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PubMed2002

Treating nicotine dependence during pregnancy and postpartum: understanding clinician knowledge and performance.

This study investigated the relationship of clinicians' knowledge of treatments for nicotine dependence during pregnancy and postpartum and explored what provider characteristics are associated with knowledge levels. Survey data from community health center (CHC)-based prenatal, pediatric (PED), and WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children) providers participating in a randomized clinical study were used. Providers reported low awareness of the health risks of smoking to the developing fetus/child of pregnant and postpartum women and of the effectiveness of nicotine replacement therapy (NRT) for doubling quit rates. Obstetric (OB) and WIC providers were more aware than PED providers that provider-delivered interventions are effective. Confidence in using counseling steps was significantly associated with general and NRT-related knowledge. NRT-related knowledge, but not general knowledge, was associated with higher performance of intervention steps. Educational programs targeting OB, WIC, and PED providers' knowledge about effective smoking cessation counseling strategies and their confidence in being effective with patients are needed.

Adult↗
PubMed1999

Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level.

OBJECTIVE: To evaluate a cardiovascular nutrition education package designed for African-American adults with a wide range of literacy skills. DESIGN: Comparison of a self-help group and a full-instruction group; each group received nutrition counseling and clinical monitoring every 4 months. SUBJECTS: Three hundred thirty African-American adults, aged 40 to 70 years, with elevated cholesterol level or high blood pressure were randomly assigned to the self-help or full-instruction group; 255 completed the 12-month follow-up. INTERVENTIONS: Counseling to reduce intake of dietary fat, cholesterol, and sodium was based on Cardiovascular Dietary Education System (CARDES) materials, which included food-picture cards, a nutrition guide (self-help and full-instruction group), a video and audiotape series, and 4 classes (full-instruction group only). MAIN OUTCOME MEASURES: Changes in lipid levels and blood pressure after 12 months. STATISTICAL ANALYSES PERFORMED: Primary analyses consisted of repeated-measures analysis of variance to examine effects of time and randomization group on outcomes. RESULTS: Total cholesterol and low-density lipoprotein cholesterol level decreased by 7% to 8% in the self-help and full-instruction groups of men and women (P < .01). The ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C) decreased in both groups of women and in the men in the full-instruction group (P < .01). In full-instruction and self-help participants with elevated blood pressure at baseline, systolic blood pressure decreased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm Hg (P < .01). Outcomes did not differ by literacy scores but were positively related to the reported initial frequency of using CARDES materials. APPLICATIONS/CONCLUSIONS: These results suggest that periodic nutrition counseling based on CARDES materials used for home study can enhance management of lipid levels and blood pressure in African-American outpatients.

Adult↗
PubMed1992

The politics of hunger: when science and ideology clash.

In recent years the WIC program, a federal nutrition program for poor mothers and babies, has become a major playing field for ideological forces hoping to shape public opinion and Congressional action on matters of domestic social policy. WIC's highly positive benefits have been distorted, research results from its scientific evaluation altered by high-level federal officials, and its public support undermined by an academic spokesman with ties to the White House and a stated desire to kill the program. While strong bipartisan support on Capitol Hill makes it likely that WIC will survive and even grow, distortion of its record provides insight into how ideological forces contaminate the well of reasoned discourse for their preconceived ends.

Female↗
PubMed2000

Healthy City Kwachon 21 Project: a community health promotion programme in Korea.

Disease patterns of Koreans changed from infectious disease to non-infectious disease in the 1970's. Even though there has been a need for a health promotion programme, it was hard to find the programme in the community before 1985 in Korea. In 1985, the Public Health Promotion Law was enacted and the Korean government started to encourage local government to plan and conduct community health promotion programs. Healthy City Kwachon 21 (HCK21) is a health promotion programme for all residents in Kwachon, a city which has about 70,000 population and is located adjacent to Seoul, Korea. HCK21 launched in 1998 with three guiding principles: 1) programs should be accessible to all citizens; 2) Programmes should stimulate strong community participation and 3) Programmes should change environment and society. The long term goal of HCK21 is to increase the healthy life span of citizens in Kwachon. HCK21 is a collaborative project between Kwachon and the Institute for Health Promotion of the Graduate School of Health Science and Management, Yonsei University. It has seven components: 1) Publication of Monthly Health Newsletter; 2) Smoking Cessation and Tobacco Prevention Program; 3) Community Nutrition Program; 4) Maternal and Women's Health Programme; 5) Programme for Development of District Health Management Information System; 6) Hypertension Prevention and Control Programme and 7) Physical Activity Programme. HCK21 is now being implemented in the third year program since the program conducted in 1998 and 1999 was successful with received support from the citizens. It is recommended that HCK21 be a model for an integrated community-based health promotion programme in developing countries.

Adolescent↗
PubMed2004

Feasibility of a partial meal replacement plan for weight loss in low-income patients.

BACKGROUND: Low-income patients are disproportionately affected by obesity. Routine care is available to this population at the Venice Family Clinic (VFC) in Los Angeles. The current study examined the effectiveness of nutrition clinic utilizing meal replacements (Slim-Fast, Slim-Fast Foods Co., FL, USA) in low-income patients over a 6-month period compared with the routine care by their primary care physician (PMD) prior to enrolling in the nutrition clinic at similar time intervals. METHODS: In total, 63 patients (51 F; 49+/-0.8 yo) who had been followed at the VFC by their PMD for at least 6 months were enrolled in this study. Patients had a body mass index (BMI) of 40+/-1.1 kg/m2, were 72% Hispanic, 25% Caucasian, and 3% African American. They had the following co-morbidities: hypertension (HTN) 45%, diabetes mellitus II (DM II) 50%, gastroesophageal reflux disease (GERD) 34%, osteoarthritis 51%, and hypercholesterolemia 48%. All patients were provided with meal replacements to be taken twice a day and were instructed to consume one complete low calorie meal per day. Weights at the first visit to the nutrition clinic, 1, 3, and 6 months after enrollment in nutrition clinic were compared to their weights at the same time intervals during routine visits to their PMD prior to enrollment in the nutrition clinic. RESULTS: There was no significant weight change during the 6 months prior to enrollment in the nutrition program despite receiving care by a PMD. At 6 months after participating in the nutrition program, there was a mean decrease of 7% body weight with a reduction in BMI from 40-37 kg/m2 (P< or =0.05). CONCLUSION: Implementation of nutrition clinic utilizing meal replacements in this low-income patient population was effective in achieving a significant reduction in weight over 6 months of treatment..

