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Position of the American Dietetic Association: food and water safety.

It is the position of the American Dietetic Association that the public has the right to a safe food and water supply. The Association supports collaboration among dietetics professionals, academics, representatives of the agriculture and food industries, and appropriate government agencies to ensure the safety of the food and water supply by providing education to the public and industry, promoting technologic innovation and applications, and supporting further research. Numerous bacterial, viral, and chemical food and water threats exist with certain populations such as the elderly, children, pregnant women, those in institutionalized settings, and the immune compromised being at high risk. Recent outbreaks of food and waterborne disease and threats of bioterrorism have focused attention on the safety of US food and water systems. The US government and other entities have developed programs to address challenges associated with maintaining food and water safety. Safety initiatives such as the Pathogen Reduction/Hazard Analysis Critical Point (HACCP), revisions to the Food Code, and the National Primary Drinking Water Regulations provide a framework to evaluate current and future challenges to the safety of food and water systems. Dietetics professionals should take a proactive role in ensuring that appropriate food and water safety practices are followed and can also assume major roles in food and water safety education and research.

Bioterrorism↗

Dietetic guidelines: diet in secondary prevention of cardiovascular disease.

AIM: To produce dietetic guidelines summarizing the systematic review evidence on dietary advice for secondary prevention of cardiovascular disease. METHODS: The Cochrane Library, MEDLINE and EMBASE were comprehensively searched for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomised controlled trials relating to diet and secondary prevention of cardiovascular disease. Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review. The quality and results of each review were discussed and summarized in a whole group meeting. The guidelines were trialled in seven dietetic departments and modified where necessary. RESULTS: Providing evidence-based dietary information (including increasing omega-3 fat plus fruit and vegetable intake) to all people after myocardial infarction will save more lives than concentrating dietary advice on those in need of weight loss or lipid lowering. The practice of prioritizing dietetic time to those with raised lipids is out of date since the advent of statin therapy. CONCLUSION: There is good systematic review evidence that dietary advice to those with cardiovascular disease can reduce mortality and morbidity as well as modify risk factors. Dietary advice that does this most effectively should be prioritized.

Cardiovascular Diseases↗

Specialty practice in dietetics: empirical models and results.

This article, which is the second of a two-part series, presents results for the second and third objectives of The American Dietetic Association (ADA) 1991 Dietetic Practice Study: to distinguish the task activities among registered dietitians practicing in renal nutrition, pediatric nutrition, and metabolic nutrition care; and to investigate the relationship between advanced-level practice and specialty practice. A nationwide mail survey of advanced-level practice was conducted on a stratified random sample of 8,012 beyond-entry-level (registered before April 1988) registered dietitians who were members of ADA and of dietetic practice groups (DPGs). The sample was supplemented with two randomly selected control groups of 1,000 entry-level and 1,000 beyond-entry-level registered dietitians. The operational definition for specialty practice was met by 1,925 sample members who were also included in the survey on practice in the three specialty areas. The overall response rate was 63.1%, and the total number of usable returns was 5,852. The results from a discriminant analysis of 121 specialty job tasks, administered in common to practitioners in each specialty, found that 84 tasks could be used to construct a generic model of specialty practice from which specific task lists were derived that defined practice in renal nutrition, pediatric nutrition, and metabolic nutrition care. Validation analyses found the generic model to be a reliable means of distinguishing the job activities in renal nutrition and in pediatric nutrition; it was somewhat less reliable for metabolic nutrition care. A weak relationship was found between advanced-level practice and practice in the three specialty areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietetics↗

Attitudes and opinions of dietetics professionals toward cost-benefit and cost-effectiveness analyses.

