BACKGROUND:Overweight and obesity in pregnancy are associated with health risks for women and babies. Providing effective weight management during pregnancy is necessary to support appropriate gestational weight gain and improve outcomes for women and their infants. This study aimed to synthesise evidence documenting healthcare-related barriers and enablers for weight management among pregnant women with overweight or obesity in English-speaking high-income countries. METHODS:An initial rapid scoping review focusing on the healthcare-related barriers and enablers for weight management in all populations with overweight or obesity was undertaken. Due to the unique weight management needs of pregnant women, this study analysed a sub-set of publications collected in the initial review pertaining to pregnant women. All publication types (except protocols and conference abstracts) were eligible for inclusion. The search was limited to publications from 2010 onwards. Academic and grey literature were identified, screened, and data extracted. Findings were summarised thematically. RESULTS:The initial review search, including all populations, identified 12,762 unique abstracts, and 181 full-text articles. Of these, 22 focused on pregnant women living with overweight or obesity. A further four articles were identified via citation searches of the included articles. The identified barriers and enablers for pregnancy weight management in healthcare settings fell under three broad themes: (1) access to, and engagement with, weight management advice during pregnancy (2), challenges for providing weight management support in healthcare settings, and (3) healthcare provider confidence in providing weight management advice during pregnancy. CONCLUSION:Pregnant women with overweight or obesity are not receiving adequate weight management guidance. Multi-level strategies are needed to ensure pregnant women have access to weight management care that is stigma-free, easily accessible, tailored to their individual needs and fosters positive relationships with healthcare providers.

A scoping review was conducted to identify barriers and enablers to effective weight management in healthcare settings for people living with overweight and obesity in English-speaking high-income countries. Peer-reviewed and gray literature were systematically searched in June 2024. Data were analyzed using inductive thematic analysis. Of the 15,684 unique articles identified and screened for relevance, 216 studies were included. Healthcare-related barriers and enablers to weight management were organized under three themes: a) healthcare provider-related factors, b) provision of care, and c) policy/funding. Prominent barriers included healthcare provider knowledge deficits and low prioritization of obesity management, mainly in the primary care setting. Weight management beyond the primary care setting was found to be especially challenging, with poor referral pathways, service fragmentation, lack of multidisciplinary practice, and restricted eligibility criteria, hindering the accessibility of services. Developing consistent policies and guidelines, improving the education of healthcare providers, and increasing funding to provide low-cost comprehensive care, were identified as enablers to access and uptake of weight management services. Considerable overlap in the identified barriers existed across healthcare providers and settings. A whole health system approach to minimize barriers and strengthen enablers to weight management services is needed, to address rising obesity rates.

General mental health inpatient units hold a valuable place in the stepped system of care, and for identification and treatment of people with eating disorders (EDs) or disordered eating behaviours (DEBs). This study aimed to pragmatically evaluate an evidence-informed screening and care pathway, alongside a staff education program, implemented to improve identification and treatment access for consumers with EDs and DEBs, with co-occurring psychiatric conditions, on a general mental health ward. A mixed methodology design was mapped to the RE-AIM implementation framework. It encompassed medical record audits across two 3-month time points pre and post implementation of the pathway, and key informant consumer and health professional interviews. Process and implementation data were compared for three-month periods pre (2019, n = 348) and post-implementation (2021, n = 284). Post-implementation, intake SCOFF screening occurred in 94.7

AIMS:In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues. METHODS:Two engagement events, in 2023, brought together experienced and mid- and early-career nutrition professionals for co-creation of implementation logic models. RESULTS:One hundred and nine early and mid-career professionals were involved. A revised model for the decadal plan pillars emerged from synthesis of all logic models. This new model integrated the precision and personalised nutrition pillar with nutrition mechanisms pillar. These combined pillars build towards the national data capability enabling platform and created new cross-cutting themes for education and training. The need arose for greater focus on respectful engagement with Aboriginal and Torres Strait Islander communities and sustained effort to build cross-disciplinary collaboration to realise the plan's societal determinants goals. A new alliance for nutrition science is proposed to become a unified advocacy voice and build trust in nutrition professionals. CONCLUSIONS:A programmatic approach provides a road map for implementing the decadal plan for the final 5 years.