Adult↗
PubMedDate not supplied

wichealth.org: impact of a stages of change-based Internet nutrition education program.

OBJECTIVE: To determine the usefulness and impact of on stage of change associated with 8 WIC client nutrition issues. DESIGN: Cross-sectional design. Data were collected through an online survey and via Web pages visited by clients for each module. SETTING: intervention and data collection are Internet-based. PARTICIPANTS: 39,541 WIC participants from 7 states completed a module and online survey. Subjects were likely between the ages of 18 and 34, residing in Michigan, Illinois, or Indiana, and accessing the Internet from home. INTERVENTIONS: Intervention included 5 online modules focusing on parent-child feeding behaviors. VARIABLES MEASURED: Impact variables included stage of change movement, user belief in ability to engage in behavior, and perception of site usefulness. ANALYSIS: Data were reported using frequency, ANOVA (analysis of variance) (P < . 01), and chi-square (P < .01) analyses. RESULTS: Movement in stage was greatest for the "picky eater" (PE) module. Contemplation as the beginning stage had the greatest stage movement. Participants responded well to all measures of site usefulness. User belief in ability to engage in behavior was associated with 7 of the 8 modules. IMPLICATIONS FOR RESEARCH AND PRACTICE: is a highly popular and viable method for impacting movement in stage of change with a number of parent-child feeding issues.

Adult↗
PubMed1998

Testing the influence of the health belief model and a television program on nutrition behavior.

This study proposed to identify relevant factors of the health belief model (HBM) that provide motivation for people to engage in healthy dietary behavior. The impact of a TV program was also assessed using a longitudinal study with 300 participants and measuring the influence of path coefficients in the HBM that predicted salience, motivation, and healthy eating practices. Findings suggested that nutrition behavior was influenced by susceptibility and efficacy mediated through health motivation and salience. Program viewing boosted salience regardless of age, education, or household size by significantly increasing viewers' confidence in their nutrition knowledge base.

Journal Article↗
PubMedDate not supplied

Total nutritional therapy: a nutrition education program for physicians.

OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.

Education, Medical, Graduate↗
PubMed2005

Outcomes of continuous process improvement of nutritional care program among geriatric units.

BACKGROUND: Up to 65% of elderly patients are protein-calorie undernourished at admission or acquire nutritional deficits while hospitalized. The aims of this project were: (a) to assess the quality of care concerning nutrition among Belgian geriatric units, (b) to include more routinely nutritional assessments and interventions in comprehensive geriatric assessment, and (c) to assess the impact of nutritional recommendations on nutritional status and on the length of hospitalization. Method. We studied 1139 patients consecutively admitted to 12 geriatric units of general hospitals prospectively for 6 months (from January through June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months, the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardized nutritional intervention was proposed for the last 3 months. RESULTS: Median value of the Mini Nutritional Assessment test score was 18 points (range 9-29), mean admission's serum prealbumin concentration was 0.185 +/- 0.076 g/L, and C-reactive protein was 5.3 +/- 7.5 mg/100 ml. Hospitalization stay was significantly lower during the interventional period than during the observational period. A higher mean serum prealbumin concentration variation was observed during the interventional period as compared to the observational period. CONCLUSIONS: Nutritional assessment should be part of routine clinical practice in elderly hospitalized patients. A comprehensive screening tool for assessment of nutritional status is needed that is clinically relevant and cost effective to perform. If malnutrition is suggested by such screening tests, then a supplemental conventional nutritional assessment should be performed before treatment is planned.

Aged↗
PubMed2006

Ten-year follow-up of the Cretan Health and Nutrition Education Program on children's physical activity levels.

OBJECTIVE: To examine the effect of a 6-year school-based intervention program, implemented on the island of Crete, on children's physical activity levels at the end of the intervention and at a follow-up examination 4 years after program's cessation. METHODS: Subjects with complete moderate to vigorous physical activity (MVPA) data at baseline, post-intervention and follow-up examination (Academic years 1992-1993, 1997-1998 and 2001-2002 respectively) were included in the analysis [n = 425: Intervention Group (IG): 238; Control Group (CG): 187]. Repeated measures analysis of variance and logistic regression analysis were mainly performed to evaluate the tested hypothesis. RESULTS: Subject's mean age was 6.3, 11.5 and 15.3 years at baseline, post-intervention and follow-up examination, respectively. MVPA levels were significantly higher for males in the IG than CG at post-intervention (510.2 +/- 404.6 vs. 350.7 +/- 308.0 min/week, P < 0.001) and follow-up (112.3 +/- 78.9 vs. 96.3 +/- 67.0 min/week, P = 0.029). Furthermore, males in the IG were 2.3 (P = 0.011) and 2.1 (P = 0.041) times more likely to meet recommendations for physical activity at the post-intervention and the follow-up examination, respectively, than the CG. No significant findings were observed for females. CONCLUSION: The current study indicates a favorable effect of the intervention on boys' physical activity levels, which was maintained 4 years after the end of the program.

Adolescent↗