OBJECTIVE: To compare the attitudes and opinions of dietitians and dietary managers in regard to cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). DESIGN: A questionnaire was sent nationwide to a sample of 1,074 dietitians and 454 dietary managers. SUBJECTS/SAMPLES: The dietitians were randomly selected from three dietetic practice groups of The American Dietetic Association that have practitioners with administrative responsibilities in health care: Clinical Nutrition Management, Consultant Dietitians in Health Care Facilities, and Management in Healthcare Systems. The random sample of dietary managers was drawn from the membership list of the Dietary Managers Association. MAIN OUTCOME MEASURES: We hypothesized that there would be a difference between the dietitians and dietary managers in their attitudes about, and experiences in conducting CBA and CEA. STATISTICAL ANALYSES: Data analysis incorporated frequencies, means, and standard deviations to describe the respondents. Pearson's pairwise correlations and analysis of variance examined the significance of the relationships among the variables of the study. Scheffe's test was conducted to identify which variables related closely to each other. RESULTS: Seven hundred twenty-two usable questionnaires were returned, which gave an overall response rate of 47%. Although both professional groups had experience with reducing costs at their jobs, they did not think it important to conduct CBA and CEA. Neither group could distinguish between CBA and CEA. Dietitians, who were more positive toward using CBA and CEA, saw them as important techniques that could justify the value of dietetics services. Dietitians were also more likely than the dietary managers to use the techniques in the future. Dietitians were beginning to explore the techniques, but they did not feel that good sources of information were available for conducting CBA and CEA studies. APPLICATIONS/CONCLUSIONS: Our findings suggest a strong need to educate dietitians and dietary managers in the techniques and proper use of CBA and CEA in practice settings. Dietitians need to be guided to appropriate teaching materials and educational programs, and dietary managers first have to be educated about the importance and the benefits of using the techniques.

Adult↗

Dietetic technicians report low to moderate levels of burnout.

This study identified and described the status of burnout experienced by dietetic technicians (DTRs) in various settings. A questionnaire was sent to a random sample of 300 members from the American Dietetic Association's (ADA's) Dietetic Technician in Practice practice group. The Maslach Burnout Inventory-Human Services Survey was used to measure burnout. On the emotional exhaustion subscale, the respondents reported a mean score of 20.6 (high level of burnout >27), 5.3 on the depersonalization subscale (high level of burnout >14), and 38.6 on the personal accomplishment subscale (high level of burnout <30). These results suggest that the DTRs as a group perceive themselves to be moderately emotionally exhausted, to have a low level of depersonalization, and to have a high level of personal accomplishment. Further analysis also suggests that DTRs in nontraditional settings experience more personal accomplishment than those in traditional healthcare and foodservice settings.

Adult↗

Patterns of continuing professional education in registered dietitians and dietetic technicians, registered.

This study compared the continuing professional education (CPE) activities of registered dietitians (RDs) with those of dietetic technicians, registered (DTRs). A descriptive research study was used with data from the baseline survey evaluating the Commission on Dietetic Registration's (CDR) Professional Development Portfolio. The survey was sent to 3,530 randomly selected RDs and DTRs; 1,429 surveys were returned (40.5% response rate), with 41% of RDs contacted responding and 32% of DTRs responding. Guidance used when selecting CPE activities and type of CPE activity selected were measured. DTRs sought more guidance than RDs when selecting CPE activities (P=.001). A significantly higher percentage of RDs than DTRs selected lectures, workshops, journal clubs, satellite courses, exhibits, professional leadership, professional reading, and poster sessions as CPE activities (P<.05). These findings will aid CPE providers in knowing which CPE activities are typically selected by both dietetics credential groups. DTRs may need guidance in selecting CPE activities.

Adult↗

On the front line: practice satisfactions and challenges experienced by dietetics and nutrition professionals working in community settings in New York State.

The goal of this study was to understand dietetics and nutrition professionals' experiences of their practice roles. Qualitative interviews using a grounded theory design covered practitioners' perceptions of their professional roles, role enactment, and practice context. Twenty-four dietetics and nutrition practitioners varying in their work settings, length of professional experience, education, and community type were recruited through professional contacts in New York State. Interview transcripts were analyzed using the constant comparative method of qualitative data analysis. An ecological model of practice in context emerged in which participants described daily practice satisfactions and challenges arising out of interactions among their personal characteristics, client characteristics, the work setting, and the food and nutrition and health care systems. Practice satisfactions related to positive interactions and measurable outcomes of work with clients and coworkers, recognition for expert and helper roles, and involvement in disease prevention. Practice challenges centered on others' misunderstandings of the dietary change process, assessment of practice outcomes, others' respect for expertise, keeping up-to-date, client and coworker expectations, isolation from peers, and the food environment. An ecological model of dietetics and nutrition practice as experienced in community settings draws attention to the need to address challenges in the multiple contexts that frame that practice.