Background: Postnatal depression (PND) is a leading cause of illness and death among women following child-birth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum.Methods: This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score >= 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equip-ment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys.Discussion: If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms. Trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p

Problem: Despite mandated Rapid-Response Systems (RRS), hospitals continue to see delays in escalation of care. There is a paucity of research regarding nurses' perceptions of the reasons for care escalation delays in the private hospital setting in which there is a different model of care and hierarchy of the medical system. It is important to understand how these elements may influence the approach to escalating care.Aim: To explore nurses' perspectives and experiences of clinical deterioration and the factors impacting on timely escalation of care in a private, non-profit hospital.Method: Twenty-three bedside and leadership nurses were purposively recruited. Qualitative descriptive methodology employed interviews and focus groups to explore knowledge of, and belief in RRS criteria and process, individual confidence, perceived barriers, and RRS education. Data were analysed thematically. Findings: Three major themes were elicited. First, hierarchy and a culture of indecisiveness. Second, gatekeeping and protocol adherence impacting on timely escalation. Third, the importance of confidence in the nurse role to escalate care. Communication barriers and inconsistent leadership were common threads across all themes. Discussion: RRS have been shown to be effective, however, if escalation criteria are implemented inconsistently, individual's prior experience can impact interdisciplinary communication, RRS processes and patient outcomes.Conclusion: The effectiveness of RRS is dependent on a supportive workplace culture, good communication, and consistent leadership. Further research is required to understand the optimal mechanisms for implementing RRS processes in private, non-profit hospitals.(c) 2023 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Abstract Olive oil (OO) polyphenols have been shown to improve HDL anti-atherogenic function, thus demonstrating beneficial effects against cardiovascular risk factors. The aim of the present study was to investigate the effect of extra virgin high polyphenol olive oil (HPOO) v. low polyphenol olive oil (LPOO) on the capacity of HDL to promote cholesterol efflux in healthy adults. In a double-blind, randomised cross-over trial, fifty participants (aged 38·5 (sd 13·9) years, 66 % females) were supplemented with a daily dose (60 ml) of HPOO (320 mg/kg polyphenols) or LPOO (86 mg/kg polyphenols) for 3 weeks. Following a 2-week washout period, participants crossed over to the alternate treatment. Serum HDL-cholesterol efflux capacity, circulating lipids (i.e. total cholesterol, TAG, HDL, LDL) and anthropometrics were measured at baseline and follow-up. No significant between-group differences were observed. Furthermore, no significant changes in HDL-cholesterol efflux were found within either the LPOO and HPOO treatment arms; mean changes were 0·54 % (95 % CI (0·29, 1·37)) and 0·10 % (95 % CI (0·74, 0·94)), respectively. Serum HDL increased significantly after LPOO and HPOO intake by 0·13 mmol/l (95 % CI (0·04, 0·22)) and 0·10 mmol/l (95 % CI (0·02, 0·19)), respectively. A small but significant increase in LDL of 0·14 mmol/l (95 % CI (0·001, 0·28)) was observed following the HPOO intervention. Our results suggest that additional research is warranted to further understand the effect of OO with different phenolic content on mechanisms of cholesterol efflux via different pathways in multi-ethnic populations with diverse diets.

Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women's expectations and goals; (2) the need for flexible, multimodal healthcare; and (3) information sharing throughout antenatal care not meeting women's information needs. Interventions to improve women's engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their individual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.

AIM Optimising preconception health increases the likelihood of conception, positively influences short- and long-term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. METHODS We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi-experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face-to-face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. RESULTS Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre-post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web-based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. CONCLUSION More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies.

txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m2, between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans.

ISSUE ADDRESSED:Retention of weight gained during pregnancy contributes to overweight and obesity and consequent chronic disease risk. Early programs have been successful in improving diet quality, physical activity levels and reducing postnatal weight retention. However, barriers to program engagement remain. This study aimed to investigate women's healthy eating, physical activity and weight experiences and explore their views regarding digital health interventions to assist meeting their lifestyle goals. METHODS:This qualitative descriptive study utilised semi-structured interviews with women who had recently become mothers who had gestational diabetes or a body mass index above 25 kg/m2 . Themes were then identified through thematic analysis of interview transcripts. RESULTS:Nine women were interviewed (average age 33.4 ± 4.2 years). The two distinct areas of questioning resulted in two overarching topics: (i) Enablers and barriers to maintaining regular physical activity and a healthy dietary pattern; and (ii) characteristics of a postpartum program to enable meeting of diet, physical activity and weight loss goals. These topics each had their own descriptive themes and sub-themes. CONCLUSIONS:Understanding women's needs and viewpoints for a postnatal diet, physical activity and weight program allows researchers to design a program to maximise engagement and outcomes. SO WHAT?: Any further postnatal program must leverage off existing infrastructure, integrate learnings from published formative work and harnesses the impact of digital delivery. This will improve program accessibility and provide ongoing contact for sustained behaviour change through text messaging and providing digital resources in a dynamic format women can engage with in their own time.

