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Past, present and future of Integrated Child Development Services (I.C.D.S.).
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Target: malnutrition. Results from Tamil Nadu.
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Community participation in the field of health and nutrition.
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[Up to 6,000 DM per month profit. Nice subsidy for nutrition counseling].
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Principles of nutritional therapy.
Provision of adequate nutrition makes a major contribution toward improvement of clinical, biochemical, cellular, and psychologic status of the cancer patient in the face of the disease process and the side effects of various treatments. The principles of nutrition support include the following: 1) Malnutrition induced by cancer and its treatment adversely affects the patient and complicates further treatment of the disease. 2) Malnutrition is not an obligatory response of the host to cancer. 3) A rational nutritional therapeutic program for a patient requires analysis of the factors inducing depletion in that patient. 4) Every patient should have an early and periodic assessment of nutritional status. 5) Nutrition therapy, when indicated, should be instituted early. 6) The application and effectiveness of therapeutic programs must become part of the medical audit and general clinical procedure for inpatients and outpatients. 7) The objectives of nutritional therapy are: a) supportive, b) adjunctive, and c) definitive. 8) Nutritional status, tumor growth and anti-tumor treatment are intimately related. 9) Nutritional therapy has the potential for difficulties as well as benefits. 10) The provision of optimal nutrition care requires a multidisciplinary approach with physicians, nurses, dietitians, and pharmacists working as a team with adequate laboratory facilities and administrative and financial support.
Outcomes in a pediatric intensive care unit before and after the implementation of a nutrition support team.
BACKGROUND: We evaluated the effect of parenteral nutrition (PN) and enteral nutrition (EN) on in-pediatric intensive care unit (PICU) mortality before and after a continuous education program in nutrition support that leads to implementation of a nutrition support team (NST). METHODS: We used a historical cohort study of infants hospitalized for >72 hours at the PICU from 1992 to 2003. Five periods were selected (P1 to P5), considering the modifications incorporated into the program: P1, without intervention; P2, basic themes and original articles discussion; P3, clinical and nursing staff participation; P4, clinical visits; P5, NST. The samples were compared in terms of sex, age, admitting service (ie, medical vs surgical), prognostic index of mortality, length of stay (LOS), duration of mechanical ventilation, in-PICU mortality rate, and percentage of time receiving EN and PN for each patient. Bi- and multivariate analyses were performed. Statistical significance was set at 0.05 level. RESULTS: Progressive increase was observed in EN use (p = .0001), median values for which were 25% in P1 and rose to 67% by P5 in medical patients; there was no significant difference in surgical patients. A reduction was observed in PN use; in P1 medians were 73% and 69% for medical and surgical patients respectively, and decreased to 0% in P5 for both groups (p = .0001). There was significant reduction in-PICU mortality rate during P4 and P5 among medical patients (p < .001). The risk of death was 83% lower in patients that received EN for >50% of LOS (odds ratio, 0.17; confidence interval, 0.066-0.412; p = .000). CONCLUSIONS: The program motivated an increase in EN and a decrease in PN use, mainly after implementation of NST and reduced in-PICU mortality rate.
National Dairy Council Award for Excellence in Medical/Dental Nutrition Education Lecture, 1995: medical-nutrition education--factors important for developing a successful program.
Currently, there are no established guidelines which define the goals, the course content, or the approach to developing a successful medical-nutrition education program. The result has been great variability in the approach to teaching nutrition to medical students. A common concern among medical educators is how to teach all of the material currently known. The obvious outcome of trying to teach the constantly expanding body of facts is an increasing demand and competition for instructional time. In turn, nutrition educators have fallen into the trap of vying for more time and claiming success for their program on the basis of their acquired number of hours of instruction rather than on the demonstrated quality or effectiveness of their program. The purpose of this report is to recommend a set of goals for nutrition training of medical students and to highlight those factors which appear to be most (and least) important to achieving those goals. It is my belief that the primary goal of educating medical students should be to sensitize students to the relevance of nutrition in the prevention and treatment of disease. A secondary goal should be to impart important information about nutrition. Relative to these goals, and based on previous studies and on my experience at the University of Alabama at Birmingham School of Medicine, I believe that two factors are critical to the success of any medical-nutrition education program: 1) demonstrated relevance of the course material to the practice of medicine, and 2) positive role modeling.(ABSTRACT TRUNCATED AT 250 WORDS)
Nutritional supplements after hip fracture: poor compliance limits effectiveness.
