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PubMed2004

Food safety education: health professionals' knowledge and assessment of WIC client needs.

A written questionnaire was used to assess the opportunities and challenges for food safety education in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The sample included directors and health professionals with nutrition counseling responsibilities in 79 WIC clinics in a midwestern state. Seventy-two percent of the clinics participated in the study. Data analysis included descriptive statistics, chi(2) analysis, and Cronbach's alpha. Seventy-two percent reported offering food safety advice to 20% or more of their clients daily. Ninety percent identified the food-safety knowledge of their WIC clients to be fair to very poor. The need for food safety handouts, targeted for WIC clients, was identified by 27% of the respondents. WIC professionals are promoting safe food handling among a high-risk population group. Expansion of current food-safety education efforts with WIC clients is encouraged with emphasis on methods to effectively overcome barriers to safe food handling.

Adult↗
PubMed1999

Defined, in-home, prenatal nutrition intervention for low-income women.

OBJECTIVES: The purpose of this project was to develop a detailed, in-home, prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake. A secondary objective was to identify predictors of infant birth weight. DESIGN: A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment, education, counseling, and goal setting for low-income women during their pregnancies. A pre/post design was used to assess the effects of the nutrition program on dietary intake. A control group was used in evaluating the effect of the nutrition intervention on birth weight. SUBJECTS/SETTING: Forty low-income pregnant women selected randomly by the county health department nursing staff completed the nutrition intervention. Twenty-six women were also selected to serve as a control group. INTERVENTION: For women in the intervention group, in-home visits were conducted weekly for 4 weeks, followed by 2 monthly visits. The purpose of the in-home visits was to use the defined protocol, which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling. MAIN OUTCOME MEASURES: The primary outcome measures were change in dietary intake from preintervention to postintervention, mothers' weight at time of delivery, and infant birth weight. STATISTICAL ANALYSIS PERFORMED: Paired t tests were used to compare the women's mean daily energy and nutrient intakes before and after the nutrition intervention. Correlation analysis identified relationships between infant birth weight and independent variables, and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight. Mean birth weight was compared in the intervention and control groups by means of a t test. A chi 2 test was used for categoric variables. RESULTS: Comparison of dietary intakes before and after the intervention revealed significant increases in total energy (2,269 to 2,431 kcal, P < .05), folate (345 to 412 micrograms, P < .01), vitamin B-6 (2.1 to 2.5 mg, P < .01), iron (17.5 to 21.2 mg, P < .01), zinc (13.6 to 14.7 mg, P < .01), and calcium (1,175 mg to 1,299 mg, P < .01) and significant (P < .01) increases in daily servings from the vegetable group (1.5 +/- 1.0 to 2.2 +/- 1.1 serving per day) and breads/grains groups (3.4 +/- 1.4 to 4.1 +/- 1.5 servings per day). There was no significant difference in mean birth weight between the intervention and control groups. Sixty-five percent of the variation in infant birth weight was accounted for by mother's weight at time of delivery, pre-pregnancy body mass index, number of visits by the nutritionist, and change in energy intake from preintervention to postintervention. APPLICATIONS: This defined, in-home, prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women. Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers.

Adolescent↗
PubMed1985

An approach to the provision of nutrition services in a cancer treatment centre.

Nutritional care of the cancer patient has been the subject of extensive publications in recent years. Its importance, although generally recognized, has not led to universal availability of nutrition services to cancer patients and their families. Nutritional care can be supportive or palliative and must be coordinated with the care provided by other members of the multidisciplinary team. This article presents some of the important factors involved in the implementation of nutrition programs in a cancer treatment centre. The need for enthusiastic, competent, and human delivery of nutritional care is emphasized.

Cancer Care Facilities↗
PubMed1979

Home parenteral nutrition.

One hundred and six patients were placed on a home parenteral nutrition program because of severe gastrointestinal tract lesions. In 41, sufficient improvement allowed the resumption of oral alimentation. Forty-eight remain on the program. Seventeen, including ten with malignant disease, died from causes not related to home parenteral nutrition. All patients achieved and maintained the appropriate weight for age and body build. In the pediatric patients, normal or accelerated linear growth occurred. Complications included sepsis, 18 episodes in 12 patients; local infection of the catheter, 14 in six; catheter thrombosis, six in five; ketoacidosis, one in one; contaminated solutions, one in one, and essential fatty acid deficiency, one in one. Home parenteral nutrition is a relatively safe and effective alternative for long term nutritional support.

Adolescent↗
PubMed2005

A pilot church-based weight loss program for African-American adults using church members as health educators: a comparison of individual and group intervention.

