This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks’ gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother’s own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.

Early Childhood Education and Care (ECEC) settings have a pivotal role in shaping children’s dietary food habits by providing the contextual environment within which they develop these behaviours. This study examines systematic reviews for (1) the effectiveness of interventions to promote healthy eating in children aged 2–5 years attending centre-based childcare; (2) intervention characteristics which are associated with promoting healthy eating and; (3) recommendations for child-health policies and practices. An Umbrella review of systematic reviews was undertaken using a standardized search strategy in ten databases. Twelve systematic reviews were examined using validated critical appraisal and data extraction tools. Children’s dietary food intake and food choices were significantly influenced. Interventions to prevent obesity did not significantly change children’s anthropometric measures or had mixed results. Evidence was more convincing if interventions were multi-component, addressed physical activity and diet, targeted individual-level and environmental-level determinants and engaged parents. Positive outcomes were mostly facilitated by researchers/external experts and these results were not replicated when implemented in centres by ECEC providers without this support. The translation of expert-led interventions into practice warrants further exploration of implementation drivers and barriers. Based on the evidence reviewed, recommendations are made to inform child-health directed practices and policies.

Purpose: – Distrust of conventional food supply systems impacts consumer food choice. This in turn has implications for consumer nutrition outcomes and acceptance of expert advice regarding food and health. The research exploring consumer trust is found across a broad range of research streams, and is not cohesive in topic or approach. The purpose of this paper is to synthesise the disparate literature exploring the interaction between food labelling and consumer trust to determine what is known, and gaps in knowledge regarding food labelling and consumer trust. Design/methodology/approach: – A systematic search of trust and food labelling literature was conducted, with study results synthesised and integrated. Studies were then critically analysed for the conceptualisation of the consumer, the label, and their interaction with a framework developed using social theories of trust. Findings: – In total, 27 studies were identified. It was found that not only is the current literature predominantly atheoretical, but the conceptualisation of labelling has been limited. Research limitations/implications: – Further empirical research is needed to enable a more comprehensive understanding of the role food labelling plays in influencing consumer trust in food systems. Originality/value: – This research develops a conceptualisation of the dual roles food labelling may play in influencing consumer trust in food systems. It distinguishes between trust in food labelling itself, and the trust consumers develop in the food supply system through food labelling. The novel theoretical model and synthesis provide a foundation upon which future research may be conducted.

Consumer trust in food system actors is foundational for ensuring consumer confidence in food safety. As food labelling is a direct communication between consumers and food system actors, it may influence consumer perceptions of actor trustworthiness. This study explores the judgements formed about the trustworthiness of the food system and its actors through labelling, and the expectations these judgements are based on. In-depth, semi-structured interviews with 24 Australian consumers were conducted. Theoretical sampling focussed on shopping location, dietary requirements, rurality, gender, age and educational background. The methodological approach used (adaptive theory) enabled emerging data to be examined through the lens of a set of guiding theoretical concepts, and theory reconsidered in light of emerging data. Food labelling acted as a surrogate for personal interaction with industry and government for participants. Judgements about the trustworthiness of these actors and the broader food system were formed through interaction with food labelling and were based on expectations of both competence and goodwill. Interaction with labelling primarily reduced trust in actors within the food system, undermining trust in the system as a whole. Labelling has a role as an access point to the food system. Access points are points of vulnerability for systems, where trust can be developed, reinforced or broken down. For the participants in this study, in general labelling demonstrates food system actors lack goodwill and violate their fiduciary responsibility. This paper provides crucial insights for industry and policy actors to use this access point to build, rather than undermine, trust in food systems.

General consumer knowledge of and engagement with the production of food has declined resulting in increasing consumer uncertainty about, and sensitivity to, food risks. Emphasis is therefore placed on providing information for consumers to reduce information asymmetry regarding food risks, particularly through food labelling. This study examines the role of food labelling in influencing consumer perceptions of food risks. In-depth, 1-h interviews were conducted with 24 Australian consumers. Participants were recruited based on an a priori defined food safety risk scale, and to achieve a diversity of demographic characteristics. The methodological approach used, adaptive theory, was chosen to enable a constant interweaving of theoretical understandings and empirical data throughout the study. Participants discussed perceiving both traditional (food spoilage/microbial contamination) and modern (social issues, pesticide and 'chemical' contamination) risks as present in the food system. Food labelling was a symbol of the food system having managed traditional risks, and a tool for consumers to personally manage perceived modern risks. However, labelling also raised awareness of modern risks not previously considered. The consumer framing of risk presented demonstrates the need for more meaningful consumer engagement in policy decision making to ensure risk communication and management meet public expectations. This research innovatively identifies food labelling as both a symbol of, and a tool for, the management of perceived risks for consumers. Therefore it is imperative that food system actors ensure the authenticity and trustworthiness of all aspects of food labelling, not only those related to food safety.

Background: Working effectively with Aboriginal and Torres Strait Islander people is important for maximising the effectiveness of a health care interaction between and Aboriginal and Torres Strait Islander patients and a health professional. This paper presents a framework to guide health professional practice in Aboriginal and Torres Strait Islander health. Methods: This qualitative study was based in a social constructionist epistemology and was guided by a critical social research methodology. Two methods were employed: interviews with Aboriginal health workers and allied health professionals about their experiences of working together in Aboriginal health, and an auto-ethnography conducted by the researcher, a non-Aboriginal dietitian and researcher who worked closely with two Aboriginal communities while undertaking this research. Results: Interviews were conducted with 44 allied health professionals and Aboriginal health workers in 2010. Critical Social research, which involves the deconstruction and reconstruction of data, was used to analyse data and guided the evolution of themes. Strategies that were identified as important to guide practice when working respectfully in Aboriginal health included: Aboriginal and non-Aboriginal people working with Aboriginal health workers, using appropriate processes, demonstrating commitment to building relationships, relinquishing control, having an awareness of Aboriginal history, communication, commitment, flexibility, humility, honesty, and persistence. Reciprocity and reflection/reflexivity were found to be cornerstone strategies from which many other strategies naturally followed. Strategies were grouped into three categories: approach, skills and personal attributes which led to development of the Framework. Conclusions: The approach, skills and personal attributes of health professionals are important when working in Aboriginal health. The strategies identified in each category provide a Framework for all health professionals to use when working with Aboriginal and Torres Strait Islander people.