Urban black women's perceptions of breast cancer and mammography

The purpose of this study was to examine differences in perceptions of breast cancer and mammography between black women who wanted a mammogram and those who did not. The subjects were 186 low socioeconomic black women who attended an inner city community health clinic (83% response rate). There were no significant differences on the demographic and background variables between women who did (N=139) and did not (N=47) want a mammogram. The knowledge level of both groups regarding breast cancer was poor. Those who desired a mammogram perceived themselves as more susceptible to breast cancer, and considered breast cancer more severe than those who did not want a mammogram. Neither group identified many barriers to obtaining a mammogram. The majority (at least 88 percent of those who wanted a mammogram and at least 55 percent of those who did not) agreed with each of the five benefit items. Eighty-five percent of both groups agreed they would receive a mammogram if their physician told them to do so. The two Health Belief Model components which accounted for the largest percentage of the variance between women who wanted a mammogram and those who did not were perceived benefits (13 percent) and perceived susceptibility (3 percent).James H. Price is Professor of Health Promotion, Department of Health Promotion, University of Toledo, Toledo, OH 43606, Sharon M. Desmond, Assistant Professor of Health Education, Department of Health Education, University of Maryland, College Park, MD 20742, Suzanne Slenker is Assistant Professor of Health Behavior, Department of Health Education and Health Behavior, School of Public Health, Boston University, Boston, MA 02215, Daisy Smith is Health Education Coordinator, Cordelia Martin Health Center, and Paula Stewart is Executive Director of the Cordelia Martin Health Center, 905 Nebraska Avenue, Toledo, OH 43607.Funded by a grant from Ohio Department of Health, Division of Chronic Diseases.     

Perceptions of colorectal cancer in a socioeconomically disadvantaged population

This study examined 500 low socioeconomic adults' perceptions and practices regarding bowel cancer. At least 20 percent of respondents incorrectly believed homosexual men are more likely to develop bowel cancer, exercising regularly will not affect bowel cancer, bowel cancer does not run in families, and eating foods high in fat does not increase bowel cancer risks. Approximately 7 in 10 respondents did not perceive themselves as more susceptible to developing bowel cancer even though the same number of respondents acknowledged that poor people are more likely to develop bowel cancer, it will kill you. The majority of respondents did not believe that fecal occult blood tests could help save their lives if they had bowel cancer since 90 percent perceived bowel cancer as incurable even if found early. The main barriers to screening for bowel cancer identified by the respondents were: being too embarrassed to have a proctoscopic exam (77%), not wanting to know if they had bowel cancer (78%), preferring to die rather than have their bowel removed for cancer (80%), and trouble with transportation (81%). Thirty percent of the respondents had personally done a stool occult blood test and the same number claimed they had a proctoscopic exam. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of economically disadvantaged subjects regarding bowel cancer.James H. Price, Ph.D., M.P.H. is a Professor of Health Promotion in the Department of Health Promotion and Human Performance at The University of Toledo, Toledo, Ohio 43606.     

Perceptions of Nut Consumption amongst Australian Nutrition and Health Professionals: An Online Survey

Habitual nut consumption is associated with reduced risk of chronic diseases; however, consumption levels in Australia are below recommendations. This study examined perceptions and knowledge regarding nut consumption among Australian healthcare professionals and their provision of nut consumption recommendations. A cross-sectional online survey of Australian health professionals was conducted in February–April 2020. Questions in the survey included demographic details, participants’ perceptions of nut consumption, and nut consumption recommendations they may make to clients and patients. A total of 204 health professionals completed the survey, of which 84% were dietitians or nutritionists. Health professionals demonstrated basic nutritional knowledge regarding nut consumption; however, non-dietitians/nutritionists lacked knowledge of long-term benefits of nut consumption. Dietitians/nutritionists were more likely to agree that nuts are healthy and do not cause weight gain when compared to non-dietitians/nutritionists (p = 0.021). A total of 63% of health professionals advised at least some of their clients to eat more nuts, and this was higher among dietitians/nutritionists (68%) than non-dietitians/nutritionists (31%). While basic nutritional knowledge regarding nut consumption was observed among all health professionals, there is scope for further education, particularly for non-dietitians/nutritionists, to ensure that nutrition information provided to patients and clients is accurate and reflects the current evidence base.     

Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians

Aim: To examine current Australian dietetic practice in the management of gestational diabetes, to identify models of dietetic care and to determine the need for national evidence‐based dietetic practice guidelines for gestational diabetes. Methods: A 55‐item cross‐sectional survey of Australian dietitians practicing in the area of gestational diabetes was undertaken. Participants were recruited via Dietitians Association of Australia interest group membership, public and private hospital maternity and diabetes services across Australia. The survey examined dietetic service provision, interventions, management recommendations, postnatal care, current guideline use and the perceived need for Australian evidence‐based dietetic management guidelines. Results: A total of 220 eligible dietitians participated in the survey. The majority (77%) reported that all women with gestational diabetes attending their service were referred to a dietitian. Group (33%) and individual consults (93%) were provided and 67% provided one to two dietetic consults per client. Fifty‐four per cent (54%) believed that their service currently offered adequate antenatal dietetic interventions and 8% adequate postnatal follow up for women with gestational diabetes. There were differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. However, consistency was seen in key components of nutrition education. Dietitians perceived that there was a need for evidence‐based gestational diabetes dietetic practice guidelines (86%) and nutrition recommendations (87%). Conclusion: The survey results strongly indicate there is a need for evidence‐based gestational diabetes practice guidelines and nutritional recommendations and provide baseline data for future practice of Australian dietitians working in gestational diabetes.     

A Model for Making Outcomes Research Standard Practice in Clinical Dietetics

In today's rapidly changing health care environment, it is imperative that dietitians demonstrate the importance of their role as health care providers by initiating and participating in outcomes research. Patient care should be based on empirical studies, and clinical dietitians should participate in or be at the helm of such investigations. Nutrition research is usually accomplished and reported by persons with MD or PhD degrees who do not have clinical training in nutrition and does not often address situations encountered by dietitians in clinical settings. This article examines the extent to which clinical dietitians are conducting and reporting outcomes research, their attitudes about such research, and how they think they could best acquire the skills needed to incorporate outcomes research into their practice. Results indicate that clinical dietitians are not writing a substantial percentage of articles and that reports of outcomes research are not commonly included in clinical nutrition journals. Clinical dietitians appear to value the inclusion of research in clinical practice, but they are not spending a great amount of time doing research. Dietitians report being comfortable about participating in research but not about designing, conducting, and reporting research. Results from several surveys were used to develop a model for integrating research in clinical practice. This model includes the research process as a basis for clinical practice. A model for collaborative efforts between clinical and academic dietitians is also proposed and emphasizes the responsibility of academic dietetics training programs in the integration of research and clinical practice. J Am Diet Assoc. 1998;98:451–457.     

Canadian dietitians'' views and practices regarding obesity and weight management

OBJECTIVE: To provide insight into Canadian dietitians' attitudes and practices regarding obesity and weight management. DESIGN: Cross-sectional mail survey of a stratified random sample of members of Canadian dietetic associations. SUBJECTS: A total of 514 dietitians (74% of those surveyed), 350 (69%) of whom actively counselled overweight/obese clients. MEASUREMENTS: Participants received a questionnaire to assess dietitians' attitudes regarding obesity and overweight, views regarding their role in weight management, counselling practices, and the criteria used to judge success. Demographic variables were collected. RESULTS: Most dietitians believed that obesity contributes to morbidity and mortality, and that small weight losses produced important health benefits. However, 80% agreed that health indicators other than weight loss should be the focus of obesity management, and 55% specifically recommended that clients not weigh themselves. Instead, weight management was promoted by recommending healthy eating and increased physical activity. Three-quarters agreed that they are the profession best trained to manage obesity but two-thirds believed their time would be better spent preventing rather than managing obesity. Dietitians most valued education received from on-the-job support and mentoring from other dietitians. Participants reported wanting to learn more about motivational and behavioural modification counselling techniques. CONCLUSIONS: Canadian dietitians follow a lifestyle approach to weight management. Studies are required to formally assess the effectiveness of various aspects of this approach.     

Nutritional management of patients undergoing major upper gastrointestinal surgery: A survey of current practice in Australia

Aim: The aim of the present study was to survey current nutrition practice in Australian hospitals for the management of patients undergoing major upper gastrointestinal surgery, and to compare this with best practice, as it currently appears in the literature. Methods: A literature review was conducted to obtain current recommendations for the nutritional management of patients undergoing major upper gastrointestinal surgery. A survey was constructed to investigate whether these recommendations are being followed. Dietitians from tertiary-referral public and private hospitals across Australia were contacted by telephone and invited to respond to the survey questions. Results: Forty-two hospitals were contacted and 34 dietitians responded to the survey questions. Sixty-three percent of dietitians reported minimal or no preoperative assessment of surgical patients, but 50% stated that they recommended immunonutrition when they did have preoperative contact, the majority following established dosage recommendations. Postoperative enteral nutrition support is not standard practice, being used routinely in only 30% of hospitals surveyed. Nutrition is usually recommenced on postoperative day 2 or 3. Post-discharge follow up was provided by 35% of dietitians surveyed. Conclusion: Current recommendations in all aspects of nutrition are not being followed and there is great scope for improvement in managing patients undergoing major gastrointestinal surgery. Best practice guidelines and a shift in service provision to include better outpatient support for such a patient group is required.     