'What is your intervention?' 'It is an app.' 'That is your delivery mechanism. What is your intervention or behaviour target?' 'It is an app!!!' (Conversation with a health researcher colleague, 2022) The advent of digital 'solutions' to help people improve their health have been vaunted since the 1990s when we, as health professionals, were told that websites would make our jobs redundant. Fortunately for our careers, this did not come to pass, but it demonstrated that we cannot change people's complex health behaviours simply through digitally delivered words, videos or pictures. Fast forward to the 2020s and an exciting array of technologies offer potential for us to reach people beyond traditional healthcare models to encourage positive health behaviours or optimize health system function.1 On the contrary, some health promoters, program designers and health consumers may make an implicit assumption that the technology itself is the intervention rather than the delivery mechanism. Too often, the focus of research is then on the digital delivery modality driving the intervention, often neglecting the complex nature of the behaviour change on which it should be designed to focus.2 Many of us are familiar with the foundation of implementation science for health service improvement requiring assessment of influencing factors and design of interventions needing to be systematic and theory-driven.3 This approach is the antithesis to adopting a practice or procedure seen to be effective in another setting or site or doing it because it 'feels right' or you 'think it will work'. Guiding this methodology are the four steps outlined by French et al.4 The first step is to systematically investigate who needs to do what differently? This process allows you to determine current practice through identifying what needs to change, who is involved, and which interests are relevant. The second step is to use a theoretical framework to identify barriers and enablers, then to identify and apply evidence-based interventions to overcome barriers and enhance enablers. The final step is to measure and understand the change you have planned. This approach aligns with design thinking for the development of digital interventions. Person-centred design processes, such as design thinking,5 are viewed as critical for the development of effective and innovative health-related systems or interventions, particularly those digitally delivered.6 The steps include empathizing with end user; defining the user needs and behaviours to be targeted; ideating around the behaviours to be targeted by challenging assumptions and creating ideas; prototyping scaled-down versions of potential solutions or products; and testing to derive an understanding of the product and its users. These steps may not be linear and may occur in parallel in a circular fashion. Consistent with theories, models and frameworks from implementation science,7 health promotion, innovation, social marketing and digital program development, person-centred design reframes the problem in human-centric ways identified. By understanding the person and behavioural context, it allows potential solutions to be mapped to the target behaviours and determinants (barriers and enablers), underpinned by behavioural theoretical frameworks (e.g.4,8–10). These steps are crucial to then anchor the discrete functionality of the digital technology to achieve the objectives and fit with the end user culture and context.11 This step is sometimes eliminated by digital health interventions, missing the opportunity to understand where interventions may best utilize technology, or other delivery mechanisms, directly related to the behaviour on which it should be targeted. Understanding digital technology as a delivery mechanism with unique opportunities to facilitate access, decisions, cognition and motivation is critical in optimizing interventions.1 Also critical is developing the intervention content to align with the behaviour change and digital functionality being delivered. In digital-led interventions, the content or messaging may sometimes be neglected. Beethoven's Ninth Symphony played on a record player is the same piece of music on a streaming service (apologies to all musicologists; for illustrative purposes only) but the streaming service offers the listener convenient engagement across time and place, access to other music, sharing opportunities with friends, ability to custom engagement, no need for physical storage and syncing music across devices. When recommending the music to a friend, to whom we think it will appeal, we recommend the Symphony via the streaming and not the streaming service alone. Interventions developers write the music, as well as tailor the delivery for the platform, and not solely focus on the platform alone. If the music engages the end user, it can be enhanced and adapted for different platforms as the technology delivery evolves. In doing so though we must evolve from a traditional healthcare paradigm where the technology directly replaces a printed resource, such as using an information-only website or 'app' with text taken directly from a pamphlet. Content development and health or service messaging requires content development tailored for the digital platform as well as the targeted behaviour. Partnering with the end users, or those that receive benefit, is also critical in the evolution of this process. Failing to collaborate and codesign with end users and being slow to innovate technology reduces the opportunity to create collective agency and unite people in system thinking committed to improvement. In one example, the hacking of insulin pumps and continuous blood glucose monitors by people in the type 1 diabetes community, who develop and share open-source code, in response to the lack of personalization and slow technological innovation.12 Collaborating with those that receive benefit could evolve the technological intervention to be of higher value, more likely to meet their needs or 'what matters to them' and provide safe access for evidence-based care to the wider population. Further, working with end users to capture data about their targeted behaviours and determinants and how they interact with technology, provides opportunities to identify segments or phenotypes within a population with specific patterns of behaviours.13 This will enable developers to personalize and tailor interventions to maximize effectiveness rather than develop for a broad cross-section of the population. The COVID-19 pandemic has enforced digital healthcare delivery with rapid increase in digitally mediated consultations and rapid evolution of technology in healthcare. This has provided previously inaccessible opportunities for healthcare organizations and the community.14 There is still much to be learned about marrying behaviour theory, implementation science and digital models as well as access, equity and the digital divide plus the time and financial opportunities or costs to organizations, clinicians and communities. Rather than just adopting a digital practice or procedure seen to be effective in another setting or site (also known as the 'When you have a hammer, everything looks like a nail' approach) it is crucial for implementation practitioners that user-centred evidence-based interventions aided by technology are constructed rather than leading with the technology and crafting an intervention to suit. We need to scaffold digitally mediated interventions so that we do not go the way of those 1990s start-up tech companies who failed to deliver, lacking an understanding of behaviour theory and business models. Acknowledgements Conflicts of interest The authors report there are no conflicts of interest.

