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PubMed2001

Understanding needs is important for assessing the impact of food assistance program participation on nutritional and health status in U.S. elderly persons.

This study aimed to assess the impact of food assistance programs on nutritional and health status of nutritionally needy elderly persons. Two cross-sectional and one longitudinal data sets were used: Third National Health and Nutrition Examination Survey (1988-94), Nutrition Survey of the Elderly in New York State (1994) and Longitudinal Study of Aging (1984-1990). Multiple logistic and linear regression analyses were used to examine whether food assistance participants among food insecure elderly (i.e., those whose needs for food assistance programs are met) have better nutrient intake, skinfold thickness and self-reported health status and less nutritional risk, hospitalization and mortality than nonparticipants (i.e., those whose needs are unmet) and whether the benefit is larger than that among food secure elderly persons. Across three data sets, food insecure elderly persons had poorer nutritional and health status than food secure elderly persons. Contrary to the hypotheses, among food insecure elderly persons, food assistance participants had similar or poorer nutrient intakes, skinfold thickness, nutritional risk, self-reported health status, hospitalization and mortality than nonparticipants. Food secure participants had similar nutritional and health status as food secure nonparticipants. Lack of information on the dynamic nature and changes in needs with program participation in the three data sets likely did not allow accurate estimation of the impact of food assistance participation. Different study designs, as well as theory and knowledge of needs that clarifies need status and its change within each older individual across an appropriate time interval, are necessary to accurately assess impacts of food assistance programs.

Aged↗
PubMed1983

Pocket computer program for performing nutritional assessment on hospitalized patients.

A pocket computer program is described which allows rapid nutritional evaluation of hospitalized patients. Entries of anthropometric and laboratory measurements, along with the results of anergy testing allows display of the patient's nutritional assessment with degrees of depletion. Use of the program provides the clinician information which is of benefit to patient nutritional management and evaluation of significant risk potentials.

Computers↗
PubMed1983

Factors affecting the demand for congregate meals at nutrition sites.

This paper examines the relative importance of factors affecting attendance by elderly persons at congregate meal sites, with particular attention to need and service variables. A 25% systematic random sample survey of nutrition projects was conducted; those project sites where attendance was not limited by a lack of capacity were then analyzed. A demand model which predicts the number of daily meals served at a congregate site was estimated via generalized least squares regression methods. The study determined that measures of the quality of services provided--such as method of food preparation, type of building used, and the presence of other nutrition programs in the community--were more important in predicting attendance at nutrition sites than conventional demographic measures of need such as persons with incomes below poverty, minority status, or living alone.

Aged↗
PubMedDate not supplied

Chyle fistula management.

Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. In view of the morbidity produced by chyle leak discovered postoperatively and the lack of success of its management by aggressive surgical techniques, we have employed a different protocol for the past six years. It is based on careful intraoperative inspection of the neck for possibly chyle fistula, minimal but specific surgical handling of the damaged duct, and a postoperative nutritional program designed to reduce chyle formation and facilitate spontaneous closure. The nutritional element involves the use of medium chain triglycerides (MCT) that are easily ingested, rapidly absorbed, and readily metabolized directly into the portal venous system, bypassing the thoracic duct lymphatic system. During a four-year period, 1976 to 1980, 574 radical neck dissections were performed with only six chyle fistulas being detected postoperatively. All have been successfully treated by the protocol with no patients requiring reexploration. There have been no deaths owing to chyle fistula and no complications or side effects from the use of medium chain triglycerides.

Bandages↗
PubMed2001

Vaccination status of children in the Women, Infants, and Children (WIC) Program: are we doing enough to improve coverage?