OBJECTIVE: The purpose of this study was to examine a church-based intervention employing a 6-month pilot weight loss program as a strategy to improve health of African-American adults. DESIGN: A randomized trial design was used without a control group. Eligible church members were randomized into two groups: an intervention delivered in the group setting and an intervention delivered in the individual setting. SETTING: The study was conducted at an African-American church in Baton Rouge, Louisiana. PARTICIPANTS: Forty church members were enrolled in the study. Two trained church members without specialization in obesity treatment conducted the study. MAIN OUTCOME MEASURES: The primary outcome measure was weight loss. RESULTS: The program retention rate was 90%. After six months, a modest but significant mean weight loss was seen in all participants of 3.3 kg. The mean weight losses in the individual and group interventions were 3.4 kg and 3.1 kg, respectively. The mean body fat loss was 2.1 kg and 1.9 kg, respectively. The difference in weight loss and fat loss between the individual and group interventions was not statistically significant. An improvement in the quality of life and an increase in physical activity were reported by the program participants. CONCLUSIONS: A church setting may provide an effective delivery mechanism for a health and nutrition program. Church members may be trained to conduct a weight control program. Both interventions (individual and group) were effective in inducing weight loss.

Adult↗
PubMed1993

Social correlates of malnutrition among Filipino street children.

This study has sought to identify subgroups of street children at high risk for nutritional deficiency in metropolitan Manila in the Philippines. A sample of 150 street children ages six through 18 were weighed, measured, and interviewed to establish nutritional parameters and to explore the interrelationships of nutritional status with social conditions. Two variables showed the highest association with low weight for age: children using drugs and children not in school. These variables should be seen as indicative of a range of variation among Filipino street children, in whom those on drugs and not in school represent the sector at greatest risk and one to which nutritional programs should be targeted.

Adolescent↗
PubMed1997

Pregnancy-related behaviors among migrant farm workers--four states, 1989-1993.

The U.S workforce includes an estimated 3-5 million migrant and seasonal farm workers; approximately 16% of migrant farm workers are women (R. Mines, U.S. Department of Labor, personal communication, 1997). Early enrollment in prenatal care and proper weight gain during pregnancy can reduce the risk for poor birth outcomes. To characterize pregnancy-related behaviors and outcomes among migrant farm workers, CDC analyzed daa for 1989-1993 on prenatal-care use, weight gain during pregnancy, and birth outcomes among migrant farm workers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in four states participating in CDC's Pregnancy Nutrition Surveillance System (PNSS). This report presents the results of that analysis, which indicate that the goals of the national health objectives for the year 2000 for pregnant migrant women enrolled in WIC have not been met.

Adolescent↗
PubMed2004

Feasibility and benefits of a parent-focused preschool child obesity intervention.

OBJECTIVES: This field study tested the feasibility and benefits of a program to promote 6 targeted parental behaviors to prevent obesity in children served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Two WIC sites participated in a nonrandomized, controlled 1-year prospective study to assess parents' self-reported behavior changes. RESULTS: Statistical analyses of preintervention and postintervention assessments of parental behavior demonstrated significant changes in 2 behaviors: frequency of offering the child water and frequency of engaging in active play with the child. In both cases, the intervention proved effective in increasing the desired behavior. CONCLUSIONS: The findings demonstrate the feasibility of changing parental behaviors through multidimensional education in a WIC clinic setting.

Adult↗
PubMedDate not supplied

Food safety beliefs and barriers to safe food handling among WIC program clients, Miami, Florida.

OBJECTIVE: To determine beliefs about and barriers to good food safety practices among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). DESIGN: Five audiotaped focus groups. SETTING: A large WIC Program clinic in Miami, Florida. PARTICIPANTS: Thirty-two women attending the clinic who were demographically similar to clinic clients. PHENOMENON OF INTEREST: Beliefs about, barriers to, and motivators for good food safety practices. ANALYSIS: Focus groups were audiotaped and transcribed. Transcripts were independently analyzed by three researchers to identify recurring ideas within and between groups. RESULTS: Participants did not perceive foodborne illnesses as a major problem or believe that foodborne illnesses usually resulted from poor food handling practices at home. The hardest practice to follow was using a cooking thermometer. Leaving perishable foods and baby bottles outside the refrigerator for longer than 2 hours were additional problems reported. Participants reported that their babies' health was the most important motivator to good food safety practices and that women may be most receptive to food safety education during their first pregnancy. CONCLUSIONS AND IMPLICATIONS: WIC clients in this clinic have several deficiencies in their food safety knowledge and practices. The WIC Program may be well positioned to help its clients, particularly pregnant women, improve food safety practices.

Adult↗
PubMed2006

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program.

