Surveys of Food Intakes by Individualswere not specifically designed to study perinatal outcomes, we cannot evaluate the potentally negative impact of low energy intake on maternalweight gain, birthweight, and lactation performance. It is likely that, as has been noted for selfreported diets, our participants were underreporting their intakes of energy.9-10 It is also possible that their energy requirements were lower than the Recommended Dietary Allowance as a result of lower than average energy expenditure. The postpartum intakes of many nonlactating mothers did not return to prepregnancy levels, which may be a risk factor for retention of pregnancy weight gain.These findings are provocative and indicate a need for additional study of nationally representative samples to determine whether the maternal energy intakes observed here are associated with adverse effects on pregnancy outcome, lactational performance, and maintenance of desirable body weight. O

BackgroundEffectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians.MethodsThe evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation.ResultsFindings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were supported by the Aboriginal Health Team at the local Population Health Unit. Participants reported health services improved in community and hospital settings, leading to increased access and trust in local health services.ConclusionThe evaluation concluded that this process of actively engaging the Aboriginal community in decisions about their health care was a key element in improving local health services, increasing Aboriginal people’s trust and access to care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1497-0) contains supplementary material, which is available to authorized users.

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable CARDIOVASCULAR DISEASE (CVD) is the leading cause of mortality in Aboriginal Australians,* and is responsible for contributing to high rates of Aboriginal hospitalisation. 1,2 Compared with other Australians, Aboriginal people have three times the rate of coronary events and more than twice the inhospital coronary heart disease death rate. 2 Cardiac rehabilitation (CR) is an organised approach to secondary prevention and cardiac care involving exercise, risk reduction, behavioural modification and education.

Although successful partnerships are crucial to optimise Aboriginal health outcomes, failed collaborations risk inflaming sensitive Aboriginal-non-Aboriginal relationships. Factors supporting successful partnerships remind us to develop genuine, trusting relationships that are tangibly linked to the Aboriginal community. Failure to invest in this relational process and push forward with 'business as usual' can ultimately have negative ramifications on client outcomes.

BackgroundThe aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities.MethodsA literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included “long term care”, “nursing home”, “research”, “trial”, “challenge” and “barrier”, etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized.ResultsOf 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations.ConclusionsConducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0934-9) contains supplementary material, which is available to authorized users.