BACKGROUND: Vaccination-promoting strategies in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to produce dramatic improvements in coverage and other health outcomes. OBJECTIVES: To determine national and state-specific population-based vaccine coverage rates among preschool children who participate in the WIC program, and to describe the strategies for promoting vaccination in WIC. DESIGN/METHODS: Demographic data, WIC participation, and vaccination histories for children aged 24 to 35 months in 1999 were collected from parents through the National Immunization Survey. The healthcare providers for the children in the survey were contacted to verify and complete vaccination information. We defined children as up-to-date (UTD) if they had received four doses of diphtheria and tetanus toxoids and pertussis vaccine (DPT), three doses of poliovirus vaccine, one dose of measles-mumps-rubella vaccine (MMR), and three doses of Haemophilus influenzae type b vaccine (Hib) by 24 months. Description of state-level vaccination-promoting activities in WIC was collected through an annual survey completed by the state WIC and immunization program directors. RESULTS: Complete data were collected on 15,766 children, of whom 7783 (49%) participated in WIC sometime in their lives. Nationally, children who had ever participated in WIC were less well-immunized at 24 months compared to children who had not: 72.9% UTD (95% CI, 71.3-74.5) versus 80.8% UTD (95% CI, 79.5-82.1), respectively. In 42 states, 24-month coverage among WIC participants was less than among non-WIC participants, including 13 states where the difference was > or = 10%. Vaccination activities linked with WIC were reported from 76% of 8287 WIC sites nationwide. States conducting more-frequent interventions and reaching a higher proportion of WIC participants had 40% higher vaccination coverage levels for the WIC participants in that state (p<0.05). CONCLUSIONS: Children served by WIC remain less well-immunized than the nation's more-affluent children who do not participate in WIC. Thus, WIC remains a good place to target these children. This study provides evidence that fully implemented WIC linkage works to improve vaccination rates. Strategies that have been shown to improve the vaccination coverage levels of WIC participants should be expanded and adequately funded to protect these children.

Aid to Families with Dependent Children↗
PubMed2000

Psychosocial factors and intervention-associated changes in those factors as correlates of change in fruit and vegetable consumption in the Maryland WIC 5 A Day Promotion Program.

This study sought to examine: (a) the relative effects of baseline demographic and psychosocial factors and an intensive nutritional intervention on changes in fruit and vegetable consumption in low-income, ethnically diverse women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in Maryland; (b) whether this intervention, designed to modify psychosocial factors associated with fruit and vegetable consumption, was successful in changing these factors; and (c) whether changes in these factors were associated with increased consumption. The same women from 15 WIC program sites were surveyed at baseline and postintervention 8 months later. Women randomized to the intervention group showed significantly greater mean change in self-efficacy, attitudes, social support, and knowledge of national consumption recommendations than control group women. Changes in all psychosocial factors were significantly associated with nutrition session attendance and increased consumption. In a hierarchical model, changes in these factors accounted for most of the intervention effect on increased consumption.

Adolescent↗
PubMed2006

Effects of zinc supplementation on 1- to 5-year old children.

OBJECTIVE: To assess the impact of zinc supplementation on nutritional and biochemical parameters among children aged 12 to 59 months. METHODS: A blinded randomized clinical trial was carried out with 58 children aged 12 to 59 months included in the Programa Governamental de Combate a Carências Nutricionais (National Child Nutritional Program), which provided them with 2 kg of iron-fortified milk. The supplementation group (n = 28) received 10 mg/day of zinc sulfate for four months, and the control group (n = 30) received placebo. The following parameters were used to assess the nutritional status: weight-for-height and height-for-age expressed as z scores, according to National Center for Health Statistics (NCHS) standards, biochemical measurements of serum iron and serum zinc, and hemoglobin and hematocrit levels. RESULTS: Zinc supplementation did not have a remarkable influence on anthropometric parameters. Baseline serum zinc levels were low in both groups. After supplementation, variations in mean hemoglobin (p = 0.002), hematocrit (p = 0.001), serum zinc (p = 0.023), and serum iron (p = 0.013) levels significantly increased in the zinc supplementation group. CONCLUSION: Zinc supplementation improved hemoglobin response and normalized serum zinc concentration. The results show the importance of establishing policies for nutritional care that can tackle zinc deficiency as well.

Anemia↗
PubMedDate not supplied

A collaborative approach to nutrition education for college students.

It is well established in the literature that college students have poor eating habits and that many barriers exist to achieving optimal nutrition for this busy population. Little is known about students' perceptions of this problem or suggestions for improving their dietary habits. Similarly, college health professionals need innovative approaches to nutritional education. In an effort to develop an online nutrition resource specifically geared to college students, the authors assessed the availability of Internet-based nutritional information for this population and conducted focus groups with students and health professionals to identify relevant nutrition concerns. They used concept-mapping techniques to conduct a systematic analysis of the qualitative information generated from their focus group participants. Their findings emphasize the need for targeted resources for college students and the importance of using students' suggestions in developing nutrition programs.

