High food wastage and low nutritional intakes in hospital patients

BACKGROUND AND AIMS: The aim of this study was to investigate the cause of continuing weight-loss in hospitalized patients. We determined 1. whether the hospital menu was able to meet the patients' minimum nutritional requirements, 2. the proportion of food being wasted and 3. the mean nutritional intakes of patients. METHODS: This study was carried out in a University hospital (1200 beds). All the food supplied and wasted was measured over a 28 day period on one ward in each of 4 different specialties. Average food intake per patient was calculated and checked against individual food intake measurements. RESULTS: The hospital menu provided over 2000 kcal/day and could meet patients' nutritional requirements. However, high wastage rates of greater than 40% resulted in energy and protein intakes within all specialties being less than 80% of that recommended. The cost of this waste was 139,655 pounds sterling in these four specialties. CONCLUSIONS: More than 40% of hospital food was wasted. Energy and protein intakes were low and patients did not, therefore, meet their recommended intakes. This helps to explain continuing weight-loss in hospital patients and represents a large waste of resources. Hospital feeding policies therefore need reviewing and made more appropriate to the needs of the sick.     

Menu changes and their effects on the nutritional content of menus and nutritional status of elderly, hospitalized, mental health patients

As part of the competitive tendering process for a National Health Service catering contract in a UK psychiatric hospital, new menus were devised. The theoretical nutritional content of the pre- and post-tender menus was assessed, and the nutritional status of elderly, mental health patients determined before and after the introduction of the new menus.
Results indicated that the pre-tender menu did not provide recommended intakes for vitamin D, and that theoretical intakes of sodium exceeded recommendations by 100%. Fat comprised 47% of total energy and carbohydrate 36% of energy. Total energy intakes were theoretically above the estimated average requirement, despite the wasted appearance of some patients. Clinical assessments of patients' nutritional status showed notable proportions of patients with low levels of serum folate, serum vitamin D and plasma vitamin C, evidence of low body weights and depleted protein stores.
The new menus supplied less energy overall, owing to a reduction in fat content. Intakes of vitamin D and folate theoretically increased, although vitamin D intakes still failed to meet recommendations. The proportion of fat as total energy fell to 34%, and the proportion of carbohydrate rose to 47%. The increase in carbohydrate was the result of an increased starch content. After 1 year consuming the new menu, the fat stores of the elderly mental health patients fell (probably as a result of the decreased energy intake). In addition, levels of serum and red cell folate, and vitamin D fell. Whilst acknowledging that nutritional status is affected by many factors this study shows the importance of considering all aspects of the diet, and all causes of nutritional losses when devising new menus to attempt to counter nutritional deficiencies.     

A recipe for improving food intakes in elderly hospitalized patients

BACKGROUND & AIMS: The aim of this study was to compare food wastage and intake between the normal hospital menu and one where more energy dense but smaller portions were provided. METHODS: This study was carried out on an Elderly Rehabilitation ward in a University hospital. Patients were randomly allocated to receive either a normal or a reduced portion size fortified menu for a 14 day cycle and then swapped-over at the end of each cycle for the 56 day study. One group received a cooked breakfast and normal menus throughout the study. RESULTS: All the menu combinations could meet the patients recommended intake. The fortified menu provided 14% more energy than the normal menu. Food wastage was highest in the cooked breakfast group (32%) and lowest in the Fortified group (27%). The total weight of wasted food was less than in the previous study. Nutritional intakes were 25% higher on the fortified menu compared with the normal menu. The mean protein intakes were still below that recommended. All patients had higher energy intakes on the Fortified menu compared with their intake on the normal menu despite being served a lower weight of food. CONCLUSIONS: We conclude from our own data and that of others that it is possible for elderly patients to achieve their nutritional targets using a combination of smaller portions of increased energy and protein density and between-meal snacks. The needs of other groups of patients also needs to be assessed in a similar way to make hospital food appropriate to the needs of the sick.     

