Starting from scratch: Developing and sustaining a rural research team lessons from a nutrition and dietetics case study.

OBJECTIVE: To describe the development of and key factors for sustaining a rural-based research team focussed on nutrition and dietetics. DESIGN: A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub-units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. SETTING: University of Newcastle Department of Rural Health across 4 rural sites. PARTICIPANTS: Publicly available data sources from existing team members. MAIN OUTCOME MEASURES: Staffing levels, research supervision, internal and external grant outcomes and peer-reviewed journal publications. RESULT: Academic staffing has increased by 4 full-time equivalent positions over 18 years, with 6 current higher-degree research students. Key factors identified in the development of a discipline-specific research workforce included staff higher degree by research completions, longevity of staff in research-active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. CONCLUSION: Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand.

Patient Perspectives of Living with Coeliac Disease and Accessing Dietetic Services in Rural Australia: A Qualitative Study.

Adapting to living with coeliac disease requires individuals to learn about and follow a strict gluten-free diet. Utilising a qualitative inductive approach, this study aimed to explore the perspectives of adults diagnosed with coeliac disease who have accessed dietetic services in a rural outpatient setting. A purposive sample of adults with coeliac disease who had accessed dietetic services from two rural dietetic outpatient clinics were recruited. Semi-structured interviews were conducted by telephone. Data were thematically analysed. Six participants were recruited and interviewed. Three key themes emerged: (i) optimising individualised support and services, (ii) adapting to a gluten-free diet in a rural context, and (iii) managing a gluten-free diet within the context of interpersonal relationships. Key issues identified in the rural context were access to specialist services and the increased cost of gluten-free food in more remote areas. The findings of this study have highlighted the difficulties associated with coeliac disease management and how dietetic consultation has the potential to influence confidence in management and improve lifestyle outcomes. Further qualitative research is required to expand on the findings of this study and inform future dietetic practice that meets the expectations and individual needs of people with coeliac disease in rural settings.

Exploring core food accessibility in Tamworth, NSW, Australia.

INTRODUCTION: A lack of core food accessibility negatively affects diet quality, potentially increasing the prevalence of health risk factors such as obesity. The purpose of this study was to investigate core food access in an Australian regional center through the use of data visualization techniques. METHODS: Supermarkets were used as a proxy for core food accessibility and were identified and mapped by town region with a combination of Google Maps and Stata/IC 15.1 software. A statistical analysis comparing the demographics of each town region was also completed using Stata. RESULTS: The maps generated suggest that there may be a disparity in core food accessibility between town regions. The analysis of demographics demonstrated that one town region had a greater proportion of disadvantaged residents, with statistically significant variation between regions. CONCLUSION: Data visualization and analysis may be a useful tool for clinicians to communicate accessibility information experienced by local residents. This need not be limited to food accessibility and extended to health services.

Vitamin and Mineral Supplementation Practices in Preterm Infants: A Survey of Australian and New Zealand Neonatal Intensive and Special Care Units.

Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementations. The aim of this survey was to investigate current vitamin and mineral supplementation practices and compare these with published recommendations and available evidence on dosages and long-term outcomes of supplementations in preterm infants. In 2018, a two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network (ANDiN) member and nonmember dietitians working in neonatal units in Australia and New Zealand. For inpatients, all units prescribed between 400 and 500 IU/day vitamin D, compared to a recommended intake range of 400-1000 IU/day. Two units prescribed 900-1000 IU/day at discharge. For iron, 83% of respondents prescribed within the recommended intake range of 2-3 mg/kg/day for inpatients. Up to 10% of units prescribed 6 mg/kg/day for inpatients and at discharge. More than one-third of units reported routine supplementations of other micronutrients, including calcium, phosphate, vitamin E, and folic acid. There was significant variation between neonatal units in vitamin and mineral supplementation practices, which may contribute to certain micronutrient intakes above or below recommended ranges for gestational ages or birth weights. The variations in practice are in part due to differences in recommended vitamin and mineral intakes between expert groups and a lack of evidence supporting the recommendations for supplementations.

Developing and maintaining collaborative practice: Exploring perspectives from dietetics and speech pathology about 'what works well'.

AIM: The aim was to support rich collaborative practice between two professions who frequently work together across both ordered and organic modes of collaboration. METHODS: This study uses a qualitative research approach of collaborative dialogical inquiry to explore the question 'From the perspective of dietitians and speech pathologists, "what works well" for developing and maintaining collaborative practice?' We deliberately chose a context where collaborative practice is evident, University Department of Rural Health (UONDRH). Participants in the research were academics and clinicians from dietetics and speech pathology. Data were sourced from our research reflections and focus group transcriptions. Analysis was dialogical and iterative. RESULTS: Beyond shared purpose, knowledge of roles and good communication, the notions of curiosity, willingness and momentum were at the core of 'what works well' for collaborative practice between dietitians and speech pathologists. Participant perspectives related to collaborative practice between these professions and beyond to other professions, and involved collaborative practice within and across healthcare organisations and a university setting. CONCLUSIONS: Our interpreted themes of curiosity, willingness and momentum for developing and maintaining collaborative practice highlight the importance of paying attention to the less visible and difficult to measure aspects of patient-centred care. Questions for reflection are suggested to inform the ongoing process of developing and maintaining our and others' collaborative practice.

An innovative dietetic student placement model in rural new South wales, australia.

Over the past 10 years, the University of Newcastle Department of Rural Health, based in Tamworth, New South Wales, has supported increased opportunities for short- and long-term rural dietetic placements through an ongoing collaboration between Hunter New England Local Health District dietitians and University of Newcastle academic staff, using an innovative student placement model. A recent strategy has been the implementation of year-long student attachments to a rural area in an attempt to improve long-term recruitment and retention of staff to rural and remote areas. This paper describes the dietetic student placement model and outcomes to date. There has been an increase in the number and diversity of student placements in Tamworth, from 2 student placements in 2002 to 33 in 2013 and a maximum increase of 317 student weeks. Students have rated the short- and long-term options highly. Intention to work rurally after graduation was reported at 49% for the 2011/2012 cohort of students. Seventy-three percent of all year-long students have obtained work in a rural setting after graduation. An increased exposure to a rural location has the potential to increase the recruitment of staff in rural areas.

Does milk cause constipation? A crossover dietary trial.

The aims of this study were to: (1) determine whether replacement of cow's milk protein with soy resolves Chronic Functional Constipation (CFC); and (2) investigate the effects of cow's milk ß casein A1 and cow's milk ß casein A2 on CFC. Children diagnosed with CFC were recruited to one of two crossover trials: Trial 1 compared the effects of cow's milk and soy milk; Trial 2 compared the effects of cow's milk ß casein A1 and cow's milk ß casein A2. Resolution of constipation was defined as greater than eight bowel motions during a two week intervention. Thirteen children (18 to 144 months) participated in Trial 1 (6 boys, 7 girls). Nine participants who completed the soy epoch all experienced resolution (p < 0.05). Thirty-nine children (21 to 144 months) participated in Trial 2 (25 boys, 14 girls). Resolution of constipation was highest during the washout epoch, 81%; followed by cow's milk ß casein A2, 79%; and cow's milk ß casein A1, 57%; however, the proportions did not differ statistically. The results of Trial 1 demonstrate an association between CFC and cow's milk consumption but Trial 2 failed to show an effect from type of casein. Some other component in cow's milk common to both A1 and A2 milk may be causing a problem in these susceptible children.