Adolescent↗
PubMed2004

Walking the talk: Fit WIC wellness programs improve self-efficacy in pediatric obesity prevention counseling.

Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the intervention's effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P <.001), be physically active (P <.01), make positive changes in counseling parents about their children's weight (P <.01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P <.05).

Adult↗
PubMed1998

Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children.

We examined the effects of household participation in the Food Stamp and WIC Nutrition Programs on the nutrient intakes of preschoolers using data from the 1989-1991 Continuing Survey of Food Intake by Individuals. Nonbreastfeeding children, 1-4 y of age, with 3 d of dietary data and whose households had incomes < 130% of the poverty level were included in the study sample (n = 499). Nutrient adequacy ratios for each of 15 nutrients were the dependent variables in multiple regression models that controlled for the following: age, sex and ethnicity of the individual; income, size and location of the household; schooling of the household head; home ownership; school lunch and breakfast participation; and season in which the interview was conducted. WIC benefits positively influenced (P < 0. 05) the intakes of 10 nutrients. For iron and zinc, the average increase due to WIC represented 16.6 and 10.6%, respectively, of the preschooler recommended dietary allowance (RDA) for these nutrients. The same analyses of the Food Stamp Program revealed increases in five nutrients. For iron and zinc, the average increase due to Food Stamps represented 12.3 and 9.2%, respectively, of the preschooler RDA. The effects of the WIC Program on the intakes of iron and zinc were greater than that of cash income, and neither program affected the intakes of fat, saturated fat or cholesterol.

Adult↗
PubMedDate not supplied

Early postnatal growth of low birthweight infants in the WIC program.

Patterns of early postnatal growth were analyzed among low birthweight infants enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Infants were divided into four groups according to their neonatal status: (1) term, normal birthweight (NBW); (2) term, low birthweight (LBW); (3) moderately preterm LBW; and (4) very preterm LBW. Comparison of mean weight and length z-scores indicated that term NBW and very preterm LBW infants were at or near the national reference averages at 8, 12, and 18 months. Term LBW and moderately preterm infants were lighter and shorter than the other two study groups at each visit. Term LBW and moderately preterm infants displayed evidence of catch-up growth during the study period. Catch-up growth was defined as a decrease in the percentage of infants below the 10th percentile for weight. The effect of neonatal body proportions on postnatal growth was investigated in term LBW infants. The infants were divided into two groups based on their ponderal index (PI) at birth (low PI and proportionate PI). Comparison of weight and length z-scores indicated that both groups of term LBW infants improved in z-scores between birth and the first visit (approximately 8 months). However, infants with evidence of asymmetric intrauterine growth restriction (low PI) continued to improve in weight and length z-scores, whereas those with symmetric growth restriction (proportionate PI) remained lighter and shorter.

Birth Weight↗
PubMed1991

Worksite health promotion in four Midwest cities.

A survey of worksite health promotion activities in nine areas of health was conducted in four Midwest cities--Winona and St. Cloud, MN; Eau Claire, WI and Sioux Falls, SD to determine how many worksites are involved in these activities; how many different kinds of programs they offer; and whether or not worksite involvement is growing in these areas of health. All worksites with over 100 employees were surveyed with a completion rate of 96% for eligible worksites. Comparing program offerings at worksites with such offerings by other community providers, we find worksites provide 40% of the total of such programs to adults. They tend to operate most programs independently of other community providers. Exercise and smoking cessation programs are most commonly offered. Worksites in the four communities significantly differed in the number of exercise program options offered and in the prevalence of worksite involvement in home, personal and drivers' safety programs. Compared to national survey results, worksites in these Midwest cities show a lower level of participation in heart disease and cancer screening activities. There is a high rate of dropout among current providers of heart disease screening activities and few nonproviders are initiating programs. Program initiation among nonproviders is highest in smoking cessation, weight loss and nutrition. Program growth among current providers is high in the areas of chemical dependency, exercise and personal, home and drivers' safety.

Data Collection↗
PubMed1993

Nutritional support of critically ill patients.