OBJECTIVE: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. DESIGN: Qualitative method of focus groups. SETTING/PARTICIPANTS: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. METHOD: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. MAIN FINDINGS: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. CONCLUSION: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.

Journal Article↗
PubMed1982

Nutrition education in the medical curriculum.

Nutrition education in medical schools is still for from established. Part of the difficulty in establishing nutrition as an integral part of the curriculum is a failure by many educators and people in the health professions to recognize the subject as a science. Graduate nutrition programs do not consistently provide practical clinical instruction. Patients look to their physicians for guidance in nutrition, and, as has been shown, such knowledge among physicians is only modest. Although aspects of nutrition are taught in medical school, they largely go unlearned because their importance is not stressed in light of the multitude of other facts that must be assimilated. Alternatives to nutrition education in medical schools, including continuing medical education, are discussed in this paper.

Curriculum↗
PubMed1998

What mothers in the Women, Infants, and Children (WIC) program feel about WIC and immunization linkage activities. A summary of focus groups in Wisconsin.

BACKGROUND: Although studies indicate that strategies to improve immunization coverage among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are effective, the attitudes of parents of children enrolled in WIC toward the linkage between WIC and immunization programs is unknown. OBJECTIVE: To gain a better understanding of how parents using WIC resources feel about the association of WIC and immunization services, their attitudes toward WIC immunization activities, factors that may cause clients to drop out of the program, and the effects of racial background on parent attitudes. PARTICIPANTS AND METHODS: We conducted 8 focus group sessions with mothers whose children receive WIC services in Milwaukee, Wis. Mothers were between 18 and 35 years old, with at least 1 child between 6 and 24 months of age. The 47 mothers participating were each assigned to 1 of 8 focus groups, including 2 groups each of Asian, white, African American, and Hispanic mothers. A systematic content analysis was conducted for themes and key points within and across ethnic groups. RESULTS: Socially disadvantaged mothers reported their overall experiences in WIC to be very positive. Lengthy waiting time during a WIC visit was identified as the most important barrier to participation. Mothers believed strongly that it was the responsibility of parents to get their children vaccinated, but that WIC staff and the primary care provider should work together to remind parents when vaccinations were due. Mothers expressed very positive attitudes toward the linking of WIC and immunization activities. Telephone reminders and education were mentioned as the best ways to encourage mothers to get their child vaccinated on time. Immunization linkage activities and the requirement that a parent report to a WIC center more frequently if the child was underimmunized were not mentioned as reasons for dropping out of the WIC program; indeed, more frequent visits to a WIC center were actually viewed as a potentially effective strategy by several mothers. Some mothers found obtaining immunizations and WIC services at the same time and place to be very convenient. There did not seem to be any significant differences among ethnic groups in attitudes toward immunization linkage activities being performed in WIC. CONCLUSIONS: Mothers with preschool-age children enrolled in WIC feel that the linkage of immunization activities with WIC services is a helpful way to improve the health of their children. This linkage was not identified as a contributing factor for leaving the WIC program.

Adolescent↗
PubMed2003

Longitudinal and horizontal integration of nutrition science into medical school curricula.

The overall goal of our Nutrition Academic Award (NAA) medical nutrition program at Mercer University School of Medicine is to develop, implement and evaluate a medical education curriculum in nutrition and other aspects of cardiovascular disease (CVD) prevention and patient management with emphasis on the training of primary care physicians for medically underserved populations. The curriculum is 1) vertically integrated throughout all 4 y of undergraduate medical education, including basic science, clinical skills, community science and clinical clerkships as well as residency training; 2) horizontally integrated to include allied healthcare training in dietetics, nursing, exercise physiology and public health; and 3) designed as transportable modules adaptable to the curricula of other medical schools. The specific aims of our program are 1) to enhance our existing basic science problem-based Biomedical Problems Program with respect to CVD prevention through development of additional curriculum in nutrition/diet/exercise and at-risk subpopulations; 2) to integrate into our Clinical Skills Program objectives for medical history taking, conducting patient exams, diet/lifestyle counseling and referrals to appropriate allied healthcare professionals that are specific to CVD prevention; 3) to enhance CVD components in the Community Science population-based medicine curriculum, stressing the health-field concept model, community needs assessment, evidence-based medicine and primary care issues in rural and medically underserved populations; 4) to enhance the CVD prevention and patient management component in existing 3rd- and 4th-y clinical clerkships with respect to nutrition/diet/exercise and socioeconomic issues, behavior modification and networking with allied health professionals; and 5) to integrate a nutrition/behavior change component into Graduate Residency Training in CVD prevention.

Bioethics↗
PubMed2003

Final results of the Maryland WIC Food for Life Program.

BACKGROUND: The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. METHODS: We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. RESULTS: Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. CONCLUSIONS: Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.