老年糖尿病患者心理状况及影响因素分析

目的了解老年糖尿病患者心理状况与相关影响因素。方法采用精神自评量表（SCL）-90、社会支持评定量表和艾森克人格问卷，对100例糖尿病患者和186名健康者进行调查。结果与健康对照组比较，老年糖尿病患者心理卫生状况较差，与多个因素有不同程度的相关性（P〈0．05，P〈0．01或P〈0．001）。结论加强老年糖尿病患者心理卫生服务，对防治老年糖尿病具有重要意义。     

与子女关系对农村老人心理健康的影响

[目的]探讨子女数量、子女经济特征、代际关系等对老人心理健康的影响。[方法]对云南省15个州(市)60周岁及以上农村老人进行抽样调查,收回1983份有效问卷,覆盖云南省92个自然村。通过二分类Logistic回归分析影响老人心理健康的因素。[结果]农村老人心理健康评分为(93.95±23.084)分,其中得分为75分及以上有1541人(77.7%),75分以下有442人(22.3%)。单因素分析显示,与子女关系、子女经济状况、子女是否外出打工、子女对老人关心程度和子女探访频率对老人心理健康影响差异有统计学意义(P<0.05)。Logistic回归分析显示,子女数、与子女关系、子女是否在外打工、子女对老人的关心程度对老年人的心理健康有影响(P<0.05)。[结论]子女仍是农村老年父母心理慰藉的重要来源;代际关系中存在一定的矛盾心理;多子未必多福,女儿作用越来越重要;子女经济状况的影响呈现出复杂性。     

The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital

Background Dysphagic older patients are prescribed texture modified food or fluids as treatment. The present study aimed to determine whether targeted feeding assistance using trained volunteers increased oral intake in elderly dysphagic patients. Method Individualized feeding assistance was given to patients who were diagnosed with dysphagia by a speech and language therapist. Data were collected between 08.00 h and 16.00 h and compared with previously collected data from dysphagic patients who received no targeted feeding assistance. Results The group with targeted assistance (n = 16) had higher intakes of energy and protein from both meals and supplements combined compared to the controls (n = 30); mean difference = 2327 kJ (554 kcal) (95% CI = 1294–3360 kJ; P < 0.001) and 28 g protein (95% CI = 13–41 g; P = 0.01). The assisted group ate more from meals only; mean difference = 1336 kJ (318 kcal) (95% Cl = 517–2155 kJ; P = 0.002) and 6 g of protein (95% Cl = 2–26 g; P = 0.02); and from nutritional supplements only, median difference = 1205 kJ (287 kcal) (95% CI = 613–1273 kJ; P = 0.0002) and 15 g protein (95% CI 6.9–15 g; P < 0.0001). Conclusion Nutritional intake can be improved by targeted feeding assistance in hospitalized elderly dysphagic patients on texture modified diets.     

山东老年人生活事件应激水平及与心理健康风险关系

目的 了解老年人生活事件应激水平及其与心理健康状况的相关性。方法 2015年1月1日-2月28日,采用多阶段分层随机抽样方法,利用课题组自行编制的老年人社会状况调查问卷、症状自评量表、社会支持评定量表、老年人生活事件量表对2 200名≥ 60岁老年人进行问卷调查,回收有效问卷2 013份。结果 山东省2 013名≥ 60岁老年人生活事件应激得分范围在0~239分,中位数为14.00,四分位数间距为28.00,患有慢性疾病（55.44%）、本人离职退休（31.59%）、本人住院治疗（30.35%）等生活事件发生频率较高;多因素分析结果显示,山东省老年人生活事件应激水平的影响因素包括性别（OR=1.245）、受教育程度（OR=0.659）、婚姻状况（OR=1.786、2.807）、生活自理能力（OR=1.813、1.939）和慢性病种类（OR=2.125~4.810）（均P<0.05）;生活事件应激水平得分与老年人SCL-90得分呈正相关（r=0.532,P<0.01）,其中家庭相关生活事件（r=0.481,P<0.01）、负性生活事件（r=0.516,P<0.01）与老年人心理健康状况相关性最强。结论 性别、受教育程度、婚姻状况、生活自理能力和慢性病种类是老年人生活事件应激水平的主要影响因素,且生活事件应激水平越高老年人心理健康状况越差。     

