Sustainable food systems and diets in dietetic training standards: an international content analysis.

BACKGROUND: Low professional confidence and perceived competence create tangible barriers to integrating sustainable food systems (SFS) and diets into dietetic practice. One opportunity to facilitate more systemic integration into dietetic education and training is to include these concepts in professional standards. To better understand the barrier of low professional confidence and perceived competence for engagement with SFS-related practice, the purpose of this research was to investigate dietetic training standards for SFS content and to highlight opportunities for growth within the profession. Questions posed by this research are: (1) how, if at all, are SFS and diets articulated in dietetic training standards, and (2) to what level of cognitive complexity? METHODS: A content analysis of dietetic training standards documents was conducted between 15 April and 15 September 2021. Search terms included 'sustain*' or 'sustainable', 'food systems' and/or 'diets'. Extracted data with applicable SFS content were analysed for level of cognitive complexity requirements. RESULTS: Of 47 National Dietetics Associations, researchers obtained 23 dietetic training standards documents, of which 16 included SFS-related content. The majority of documents used broad descriptors of the concepts, with little granularity and at a lower level of cognitive complexity. CONCLUSIONS: Adoption of more robust frameworks for sustainability with specific learning outcomes that can be adapted to regional contexts would strengthen higher education curricula and thus the profession's ability to contribute more meaningfully to SFSs and diets.

Comparison of 3D printed and molded carrots produced with gelatin, guar gum and xanthan gum.

This study examined the effects of different hydrocolloids (guar gum, xanthan gum and gelatin) on the sensory and textural properties of pureed carrots. There were eight products involved in the study; 3D printed carrots and molded carrots without the addition of gums and with guar gum, xanthan gum and gelatin. All products were evaluated using trained panelists (n = 12) and underwent a texture profile analysis. No significant differences were found between the molded and 3D printed pureed carrots; instead, the samples were grouped based on the gum used in their production. The samples made with gelatin and xanthan gum were the hardest (texture profile analysis) and the densest samples when evaluated by the trained panelists. The 3D printing did not affect the taste properties of the pureed carrots, as they were evaluated to be similar to that of the molded carrots (p > .05). This study demonstrated that 3D printing did not affect the textural and sensory properties of pureed carrots when compared to molded carrots. However, changes in the printing parameters (infill percentage, nozzle diameter, flow rate, nozzle height) need to be evaluated to determine their effect on the sensory properties of 3D printed pureed carrots.

Adolescent SBIRT Practices Among Pediatricians in Massachusetts.

OBJECTIVES: Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care is a key strategy to prevent, identify, and respond to substance use problems and disorders, including opioid and other drug addictions. Despite substantial investment in recent years to increase its implementation, few studies have reported on recent levels of SBIRT implementation among pediatricians. We aimed to assess self-reported use of the SBIRT framework with adolescent patients among Massachusetts pediatricians, and describe trends since an earlier survey. METHODS: We analyzed responses to a cross-sectional survey mailed in 2017 to a representative sample of pediatricians in Massachusetts. We computed response frequencies for all SBIRT practice questions. We used the chi-square test to compare current data to data collected in 2014, as we found no demographic differences between the 2 samples. RESULTS: Nearly all pediatricians in the 2017 sample (n = 160) reported annual screening of their adolescent patients (99%). The majority reported giving positive reinforcement (87%), brief advice (92%), counseling (90%), and referral to treatment (66%) in response to screen results. Compared with 2014, a significantly higher proportion of pediatricians in 2017 referred patients who screened positively for problematic alcohol use, but perceived barriers to screening and follow-up remain, such as insufficient time to screen and patient refusal to return. CONCLUSIONS: Among respondents to a Massachusetts pediatrician survey, we found high rates of delivering SBIRT in accordance with published guidelines, though barriers remain. Whether the content of the counseling adheres to guidelines is unknown.

Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians.

OBJECTIVES: Substance use screening is a recommended component of routine healthcare for adolescents. A 2008 survey of Massachusetts primary care physicians found high rates of screening, but low rates of validated tool use, leading to the concern that physicians may be missing substance use-related problems and disorders. In an effort to improve practice, a cross-disciplinary group developed and distributed an adolescent screening, brief intervention, and referral to treatment toolkit in 2009. A new survey of Massachusetts primary care physicians was conducted in 2014; this report describes its findings, and compares them to those from 2008. METHODS: A survey was mailed to a randomly selected sample of Massachusetts primary care physicians listed in the state Board of Registration in Medicine database. Item response frequencies were computed. Multiple logistic regression modeling was used to compare 2008 and 2014 responses, while controlling for any demographic differences between samples. RESULTS: Pediatrician respondents in 2014 (analysis N = 130) reported a high rate of annually screening patients for alcohol use (96.2%), but only 56.2% reported using a validated screening tool. Rates of screening and validated tool use were higher in 2014 than 2008. Insufficient knowledge as a reported barrier to screening decreased from 2008 to 2014. However, lack of time or staff resources remained key perceived barriers to screening. CONCLUSIONS: Our findings suggest that adolescent alcohol use screening practices among Massachusetts pediatricians have improved in recent years, during a time of national and statewide efforts to educate physicians. However, opportunities for practice improvement remain.

Clarifying the role of the mental health peer specialist in Massachusetts, USA: insights from peer specialists, supervisors and clients.

Mental health peer specialists develop peer-to-peer relationships of trust with clients to improve their health and well-being, functioning in ways similar to community health workers. Although the number of peer specialists in use has been increasing, their role in care teams is less defined than that of the community health worker. This qualitative study explored how the peer specialist role is defined across different stakeholder groups, the expectations for this role and how the peer specialist is utilised and integrated across different types of mental health services. Data were collected through interviews and focus groups conducted in Massachusetts with peer specialists (N = 44), their supervisors (N = 14) and clients (N = 10) between September 2009 and January 2011. A consensus coding approach was used and all data outputs were reviewed by the entire team to identify themes. Peer specialists reported that their most important role is to develop relationships with clients and that having lived mental health experience is a key element in creating that bond. They also indicated that educating staff about the recovery model and peer role is another important function. However, they often felt a lack of clarity about their role within their organisation and care team. Supervisors valued the unique experience that peer specialists bring to an organisation. However, without a defined set of expectations for this role, they struggled with training, guiding and evaluating their peer specialist staff. Clients reported that the shared lived experience is important for the relationship and that working with a peer specialist has improved their mental health. With increasing support for person-centred integrated healthcare delivery models, the demand for mental health peer specialist services will probably increase. Therefore, clearer role definition, as well as workforce development focused on team orientation, is necessary for peer specialists to be fully integrated and supported in care teams.