Adolescent↗
PubMed2001

The role of the dietitian in a multicenter clinical trial of dialysis therapy: the Hemodialysis (HEMO) Study.

The Hemodialysis (HEMO) Study is a randomized multicenter prospective clinical trial, supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health. The trial is designed to assess the effects of a standard versus higher dialysis dose and low versus high dialysis membrane flux on morbidity and mortality of chronic hemodialysis patients. The role of the dietitian in the HEMO Study is to support and maintain the nutritional status of randomized participants. To ensure participant safety, nutritional status is closely monitored by a variety of biochemical and participant-reported parameters. Serum albumin and equilibrated normalized protein catabolic rates are obtained monthly. Appetite assessment and dietary energy and protein intakes using a 2-day diet diary assisted recall are ascertained at baseline and on a yearly basis. Consumption of vitamins, minerals, and nutritional supplements, including oral enterals, tube feedings, and parenteral nutrition, is obtained at least once a year. In addition, anthropometry is performed at baseline and on a yearly basis. Prespecified changes in serum albumin level or body weight trigger action by the dietitian to prevent protein calorie malnutrition. The HEMO Study dietitians play a vital role in carrying out the nutrition program for the trial. The HEMO Study should provide important information about the natural history of the nutritional status of chronic hemodialysis patients and the impact of dialysis dose and dialysis membrane flux on these parameters.

Anthropometry↗
PubMed2000

Collaborative inquiry with low-income Latina women.

Collaborative inquiry is a form of research in which researchers and participants work collaboratively as partners. The purpose of this paper is to demonstrate the process of collaborative inquiry through an example of a longitudinal, community-based study conducted over a six-year period. The research program focused on HIV education, counseling, and antibody testing with low-income Latina women attending a nutrition program for women, infants, and children (WIC) in Los Angeles. Collaborative, community-based inquiry emerges from the community and uses members of the targeted group to design the program, convey the message, act as advocates, evaluate the outcomes of the program, and disseminate research findings. The goal is empowerment and emancipation of both participants and researchers. Five areas in the conduct of community-based collaborative inquiry are demonstrated here: program design, implementation, evaluation, dissemination of the results of the program, and empowerment and emancipation.

Community Health Planning↗
PubMed1983

Nutrition and iodine versus genetic factors in endemic goiter.

Consanguinity has been considered to be the major factor responsible for the high incidence of goiter in the area of Las Hurdes in Spain. However, iodine deficiency was later found to be severe enough to account for endemic goiter, and the presence of cretins in this area. Children from very similar family and socioeconomic backgrounds were found to be on three different nutritional programs, depending on the schools they were attending, and it appeared of interest to determine the effect of nutrition on the goiter incidence in children from the same population. Total iodine, nitrogen and creatinine concentrations were measured in casual urine samples. All three were found to change in parallel in the different subpopulations. They were low in schoolchildren receiving most of their meals at home. Such meals were composed of locally grown food. They were normal in children living in a boarding school, where all of the food is provided from outside the area. They were intermediate in children from a day care center, who received only some meals from an outside source. In the boarding school, goiter incidence was 21%, as opposed to 87% for schoolchildren fed at home. Such results indicate that in this area consanguinity plays a minor role, if any, in the high incidence of goiter.

Adolescent↗
PubMed2004

Conditional cash transfers are associated with a small reduction in the rate of weight gain of preschool children in northeast Brazil.

Programs providing cash transfers to poor families, conditioned upon uptake of preventive health services, are common in Latin America. Because of the consistent association between undernutrition and poverty, and the role of health services in providing growth promotion, these programs are supposed to improve children's growth. The impact of such a program was assessed in 4 municipalities in northeast Brazil by comparing 1387 children under 7 y of age from program beneficiary households with 502 matched nonbeneficiaries who were selected to receive the program but who subsequently were excluded as a result of quasi-random administrative errors. Anthropometric status was assessed 6 mo after benefits began to be distributed, and beneficiary children were 0.13 Z-scores lighter (weight-for-age) than excluded children, after adjusting for confounders (P = 0.024). The children's growth trajectories were reconstructed by copying up to 10 recorded weights from their Ministry of Health growth monitoring cards and by relating each weight to the child's age, gender, and duration of receipt of the program benefit in a random effects regression model. Totals of 472 beneficiary and 158 excluded children under 3 y of age were included in this analysis. Each additional month of exposure to the program was associated with a rate of weight gain 31 g lower than that observed in excluded children of the same age (P < 0.001). This failure to respond positively to the program may have been due to a perception that benefits would be discontinued if the child started to grow well. Nutrition programs should guard against giving the impression that poor growth will be rewarded.

Brazil↗