Improving food services for elderly,long‐stay patients in Australian hospitals: Adding food fortification,assistance with packaging and feeding assistance

Aim: The study aims to highlight barriers and feasible opportunities to enhance nutrition support of elderly, long‐stay patients in Australian hospitals. Methods: A total of 218 dietitians, nurse unit managers and food service managers from medical and rehabilitation wards of 184 hospitals completed a web‐based survey about current practices, perceived barriers and priority opportunities to enhance nutrition support in their context. Results: Cook‐fresh food was the most commonly reported food‐service system (50%). Eighty‐eight percent still used paper menus and one‐ or two‐week cycles were the most common menu cycle lengths. Lack of choice due to special diet, boredom arising from the length of stay, a lack of feeding assistance, limited variety and inadequate flexibility of food service were the key barriers identified. Food fortification, assistance with packaging, additional feeding assistance by nurses, non‐nursing feeding assistance and further nutrition assessment were key priorities for improvement. Conclusion: A ‘toolbox’ of strategies is needed as no one intervention will improve nutrition support of all patients. Further practice‐based outcomes and cost‐benefit studies are needed to enhance support and advocacy for feasible food service interventions in the future.     

The British welfare state and mental health problems: the continuing relevance of the work of Claus Offe

It is now over thirty years since Claus Offe theorised the crisis tendencies of the welfare state in late capitalism. As part of that work he explored ongoing and irresolvable forms of crisis management in parliamentary democracies: capitalism cannot live with the welfare state but also cannot live without it. This article examines the continued relevance of this analysis by Offe, by applying its basic assumptions to the response of the British welfare state to mental health problems, at the turn of the twenty first century. His general theoretical abstractions are tested against the empirical picture of mental health service priorities, evident since the 1980s, in sections dealing with: re‐commodification tendencies; the ambiguity of wage labour in the mental health workforce; the emergence of new social movements; and the limits of legalism.     

Videoconferencing could reduce the number of mental health patients transferred from outlying facilities to a regional mental health unit

Objective : To determine if the addition of a video link to the existing phone connection, enabling patients admitted for mental and behavioural disorders to be seen by a centrally located psychiatrist or mental health clinician, would change the probability of these patients being transferred to the central mental health unit. Methods : Data analysed were patients admitted (n=1,943) to a health services regional hospital with a primary diagnosis of mental and behavioural disorders (ICD10‐AM code F00‐F99) between January 2002 and December 2010. The probability of being transferred was modelled using multilevel random intercept logistic regression. The introduction of videoconferencing in January 2008 was examined by testing if the inclusion of a binary intervention variable was significant when added to the best fitting risk adjustment model. Results : After the introduction of videoconferencing the percentage of patients transferred fell from 66.8% (95%CI 64.0 to 69.5) to 59.6% (95%CI 56.1 to 63.1) (χ²=10.42, p=0.001). After adjusting for age, sex, clustering in hospitals and repeat visits the odds of transfer were 0.69 (95%CI 0.49 to 0.97) of previous. Aboriginality, being non‐Australian, long‐term linear trend, admitted on the weekends or after hours were not significant predictors of the probability of transfer. Conclusions and Implications : The ability for the psychiatrist or senior mental health clinician to see mental health patients via videoconferencing was associated with a reduced probability of the patient being transferred. This satisfies the preference of patients to remain in their community and access mental health services.     