BACKGROUND: Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial. AIMS OF THE PROJECT: To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and/or lead to improved clinical outcomes (mortality rates, discharge destination, activities of daily living or length of hospital stay) in non-malnourished community-dwelling older women with hip fracture. METHODS: One hundred and nine women with BMI range 20-30 kg/m(2) were allocated to either nutritional supplements (352 kcal/day) or usual hospital nutrition using a quasi-randomisation technique. Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months. RESULTS: No significant differences in weight change or clinical outcomes were seen between the two groups. Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change (r=-0.36, P=0.019). CONCLUSIONS: Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture. Whilst this may explain the lack of clinical improvements seen, our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients.
The metabolic response to brain injury.
Every year several million people sustain brain injury. The development of an optimal metabolic and nutritional support program for brain-injured patients relies on an understanding of the metabolic response and nutritional complications that occur with brain injury. Severely brain injured patients have increased serum and urine levels of norepinephrine, epinephrine, and cortisol. These patients also have increased oxygen consumption and urinary nitrogen excretion. This group has observed hypozincemia, hyperzincuria, increased serum C-reactive protein and copper concentrations, and hypoalbuminemia in nonsteroid-treated severely brain-injured patients. Experimental head injury produces interleukin-1 (IL-1) of brain origin. This cytokine mediates many of the aspects of the acute phase response, including all of the metabolic abnormalities reported by our group. IL-1, when administered intracerebroventricularly to experimental animals, appears to have enhanced biological activity compared to that administered systemically. Interleukin-1 activity has been found in significant amounts in the intraventricular fluid of head-injured patients. We suggest that IL-1 acts in concert with traditional stress hormones such as epinephrine, norepinephrine, and cortisol to produce the profound metabolic disturbances observed in the head-injured patient.
Use of height-arm circumference measurement for nutritional selectivity in Sri Lanka school feeding.
In order to maximize the impact of limited resources available for the government of Sri Lanka/CARE school feeding program, a nutrition survey was carried out in 1973 using the measurements of arm circumference for height of 1,122,773 school children aged 6-12 years. The results of the survey provided a score of the incidence of malnutrition in each government primary school and schools with the highest percentage of malnutrition were selected as eligible for the feeding program. The height-arm circumference technique as found to be a valid tool for diagnosing malnutrition when compared with either weight-height-age or clinical assessment. This technique requiring only measuring tapes, was found to be rapid, economical, and highly practical for field situations as a device for nutritional selectivity. The survey findings revealed that 40 per cent of the primary school population were malnourished.
Dietary guidance workshop helps tribal program cooks make changes.
Nutrition educators need to view tribal program cooks as important food and nutrition gatekeepers for their clients, families, and communities. They need to train these cooks using a variety of educational techniques, including culturally sensitive food preparation sessions and classroom activities to increase cooks' knowledge and skills, enhance their self-esteem, and improve their attitudes about cooking more healthfully.
Managed health care: understanding the role of the nutrition professional.
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The renaissance of nutrition education.
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Nutrition and the older individual.
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Nutritional care of the patient: nurses' knowledge and attitudes in an acute care setting.
Concern is growing about the occurrence of malnutrition in hospitals throughout the developed world. Reduced involvement of nurses in patients' nutritional care may be one of the contributing factors. This study explored nurses' attitudes and knowledge about nutrition and food service in hospital. Semi-structured interviews were conducted with seven nurses from the internal medical service of a large Australian acute care hospital. Analysis of the interview transcripts revealed that many nurses lacked the in-depth knowledge needed to give proper nutritional care to their patients. Although nurses considered nutritional care to be important many had difficulty in raising its priority above other nursing activities, as a result of time constraints and multitasking issues. Several problems relating to food service arrangements were also highlighted. The findings suggest a need to raise nurses' awareness of the importance of nutrition in patient outcome. This study provides information which will guide in-service nurse education programs about nutrition, and suggests strategies for practice and organizational change.
Applying the School Health Index to a nationally representative sample of schools.
The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. The SHPPS 2000 data were collected through computer-assisted personal interviews with faculty and staff in a nationally representative sample of schools. The SHPPS 2000 questions were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. Although schools nationwide are meeting a few SHI items in each of these areas, few schools are addressing the entire breadth of items. A more coordinated approach to school health would help schools reinforce health messages.