Severe depletion of body protein stores can result from prolonged starvation or from hormonal and cytokine-mediated effects during critical illness. Recent advances in the understanding of cytokine actions have substantially refined the interpretation of the nutritional assessment of critically ill patients. In addition, the design of nutritional programs for hospitalized patients has changed considerably during the past decade. Although nutritional support of critically ill patients will not lead to positive nitrogen balance, nutrition can increase protein synthesis, enhance immune function, and beneficially modify the body's response to an illness.

Critical Illness↗
PubMedDate not supplied

Food matters: changing dimensions of science and practice in the nutrition profession.

OBJECTIVE: This qualitative research describes some of the social organization of the American nutrition profession set in place by an apparent competition between two kinds of knowledge-a science-based knowledge and another more experimental knowledge drawn from practice. DESIGN: The methodological approach is constructivist and uses the theoretical framework of sociologist Dorothy Smith. SUBJECTS AND SETTINGS: Multiple data sources include: interviews and bibliographic data from 23 purposefully selected subjects who taught or studied in a graduate-level Nutrition Program at Teacher College, Columbia University from 1937 to 1992; administrative reports of the Program; faculty writings; dissertations approved by the program; the author's twenty-five years of experience in the nutrition profession; and a series of diagrams drawn to interpret and describe the data. Subjects recounted their varied professional experience during the 55-year period as a part of a larger study. MAIN OUTCOME MEASURES: The research traces changes in the relationship between nutrition science and practice as shaped by underlying sciences (food, agriculture, nutrition and health), related industries (food and health care), and culturally-bound gender ideals. DATA ANALYSIS: Data analysis was based on recommended strategies for an inductive, interpretive, ethnographic case study. RESULTS: Subjects identified three forms of the construct of food-as nutrients, as marketable products, and as nurturance. This research suggests that the nurturing properties of food, the knowledge this generates, and the practitioners associated with nurturance are vulnerable and risk disappearance inside the profession, due to a history of resistance to this aspect of our discipline. IMPLICATIONS: The author recommends collaborative research between nutritionists and historians, sociologists and others to bring forth a more critical history of this profession.

Female↗
PubMed1992

Evaluation of implementation of a cholesterol management program in physicians' offices.

This article describes an evaluation of the implementation of a cholesterol management program in family physicians' offices as part of the Physician-Based Nutrition Program to Lower Coronary Heart Disease Risk (PBNP). The evaluation, conducted through a partnership evaluation model, used multiple case study methodology and combined the use of quantitative and qualitative methods. Data sources included office staff reports and interviews, records of contacts with study personnel, patient care data, and patient telephone interviews. Data from these sources revealed gradual program implementation and considerable variation in practitioner and clinic involvement in cholesterol management. Clinic staff reported that the support provided by PBNP in the form of training, operations materials, patient education materials and ongoing assistance was very useful. This formative evaluation has implications for refinement of the PBNP and for other prevention programs in primary care settings. It demonstrates the feasibility and acceptability of a systems approach to physicians, cholesterol/nutrition educators and clinic support staff. It also suggests ways in which researchers and clinicians can implement and evaluate health care innovations.

Adult↗
PubMed1990

Food supplement use as related to nutrition knowledge and dietary quality of the elderly.

A study of 227 elderly participants attending Title III-C nutrition programs was conducted to determine food supplement use and its relationship to nutrition knowledge and quality of the diet. Although nutrition knowledge was found to be positively related to the quality of the diet for all subjects, no significant differences were found between supplement and nonsupplement users for these two variables. Although the mean knowledge score was low, positive relationships were found between nutrition knowledge and both education and income for all subjects. Amount of participation in the government-sponsored nutrition centers was negatively correlated with nutrition knowledge.

Aged↗
PubMed1997

Nutrition during pregnancy.

Nutrition assessment and counseling are integral components of preconception and prenatal care. The average-size woman should gain between 11.25 and 15.75 kg (25 and 35 lb) during a normal pregnancy. Some factors identify the pregnant woman with a nutrition risk. Vitamin and mineral supplementation should be based on a dietary assessment. Common discomforts of pregnancy frequently can be managed with dietary modification and safe pharmacotherapeutics. The coordinated efforts of health care providers, registered dietitians, the Women, Infants, and Children (WIC) nutrition program, local health departments and Cooperative Extension Service offices can provide appropriate nutrition assessment, education and intervention.

Caffeine↗