Background: Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals’ views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education. Methods: A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists ( n = 10), midwives ( n = 9) and obstetricians ( n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis. Results: The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals’ nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education. Conclusions: Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.

There is a clear impetus for researchers to facilitate cross‐sector and interdisciplinary collaboration to achieve collective action for maternal obesity prevention. Building early‐ and mid‐career researchers’ capacity to sustainably develop collective action into the future is key. Therefore, the national Health in Preconception, Pregnancy, and Postpartum Early‐ and Mid‐career Researcher Collective (HiPPP EMR‐C) was formed. Here, we describe the aim, key goals and future directions of the HiPPP EMR‐C. Guided by the Simplified Framework for Understanding Collective Action, we aim to build our capacity as researchers, form policy stakeholder relationships and focus on generating impact to optimise maternal and child health and well‐being.

OBJECTIVE:Adequate and appropriate nutrition education is expected to contribute towards preventing risk of child stunting and maternal overweight/obesity. Understanding women's information-seeking behaviours is an important key step for health professionals and departments of health in order to improve the development of optimal and targeted nutrition education during pregnancy. This study investigated the experience of Indonesian women in seeking and receiving nutritional information during pregnancy and its relationship to women's socio-demographic and pregnancy characteristics. DESIGN:An online cross-sectional study. SETTING:Malang City, Indonesia. PARTICIPANTS:Women who had given birth within the past 2 years (n 335). RESULTS:All women in this study sought or received food and nutrition information from multiple sources, including social and health professional contacts and media sources. The women frequently discussed nutrition issues with their family, particularly their husband (98·2 %) and mother or mother-in-law (91·6 %). This study identified four groups of sources based on women's search habits. Women from high socio-economic strata were more likely to discuss food and nutrition issues or received nutrition information from obstetricians, their family or online sources (adjusted R2 = 26·3 %). Women from low socio-economic strata were more likely to receive nutrition information from midwives, health volunteers or Maternal and Child Health books (adjusted R2 = 14·5 %). CONCLUSIONS:A variety of nutrition information sources needs to be provided for women from different socio-economic strata. Involvement of family members in antenatal nutrition education may improve the communication and effectiveness of young mothers' dietary and nutrition education.

Spontaneous preterm birth is the leading cause of neonatal morbidity and mortality. Inflammation plays a central role in the activation of myometrial contractions and rupture of fetal membranes associated with spontaneous preterm birth. The pomegranate polyphenol punicalagin is known to possess anti-inflammatory properties. In this study, we aimed to determine the effect of punicalagin on pro-inflammatory and pro-labor mediators in an in vitro model of intrauterine inflammation associated with preterm birth. Primary human cells isolated from myometrium, decidua and fetal membranes (amnion mesenchyme) were stimulated with or without IL1B or TNF, in the absence or presence of punicalagin. Punicalagin blocked inflammation-induced expression of pro-inflammatory cytokines, chemokines and extracellular matrix degrading enzymes in primary myometrial, decidual and amnion cells. Punicalagin also suppressed inflammation-induced myometrial activation as evidenced by a decrease in PTGS2 mRNA expression, PGF2α secretion and myometrial cell contractility in situ. Overall, punicalagin may block pro-inflammatory and pro-labor mediators in human gestational tissues. Further study should identify if punicalagin can delay LPS-induced spontaneous preterm birth in an in vivo mouse model.