Adult↗

Dietetics students perceive themselves as leaders and report they demonstrate leadership in a variety of contexts.

A leadership survey was designed and administered to undergraduate dietetics students (n=283) at eight universities to examine leadership actions reported most frequently, the context of these leadership actions, and students' reported perceptions of themselves as leaders. The majority of students perceive themselves as leaders in all context areas. The leadership practice, "Enabling Others to Act," was the most frequently reported. There were no significant differences in leadership behaviors based on college classification status and supervisory experience. Leadership behaviors were more prevalent in students who had previous leadership course-work, were older, or who had previous leadership experience. Dietetics students perceive they demonstrate leadership and do so in a variety of contexts, most frequently in class. Therefore, classroom activities may help strengthen leadership abilities of future dietetics professionals.

Adult↗

Metabolomics in practice: emerging knowledge to guide future dietetic advice toward individualized health.

The profession of dietetics can take an increasingly prominent role in managing health and patient care as clinicians gain access to three new resources: detailed information about the metabolic status of healthy individual clients, metabolic knowledge about the relationships between metabolite abundances and health, and bioinformatics tools that link clients' metabolism to their present and future health status. The current use of single biomarkers as indicators of disease will be replaced by comprehensive profiling of individual metabolites linked to an understanding of health and human metabolism--the emerging science now known as metabolomics. Industrial and academic initiatives are currently developing the analytical and bioinformatic technologies needed to assemble the quantitative reference databases of metabolites as the metabolic analog of the human genome. With these in place, dietetics professionals will be able to assess both the current health status of individuals and predict their health trajectories. Another important role for dietetics professionals will be to assist in the development of the tools and their application in predicting how an individual's specific metabolic pattern can be changed by diet, drugs, and lifestyle, with the goal of improving health and preventing the development of chronic diseases.

Biomarkers↗

Use of a risk communication model to evaluate dietetics professionals' viewpoints on genetically engineered foods and crops.

The complex issues surrounding the application of genetic engineering to food and agriculture have generated a contentious debate among diverse interest groups. One pervasive dimension in the resultant discourse is the varying perceptions of the risks and benefits of genetically engineered foods and crops. In the risk communication model, technical information is evaluated within the context of an individual's values and perceptions. The purpose of this study was to explore how dietetics professionals respond to a complex set of interrelated issues associated with genetically engineered foods and crops and to identify what varying viewpoints may exist. Participants were asked to sort a total of 48 statements distributed across eight issue areas according to level of agreement and disagreement. Using Q methodology, a total of 256 sortings were analyzed using the centroid method and varimax rotation in factor analysis. Three distinct viewpoints emerged: Precautionary (R(2)=43%), Discerning Supporter (R(2)=11%), and Promoting (R(2)=5%). Across all viewpoints, respondents agreed that dietetics professionals should employ critical thinking skills to communicate the social, economic, environmental, ethical, and technical aspects of genetically engineered foods and crops. The findings have implications for how dietetics professionals can foster an open interchange of information among diverse groups.

Attitude of Health Personnel↗

Dietetics students possess negative attitudes toward obesity similar to nondietetics students.

This study explored attitudes toward obesity between dietetics and nondietetics majors at Ohio University and their relationship with dietary intake and body composition. A convenience sample comprised of 76 female dietetics (n=38) and nondietetics (n=38) majors was assessed for attitudes toward obesity using a validated Fat Phobia Scale. Dietary intake and percent body fat were measured using a food frequency questionnaire and air displacement plethysmography, respectively. Results show that both groups were well matched with respect to age, weight, and percent body fat. The two groups were similar with respect to negative attitudes toward obesity and these perceptions were comparable to norms reported in previous studies. However, there were intriguing, but subtle, differences in the rating of adjectives comprising the Fat Phobia Scale and in dietary intake between the groups. Together, these results suggest that dietetics students are no more or less susceptible to negative attitudes toward obesity than their peers.