Physical health,mental health,and behaviour problems among early adolescents in foster care

Background Adolescents with chronic illness in the general population are at increased risk of mental health and behaviour problems. Depression is also associated with delinquency. Adolescents in foster care are more at risk for chronic illness and mental health issues. We investigated whether adolescents in long‐term foster care with chronic illness have associated higher rates of internalizing and externalizing problems and delinquency. We also investigated if depression mediates the relationship between physical health and externalizing behaviours. Methods Data are from the National Survey of Child and Adolescent Well‐Being; adolescents age 11 and older residing in long‐term foster care (n= 188). Children whose caregivers reported on the occurrence of a chronic illness were compared using anova on internalizing and externalizing subscale scores and total scores of the Youth Self Report (YSR) and Child Behavior Checklist (CBCL), and modified Self‐Report of Delinquency (MSRD) scores of delinquency and total number of delinquent acts. Bootstrapping analyses were used to test our hypothesis that depressive symptoms (Children's Depression Inventory) function as a mediator. Results Adolescents with a chronic illness reported greater internalizing (YSR: F= 7.069, P= 0.009; CBCL: F= 4.660, P= 0.032) and externalizing (YSR: F= 5.878, P= 0.016; CBCL: F= 3.546, P= 0.061) problems, a greater number of delinquent acts (6.66, F= 5.049, P= 0.026) and heightened overall delinquency (F= 5.049, P= 0.026). Depression significantly mediated the effects of overall health on delinquency (95% CI, 0.03–1.76). Conclusions It is important to consider the complex interrelationships between physical health, mental health, and behaviour for adolescents in foster care. These findings support the need for comprehensive services for these youths, including specialized assessments and collaboration between protective services and healthcare systems.     

Engagement with health and social care services: perceptions of homeless young people with mental health problems

The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.     

河北省城乡老年人家庭、社会支持对心理健康影响

目的 分析河北省城乡老年人家庭及社会支持系统对老年人心理健康的影响,为改善老年人心理健康、提高老年人生活质量提供科学依据。方法 采用自行设计的一般人口学调查表、家庭功能评定量表(FAD)、社会支持评定量表(SSRS)及症状自评量表(SCL-90)对河北省6 173名≥60岁城乡老年人进行问卷调查。结果无心理症状者4 758人,占77.1%;轻度心理症状者1 257人,占20.4%;中重度心理症状者154人,占2.5%;不同性别、年龄、居住地、婚姻状况、文化程度、有无固定收入、子女关心程度和社会支持均是老年人心理健康的可能影响因素(P<0.05);多因素分析结果显示,年龄(OR=0.931)、婚姻状况(OR=1.107)、文化程度(OR=0.921)、有无固定收入(OR=1.155)、子女关心程度(OR=1.317)及社会支持水平(OR=0.794)是老年人心理健康的主要影响因素(P<0.05)。结论河北省老年人心理健康状况不容乐观,提高家庭及社会支持度是维护老年人心理健康的重要条件。     

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness

ObjectiveTo evaluate the impact of Maryland''s behavioral health homes (BHHs) on receipt of follow‐up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI).Data SourcesMaryland Medicaid administrative claims for 12 232 individuals.Study DesignWeighted marginal structural models were estimated to account for time‐varying exposure to BHH enrollment and time‐varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow‐up care within 7 and 30 days following hospitalization.Data Collection/Extraction MethodsEligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21‐64 years; and use of psychiatric rehabilitation services.Principal FindingsOver three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow‐up service within 7 days of discharge from a mental illness–related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow‐up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission.ConclusionsBHHs may improve follow‐up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.     

Barriers to accepting mental health care in cancer patients with depression

ABSTRACT

This study aimed to determine barriers to accepting mental health care among depressed cancer patients. Cancer patients who screened positive for depression were referred for mental health treatment and sent a validated questionnaire designed to assess barriers to receiving mental health care. Responses were compared between patients who accepted their referral and those who did not. Among 75 patients who agreed to participate, 51 (68%) completed the questionnaire. Reported barriers to accessing mental healthcare were not significantly different between the two groups but patients residing within 50 miles of the clinic had increased odds of attending their appointment.