There is a need for empowering nursing students and enhancing their self-confidence in smoking cessation interventions by incorporating theory-based educational materials and strategies regarding smoking cessation interventions in their curricula.