AbstractObjective:Social media analytics (SMA) has a track record in business research. The utilisation in nutrition research is unknown, despite social media being populated with real-time eating behaviours. This rapid review aimed to explore the use of SMA in nutrition research with the investigation of dietary behaviours.Design:The review was conducted according to rapid review guidelines by WHO and the National Collaborating Centre for Methods and Tools. Five databases of peer-reviewed, English language studies were searched using the keywords ‘social media’ in combination with ‘data analytics’ and ‘food’ or ‘nutrition’ and screened for those with general population health using SMA on public domain, social media data between 2014 and 2020.Results:The review identified 34 studies involving SMA in the investigation of dietary behaviours. Nutrition topics included population nutrition health investigations, alcohol consumption, dieting and eating out of the home behaviours. All studies involved content analysis with evidence of surveillance and engagement. Twitter was predominant with data sets in tens of millions. SMA tools were observed in data discovery, collection and preparation, but less so in data analysis. Approximately, a third of the studies involved interdisciplinary collaborations with health representation and only two studies involved nutrition disciplines. Less than a quarter of studies obtained formal human ethics approval.Conclusions:SMA in nutrition research with the investigation of dietary behaviours is emerging, nevertheless, if consideration is taken with technological capabilities and ethical integrity, the future shows promise at a broad population census level and as a scoping tool or complementary, triangulation instrument.

OBJECTIVE:To investigate Indonesian pregnant women's experiences in seeking and receiving nutrition information.DESIGN:Qualitative semi-structured interviews analysed with thematic analysis.SETTING AND PARTICIPANTS:Twenty-three pregnant women in Malang City, Indonesia were interviewed between December 2018 and January 2019.FINDINGS:Four key themes emerged concerning pregnant women's nutrition information-seeking behaviour: (i) Most women passively received nutrition information rather than actively seeking it; (ii) Women sought and received nutrition information from multiple sources including health professionals, social networks and the Internet, with varying levels of trust; (iii) Health professionals, including doctors, midwives and nutritionists, did not provide consistent and timely information; and (iv) Most women could identify gaps between nutrition information provided by health professionals and their expectations.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:This study identified opportunities for Indonesian health authorities to enhance their nutrition education services. This study suggests improvements that could extend the systematic provision of nutrition education to meet the needs of pregnant women in developing countries.

BACKGROUND:Commercial growing up milks (GUMs) targeted at children from 12 to 36 months of age are a rapidly growing industry, particularly across the Asia Pacific.METHODS:The present study assessed the frequency of use and socio-demographic and child associations of commercial GUM feeding in children, aged between 12 and 36 months, in capital cities in four Asia Pacific countries. Mothers of children aged between 12 and 36 months were surveyed, assessing GUM feeding frequency in the past month. A market research company database was used to survey across Asia Pacific urban cities, including Bangkok Thailand, Jakarta Indonesia, Singapore and Australian Capital Cities (ACC).RESULTS:More than 1000 women (n = 1051) were surveyed (Bangkok, n = 263; Jakarta, n = 275; ACC, n = 252; Singapore, n = 261). The mean (SD) age of mothers was 32.4 (5.3) years and that of children was 23.6 (6.7) months. In total, 62.7% of the children were fed GUMs more than once per week with significant country variance. In comparison with ACC, Asian countries were significantly more likely to feed GUMs ≥once per week: Bangkok [odds ratio (OR) = 5.7, 95% confidence interval (CI) = 3.8-8.6]; Jakarta (OR = 3.5, 95% CI = 2.3-5.5); and Singapore (OR = 7.4, 95% CI = 4.9-11.1). Associations of GUM feeding included: maternal tertiary education; mothers younger than 30 years; working full time; and feeding of commercial infant formula under 12 months.CONCLUSIONS:This is the first published study to explore commercial GUM feeding in and between countries. The incidence of GUM feeding, in contrast to international recommendations, signals the need for further research into the drivers for GUM feeding and its contribution to the diet.

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.