Dr Susan Heaney

Background: Preoperative immunonutrition has been proposed to reduce the duration of hospital stay and infective complications following major elective surgery in patients with gastrointestinal malignancy. A multicentre 2 × 2 factorial RCT was conducted to determine the impact of preoperative and postoperative immunonutrition versus standard nutrition in patients with oesophageal cancer. Methods: Patients were randomized before oesophagectomy to immunonutrition (IMPACT®) versus standard isocaloric/isonitrogenous nutrition, then further randomized after operation to immunonutrition versus standard nutrition. Clinical and quality-of-life outcomes were assessed at 14 and 42 days after operation on an intention-to-treat basis. The primary outcome was the occurrence of infective complications. Secondary outcomes were other complications, duration of hospital stay, mortality, nutritional and quality-of-life outcomes (EuroQol EQ-5D-3 L¿, European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-OES18). Patients and investigators were blinded until the completion of data analysis. Results: Some 278 patients from 11 Australian sites were randomized; two were excluded and data from 276 were analysed. The incidence of infective complications was similar for all groups (37 per cent in perioperative standard nutrition group, 51 per cent in perioperative immunonutrition group, 34 per cent in preoperative immunonutrition group and 40 per cent in postoperative immunonutrition group; P = 0·187). There were no significant differences in any other clinical or quality-of-life outcomes. Conclusion: Use of immunonutrition before and/or after surgery provided no benefit over standard nutrition in patients undergoing oesophagectomy. Registration number: ACTRN12611000178943 (https://www.anzctr.org.au).

The aim of the present study was to investigate and benchmark the level of general nutrition knowledge in elite Australian athletes (EA) against a similar aged community (CM) and criterion sample with dietetic training (DT). EA (n 175), CM (n 116) and DT (n 53) completed the General Nutrition Knowledge Questionnaire (GNKQ), which assesses four domains (sections A-D) of general nutrition knowledge (section A: dietary guidelines; section B: sources of nutrients; section C: choosing everyday foods; section D: diet-disease relationships). Age, sex and education level were collected in all groups, and athletic calibre and sport type (team or individual) in EA. Dietitians and nutrition scientists (n 53) re-examined the GNKQ for content validity, resulting in instrument revision (R-GNKQ; ninety-six items). Psychometric assessment (internal consistency: Cronbach-a; test-retest: Spearman rank correlation) was performed in a sub-sample (n 28). Independent t tests, ANOVA and ANCOVA (¿ 2 for categorical variables) were used to assess between-group differences. DT scored higher than EA and CM in all sub-sections and overall (P < 0¿005). EA scored lower than CM in GNKQ for section B (P < 0¿005) and overall (P < 0¿005), and in R-GNKQ for section B (P < 0¿005), section C (P < 0¿005), section D (P = 0¿006) and overall (P < 0¿005). Overall score was influenced by age (P = 0¿036 for GNKQ: P = 0¿053 for R-GNKQ), sex (P = 0¿016 for GNKQ: P = 0¿003 for R-GNKQ) and athletic calibre (P = 0¿029 for R-GNKQ only), but not level of education, living situation or ethnicity. EA and CM performed best on section A and worst on D. EA had lower overall general knowledge scores than CM. This was significantly influenced by age and sex. © 2011 The Authors.

Context: Nutrition education aims to enhance knowledge and improve dietary intake in athletes. Understanding athletes' nutrition knowledge and its influence on dietary intake will inform nutrition-education programs in this population. Purpose: To systematically review the level of nutrition knowledge in athletes, benchmark this against nonathlete comparison groups, and determine the impact of nutrition knowledge on dietary intake. Methods: An extensive literature search from the earliest record to March 2010 using the terms nutrition knowledge or diet knowledge and athlete or sport was conducted. Included studies recruited able or physically disabled, male or female, competitive (recreational or elite) athletes over the age of 13 yr. Quantitative assessment of knowledge and, if available, diet intake was required. Because of variability in the assessment of nutrition knowledge and dietary intake, meta-analysis was not conducted. Results: Twenty-nine studies (17 published before 2000) measuring nutrition knowledge (7 including a nonathlete comparison group) met inclusion criteria. Athletes' knowledge was equal to or better than that of nonathletes but lower than comparison groups including nutrition students. When found statistically significant, knowledge was greater in females than males. A weak (r < .44), positive association between knowledge and dietary intake was reported in 5 of 9 studies assessing this. Common flaws in articles included inadequate statistical reporting, instrument validation, and benchmarking. Conclusion: The nutrition knowledge of athletes and its impact on their dietary intake is equivocal. There is a need for high-quality, contemporary research using validated tools to measure nutrition knowledge and its impact on dietary intake. © 2011 Human Kinetics, Inc.

Purpose: This study aimed to compare strategies for assessing nutritional adequacy in the dietary intake of elite female athletes. Methods: Dietary intake was assessed using an adapted food-frequency questionnaire in 72 elite female athletes from a variety of sports. Nutritional adequacy was evaluated and compared using mean intake; the proportion of participants with intakes below Australian nutrient reference values (NRV), U.S. military dietary reference intakes (MDRI), and current sports nutrition recommendations; and probability estimates of nutrient inadequacy. Results: Mean energy intake was 10,551 ± 3,836 kJ/day with macronutrient distribution 18% protein, 31% fat, and 46% carbohydrate, consistent with Australian acceptable macronutrient distribution ranges. Mean protein intake (1.6 g·kg -1·d-1) was consistent with (>1.2 g·kg-1·d-1), and carbohydrate intake (4.5 g·kg-1·d-1), below, current sports nutrition recommendations (>5 g·kg-1·d-1), with 30% and 65% of individuals not meeting these levels, respectively. Mean micronutrient intake met the relevant NRV and MDRI except for vitamin D and folate. A proportion of participants failed to meet the estimated average requirement for folate (48%), calcium (24%), magnesium (19%), and iron (4%). Probability estimates of inadequacy identified intake of folate (44%), calcium (22%), iron (19%), and magnesium (15%) as inadequate. Conclusion: Interpretation of dietary adequacy is complex and varies depending on whether the mean, proportion of participants below the relevant NRV, or statistical probability estimate of inadequacy is used. Further research on methods to determine dietary adequacy in athlete populations is required. © 2010 Human Kinetics, Inc.

Background: Workplace violence in general practice has been found to be an important problem in the United Kingdom. No research has been undertaken in this area in Australian urban practice. Method: Four focus groups involved 18 urban general practitioners and over 9 hours of taped responses were transcribed. The transcripts were coded and subjected to thematic analysis. Results: General practitioners expressed a wide range of risks relating to the provision of after hours care. This makes them apprehensive about participating in it. Those who had experienced violence, or perceived its risk, had limited their participation in after hours care; sometimes completely. Discussion: Structures may be needed to support provision of after hours general practice services.

BACKGROUND: Primary care research needs strengthening. The Commonwealth Government Department of Health and Aged Care has recently funded the university departments of general practice and rural health to build research capacity in primary care. OBJECTIVE: To explore issues surrounding building primary care research capacity, as well as looking at barriers to research capacity building and ways of overcoming them. DISCUSSION: New funding provides many opportunities for increasing research capacity in primary health care areas. Different institutions will select those methods that are best suited to their skills and the requirements of their area.