Addressing Food Insecurity in Primary Care

Food insecurity is a significant health disparity with associated socioeconomic, physical, and psychologic implications for millions of Americans. The inability to consistently access adequate amounts of nutritious food to sustain a healthy, active life both directly and indirectly leads to depressive symptoms and diagnoses. Primary care providers should screen all patients for depression and food insecurity and are poised within the community to make a significant impact on health disparities such as food insecurity, depression, and chronic disease that decrease the quality of life for millions of Americans.     

Exploration of the Relationship Between Household Food Insecurity and Diabetes in Canada

OBJECTIVE

To determine the household food insecurity (HFI) prevalence in Canadians with diabetes and its relationship with diabetes management, self-care practices, and health status.

RESEARCH DESIGN AND METHODS

We analyzed data from Canadians with diabetes aged ≥12 years (n = 6,237) from cycle 3.1 of the Canadian Community Health Survey, a population-based cross-sectional survey conducted in 2005. The HFI prevalence in Canadians with diabetes was compared with that in those without diabetes. The relationships between HFI and management services, self-care practices, and health status were examined for Ontarians with diabetes (n = 2,523).

RESULTS

HFI was more prevalent among individuals with diabetes (9.3% [8.2–10.4]) than among those without diabetes (6.8% [6.5–7.0]) and was not associated with diabetes management services but was associated with physical inactivity (odds ratio 1.54 [95% CI 1.10–2.17]), lower fruit and vegetable consumption (0.52 [0.33–0.81]), current smoking (1.71 [1.09–2.69]), unmet health care needs (2.71 [1.74–4.23]), having been an overnight patient (2.08 [1.43–3.04]), having a mood disorder (2.18 [1.54–3.08]), having effects from a stroke (2.39 [1.32–4.32]), lower satisfaction with life (0.28 [0.18–0.43]), self-rated general (0.37 [0.21–0.66]) and mental (0.17 [0.10–0.29]) health, and higher self-perceived stress (2.04 [1.30–3.20]). The odds of HFI were higher for an individual in whom diabetes was diagnosed at age <40 years (3.08 [1.96–4.84]).

CONCLUSIONS

HFI prevalence is higher among Canadians with diabetes and is associated with an increased likelihood of unhealthy behaviors, psychological distress, and poorer physical health.More than 2 million Canadians have diabetes, and the rising prevalence is alarming (1). In 2003, the economic burden of treating diabetes and its complications and the subsequent loss of productivity and life were estimated to be 9 billion dollars (2). Evidence supports the benefits of aggressive glycemic control to reduce the risk of the development and progression of diabetes complications (3,4). Self-management, including nutrition therapy, is very challenging for individuals with diabetes.Food security, an important determinant of health, “exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life” (5). In 2004, 9.2% of Canadian households, an estimated 1.1 million households, were food insecure (6). Among adults, household food insecurity (HFI) is associated with lower nutrient intakes and consumption of a less healthy diet (7). A healthy diet is important for both the prevention and treatment of diabetes.Our objectives were to determine the prevalence of HFI and its associated factors in Canadians with diabetes and to examine the relationship between HFI and diabetes management. The findings have potential policy implications for delivery of health care and social services.     

Food Security,Health, and Medication Expenditures of Emergency Department Patients

Background: In the United States, 35 million people live in food-insecure households. Although food insecurity and hunger are undesirable in their own right, they also are potential precursors to nutritional, health, and developmental problems. Study Objectives: To examine the prevalence of household food insecurity and its association with health problems and medication expenditures among Emergency Department (ED) patients. Methods: We conducted a cross-sectional study in four Boston-area EDs and enrolled consecutive adult patients during two 24-h periods at each site. Food security status was measured using the validated 18-item US Household Food Security Survey Module. Results: Overall, 66 (13%; 95% confidence interval [CI] 10–17%) of 520 ED patients screened positive for food insecurity. Among these 66 patients, 32 (48%; 95% CI 36–61%) reported food insecurity with hunger. Patients from food-insecure households differed from food-secure patients with respect to sociodemographic factors. Food-insecure patients were more likely than food-secure patients to report a variety of chronic and mental health problems (all p < 0.05), including obesity. Food-insecure patients, compared to food-secure patients, also were more likely (all p < 0.001) to put off paying for medication to have money for food (27% vs. 4%, respectively), to take medication less often because they couldn't afford more (32% vs. 4%, respectively), to report needing to make a choice between buying medication and food (27% vs. 2%, respectively), and to report getting sick because they couldn't afford to take medication (27% vs. 1%, respectively). Conclusions: ED patients from food-insecure households report more chronic and mental health problems, and difficulty purchasing medication.     

Perceptions about menopause and health practises among women in northeast Thailand

The purpose of the present qualitative study was to understand health perceptions and practises among Thai menopausal women. One hundred and forty-two women aged 45-59 participated in the study in 1999. Data gathered from observations, focus group discussions, and in depth interviews were analyzed by using the hermeneutic phenomenological method. Four main themes emerged as characteristic of the health perceptions, practises and worldviews of the participants. These findings contribute to a deeper understanding of what it is like to be a menopausal woman, and why certain health activities are practised.     

Treatment default among urban tuberculosis patients, Thailand

Tuberculosis treatment default, missing medical appointments for two consecutive months or more, is a serious problem not only for individuals but also for societies and health-care systems. Most research focuses only on patient factors without considering health-care system factors' effects on treatment default. The study purpose was to examine the influence of process of care on treatment default. Structured interviews and medical chart reviews were conducted in 160 tuberculosis patients receiving care at a tertiary hospital in Thailand. The samples included 54 patients with treatment default and 106 patients with treatment completion. Hierarchical logistic regression was used to examine relationships among the variables. After adjusting for patient factors, having severe medication side-effect and travel time to clinic increased treatment default. The patient factor of being paid on a daily basis was also significantly associated with treatment default. Evidence indicates that some process of care factors influence treatment default. Findings can be applied to practice levels to maintain patients until treatment completion.     