Adult↗

Computer-based simulations enhance clinical experience of dietetics interns.

OBJECTIVE: To determine the impact of computer-based simulations on the performance of dietetics interns in initial clinical rotations. DESIGN: Interns used either a simulation program (Care Planning Simulation System CPSS[) or a computer-based tutorial (Nutrition Care Planning Tutorial NCPT[) during their orientation. Performance of these interns on nutrition care skills was evaluated during their initial clinical rotations. SUBJECTS/SETTING: Participants were 108 dietetics interns from 8 different programs. Each internship had at least 8 interns, and none of the internships awarded a graduate degree. INTERVENTION: Subjects in the experimental group completed nutrition assessment and care planning activities for 3 simulated patients. Subjects in the control group completed a tutorial on assessment and care planning. MAIN OUTCOME MEASURES: Likert scale ratings of 31 behaviors were recorded by clinical preceptors. Behavior statements were grouped into 8 categories and average ratings for each category were determined. STATISTICAL ANALYSIS: Repeated-measures analysis of variance and linear regression were used to compare performance ratings between groups. RESULTS: There were no differences in overall evaluations of the simulation and tutorial groups for the 8-week period. Interns who started clinical rotations immediately after orientation (CPSS-I and NCPT-I groups) were rated lower in all categories than those who began their clinical rotations later (CPSS-D and NCPT-D groups). Maturation and acquisition of general skills likely influenced ratings of interns with delayed clinical rotations. For most categories of behavior the rate of improvement in rating scores was greatest for interns who used CPSS. APPLICATIONS: Computer-based simulations are a promising supplement to current techniques in didactic instruction and may be useful in both didactic and practice settings. Computer-based simulations can provide more varied practice experiences to didactic students and interns in preparation for more skilled entry-level positions in dietetics.

Adult↗

Improving dietetics education with interactive communication technology.

Changes occurring in health care, education, and technology are altering dietetics education. A model of learnercentered, cooperative, distance education based on interactive online technology is described for use in a dietetic internship. Evaluation of this model includes review of key-feature exams, results of computer attitudes surveys, use of the technology by interns, exit interviews, and performance on the examination for registered dietitians. In a pilot study of the model with 8 subjects, comfort using the Internet improved significantly. Use of interactive communication technology in dietetics education has the potential to improve competency, technological aptitude, professional partnering skills, and lifelong learning skills.

CD-I↗

Position of the American Dietetic Association: child and adolescent food and nutrition programs.

It is the position of the American Dietetic Association that all children and adolescents, regardless of age; gender; socioeconomic status; racial, ethnic, or linguistic diversity; or health status should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, and social growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, nutrition screening and assessment followed by appropriate nutrition intervention, and anticipatory guidance to promote optimal nutrition status. Malnutrition has been linked to delayed physical, psychosocial, and cognitive development and is now recognized as a major contributor to the growing problem of overweight and obesity in the child and adolescent population. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment evaluation, and intervention. It is important that continued funding be provided for these programs, which have been consistently shown to have a positive impact on child and adolescent well-being. Food and nutrition programs will continue to serve not only as a means to combat hunger and food insecurity but also as a vehicle for nutrition education and promotion of physical activity designed to combat overweight and prevent chronic disease. It is the role of the credentialed dietetics professional to support permanent, adequate funding to food and nutrition programs, universal health-care reimbursement for nutrition services, and the use of research and surveillance programs to justify, evaluate, and improve these programs. In addition, the dietetics professional is responsible for serving as a nutrition resource to all groups and individuals working with children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits. J Am Diet Assoc. 2003;103:887-893.

Adolescent↗

Criteria for acceptance to preprofessional dietetics programs vs desired qualities of professionals: an analysis.