Multiple Comorbidities and Interest in Research Participation Among Clients of a Nonprofit Food Distribution Site

Background

Persons accessing food from nonprofit distribution sites face numerous challenges and typically have significant unmet health needs. However, given limited and intermittent healthcare system engagement, this vulnerable population is underrepresented in clinical research. We sought to better understand the health needs of a nonclinical population to inform future research and interventions.

Methods

: Focus groups were conducted in English (n = 4) and Spanish (n = 4) with clients of Crossroads Community Services (CCS), the largest distributor of North Texas Food Bank. Discussions probed participants’ health status, healthcare utilization, understanding and utilization of mammography, and attitudes toward participation in research.

Results

Participants included 42 CCS clients, primarily Hispanic or African American women. Participants reported multiple comorbid conditions among household members, yet utilization of health services was often limited by cost. The majority expressed interest in participating in research to communicate their health concerns and obtain emotional support.

Conclusion

CCS clients represent a high‐need, under‐reached population willing to engage in health‐related research that affords them opportunity to connect with peers in group settings and obtain information to improve management of daily life challenges. The Community Assistance Research (CARe) Initiative, a community–academic collaboration, establishes a much‐needed opportunity for ongoing clinical research and intervention among this underserved population.     

Nursing Minimum Data Set development and implementation in Thailand

BACKGROUND: In 1997, the Thai Ministry of Public Health began planning to implement a national health information system. Development of the nursing component of this system is an ongoing process. The first step in developing a nursing information system is to identify an essential Nursing Minimum Data Set (NMDS). AIM: To describe the development of a NMDS in Thailand and explore the challenges of implementing it, including the issue of the comparability with data sets in other countries, primarily the United States of America. METHODS: The process of developing a NMDS specific to Thailand is reviewed. Strategies for implementing this data set and important issues related to it are then discussed. FINDINGS: Although a preliminary Thai NMDS has been identified, challenges associated with its development and implementation within the Thai National health information system remain. CONCLUSION: A Thai NMDS and its elements have been identified. The International Classification of Nursing Practice was translated and is to be used to implement the data set describing the nursing care of patients and their families. However, many issues, such as the need for conceptual translation and increasing nurses' involvement in the process, still need to be addressed in order to implement the data set successfully.     

Providing Primary Care to Poor Urban Woman

Public health nurses used the findings of a 1989 community survey to develop a program to meet the healthcare needs of an urban poulation in western Pennsylvania. The article details the expansion of the services beyong the storefront location to provide comprehensive women's care through the Raninbow Bridge Project. A formula for otherj public health nurses to use in replication a neighborhood center, pointin to the need for many skills not traditionally considered nursing, such as neworking, fund-raising, and public relations is illustrated.     

The development and evaluation of a health education programme for pregnant women in a regional hospital, southern Thailand

The maternal mortality rate (MMR) in Thailand is higher than neighbouring developing countries including Malaysia and Singapore. The 1993 MMR of Thailand was 249 per 100 000 livebirths which was four times higher than the rates in Malaysia and Singapore (World Health Organization 1995). The major causes of these deaths were haemorrhage, toxaemia of pregnancy and sepsis which were likely to be prevented by adequate prenatal care (Thailand Ministry of Public Health 1996). A large proportion of Thai pregnant women have poor health. Between 1994 and 1995, a national study conducted by Thailand Ministry of Health showed that 39% of pregnant women were anaemic, defined as haemoglobin concentration lower than 33% (Supamethaporn 1997). Another study conducted in the southern region also indicated that 13.8% of pregnant women were anaemic caused by iron deficiency (Phatthanapreechakul et al. 1997). Other behaviours which increased risks associated with child birth included non-antenatal care (ANC) attendance, undertaking physically demanding tasks and failure to increase nutritional intake during their pregnancy period (N. Phiriyanuphong et al. 1992, unpublished report). These factors emphasize the importance of a health education programme which could facilitate women to, for example, increase protein and iron intake during pregnancy which would reduce complications from their poor health status. This study was conducted in a regional hospital in Thailand where there was no systematic and well-planned health education programme for pregnant women. The initial aim was to design a health education programme using input from the hospital health care professionals including obstetricians, nurses, nutritionists, health educators and health promoters. An active involvement of these personnel assisted to sustain the provision of the programme provided for pregnant women after the cessation of the study project. Another aim of the study was to evaluate the outcomes of the programme using a pre-test-post-test method among selected pregnant women who participated in the newly designed health education programme.     

Nurse preparedness for the non‐communicable disease escalation in Thailand: A cross‐sectional survey of nurses

Chronic diseases are now the largest cause of mortality in Thailand, and form an increasingly large portion of the healthcare landscape. In the Thai health system, many patients with chronic conditions receive care and disease management services from nurses, yet specialized training in chronic diseases is not currently part of standard nursing degree programs. Given the evolving epidemiology of the Thailand population, we questioned whether practicing nurses remain confident in their knowledge and skills in chronic disease management. We conducted a cross‐sectional, self‐efficacy survey of nurses in eight randomly‐selected provinces in Thailand, receiving 468 responses. Nurse self‐efficacy was analyzed in prominent chronic disease types, including cancer, hypertension, diabetes, heart disease, cerebrovascular diseases, and pulmonary diseases. Factors, such as geographic location, education level, continuing education experience, and hospital size, were found to significantly affect nurse self‐efficacy levels; nurses highly prioritized additional training in heart diseases and cerebrovascular diseases, followed by hypertension, cancer, and diabetes.