The objectives of this analysis were to examine the literature and compare and contrast (a) qualities preferred in preprofessional dietetics students by directors of internships and approved preprofessional practice programs (AP4s), (b) characteristics needed to succeed in a scientific field, (c) traits emphasized by dietetics training programs compared with those most valued by employers, (d) skills needed by high-level managerial dietitians and those in business and communications, and (e) qualities dietitians have aspired to develop for increased competitiveness in the marketplace. Even though the revised Standards of Education have been in place since 1988, recent evaluation of criteria for internship and AP4 admission has shown traditional emphasis on academic performance and the importance of work experience. Success in scientific pursuits has been linked with more than innate intelligence; a drive for success and enthusiasm for learning are also involved. Internships foster mostly technical learning, so development of skills in human and conceptual areas are somewhat lacking. These skills, which have been identified as valuable to employers, need greater development or more consistent identification in the selection and training process. Perhaps serious consideration should be given to applicants for preprofessional programs who have shown leadership qualities through extracurricular activities or who have given themselves the opportunity to develop and improve these skills. Such students might hasten the metamorphosis of dietetics practitioners toward improved levels of compensation and professional fulfillment.

Dietetics↗

Position of the American Dietetic Association: the role of nutrition in health promotion and disease prevention programs.

A healthful diet and wise food choices are critical components of promoting health and reducing the risk of chronic disease. A substantial amount of health care resources could be saved by expanding health promotion and disease prevention programs that target dietary change among Americans. To effectively reduce health care costs, the emphasis and delivery of health care must promote health as well as deliver treatment and rehabilitative services to the sick. Prevention measures, such as nutrition interventions that also encourage physical activity, can help prevent or halt progression of full-blown chronic disease and thus decrease chronic disease disability. Health promotion and disease prevention need to be integral parts of all health care, community, public health, and worksite programs across the life cycle. Correspondingly, such programs must be culturally competent and address the specific needs of vulnerable or underserved populations. Dietetics professionals in all areas of practice should play an integral role in health promotion and disease prevention programs. Achieving this goal will require expansion of training programs and active learning by dietetics professionals that includes theory and practice in using team approaches, developing coalitions, and managing complex systems. Dietetics professionals also need to amplify their understanding of politics, administration, health care financing, and reimbursement. Attention must also be expanded to include social and behavioral sciences and to address program evaluation, outcomes, and cost-benefit and cost-effectiveness in nutrition-focused health promotion and disease prevention programs. Continued training in program development, research, and evaluation will help build the body of evidence that supports ongoing inclusion of prevention in a rapidly changing health care environment.

Chronic Disease↗

Attitude changes of dietetic students performing nutritional assessment on healthy elderly.

As the population of individuals over 65 yrs of age continues to grow, so does the demand for nutrition counseling and intervention for this age group. Dietetic students traditionally have minimal exposure to groups of healthy elderly yet entry level dietitians must effectively interact with these groups immediately upon employment. Attitudes and perceptions held by dietetic students about the elderly are important to their professional development and may affect the quality of care these students provide in the future. This study investigated attitudes of dietetic students before and after a short, direct experience with a group of elderly. Students had a significant positive change in attitudes as a result of interacting with the older adults.

Adult↗

Entrepreneurship of dietetic program graduates.

Successful dietetic program graduates must have an entrepreneurial mindset and skills to respond to environmental changes and consumer trends. The purpose of this study was to determine current or intended entrepreneurship by graduates of a Dietitians of Canada accredited university program, as influenced by self-efficacy stemming from entrepreneurial experiences in education or early career, as well as by internal and external factors. This study employed an exploratory descriptive methodology with a questionnaire mailed to a discrete sample. Ninety graduates completed and returned the questionnaire for a response rate of 55%. Data analysis included descriptive statistics, two-way table analysis, the chi-square test for independence, and Fisher's exact test. Significant relationships were found between self-efficacy scores and entrepreneurial action, specific entrepreneurial experiences and entrepreneurial intent and action, dietetic internship and intent, and belief in the importance of business skills and intent. Those with entrepreneurial intent and/or action identified creativity, dietetic education/internship, persistence, business skills, and family/friend support as helping factors. These results suggest that undergraduate, internship, and continuing education programs for dietitians should incorporate activities that develop entrepreneurial skills and contribute toward an entrepreneurial mindset.

Adult↗