Advancing institutional dietetics and school nutrition program in Korea

More than 21,000 practicing dietitians are working in the various fields of institutional foodservice settings in Korea. For the effective placement and practice of dietitians in their special areas, proper enactment and implementation of required legislations shall be imperative. Following legislations are few of those: regulations for dietitians enacted in 1963 in accordance with decree of the Ministry of Health and Social Affair; the School Meals Act in 1981; placement regulation for dietitians in childcare and nursery facilities with over 100 children under the enforcement of Infant Care Act of 1991; regulation for nutrition improvement program stated in the National Health Promotion Act of 1995; enforcement regulation for the placement of dietitians in public health centers under the Regional Public Health Act of 1997; amendment of School Meal Act and Primary and Secondary Education Act in 2003 stating that school shall have the nutrition education teacher who is dietitian qualified and passed national teacher qualifying examination; amendment of the Ministry of Health and Welfare Notification in 2003 enabled clinical dietitians at hospitals to bill a medical nutrition therapy service fee officially to patients with the following diseases: diabetes, hypertension, cardiac disease, and cancer; and amendment of the Justice Department and its Affiliates Notification in 2006 stating dietitians are placed at correction facilities. Newly introduced nutrition teachers who have tasks of nutrition education and meal service management were arranged at 4,134 schools of public or national primary and secondary as well as special schools for the handicapped in September, 2007.     

Compulsory continuing professional development: a questionnaire-based survey of the UK dietetic profession

Background:  Continuing professional development (CPD) for Health Professions Council (HPC) registrants became mandatory in July 2006. Some health professions have identified external barriers to CPD participation, and other research suggests that mandatory CPD can devalue learning. The present study aimed to investigate current CPD practices of UK dietitians and to identify their attitudes towards the new mandatory requirement.
Methods:  UK Dietitians were asked to participate in an online questionnaire made available via an advert placed on the British Dietetic Association's website and in an electronic newsletter.
Results:  Of 206 respondents, 98.1% kept a CPD portfolio. Those who had undertaken the 'ABC' placement model (23.7%) were more likely to keep their portfolio up to date ( P  = 0.006). Only 41.3% dietitians were confident that they would currently meet the minimum CPD requirement, whereas 77.2% believed they would comply by the first audit in 2010. Some 50.5% dietitians considered their CPD time commitment insufficient due to obstacles such as workload and time constraints. A total of 96.1% respondents acknowledged the importance of undertaking CPD, with the introduction of a mandatory system appearing to provide the motivation to engage in CPD.
Conclusions:  UK dietitians are currently engaging in CPD. There is, however, concern regarding achievement of the compulsory requirement for the HPC 2010 audit. The findings show barriers exist to engaging in CPD activities and to maintaining a portfolio. These issues could be addressed with the introduction of protected time for CPD.     

The integration of school nutrition program into health promotion and prevention of lifestyle-related diseases in Japan

After World War II, Japan has imported food from other countries to solve malnutrition, and then dietitians provided nutrition education to people for effective food utilization. Flour and skimmed milk imported from the United State were distributed to the school lunch program. Dietitians were trained to encourage the people to adapt western style dietary habits. The western style dietary habit issues have been brought since in 1980's as overeating and obesity have been considered as nation's health problems. In the 1990's, the prevention and treatment of lifestyle-related diseases became key objects for the nation. Government settled on "Healthy Japan 21" as a preventive policy of the lifestyle-related disease in 2000. In 2006, the middle survey for the effectiveness of the campaign was conducted, but it did not bring a good result as expected. The Ministry of Health, Labor and Welfare made the "Japanese Food Guide Spinning Top" for practical and easy mean to improve eating habits. Dietitians are in the process of developing new nutrition education using this tool. In 2005, the nine specific targets' Basic Law on Dietary Education "Shoku-Iku" was enacted to promote childhood dietary education. The Ministry of Education and Science started the new education to become a teacher called "diet and nutrition teacher" on the professional education programs of registered dietitian in university. "Diet and nutrition teachers" have already started teaching in some schools. From now, the roles of dietitians are not only supervising food preparation and planning meals but also nutrition education as teachers.     

Dietetic care of hip fracture patients across Australia: Are we doing enough?

Aim: To determine the composition of usual nutrition care provided by Australian dietitians to patients with a falls related femoral neck fracture. Methods: A cross‐sectional survey administered via the World Wide Web using SurveyMonkey to dietitians across Australia. Results: One hundred and sixty‐eight dietitians working with patients with a femoral neck fracture in Australia responded to the survey. Few dietitians (n = 7) indicated they worked in the community setting. Nutritional screening was used among respondents (n = 93), but 32/93 indicated they did not use a validated tool. Most commonly used interventions included strategies to increase intake of nutrients, such as provision of nourishing meals, snacks and oral supplements. Conclusions: Some concerns remain regarding provision of optimal nutritional care of femoral neck fracture patients in Australia. There were few respondents working in the community with falls related femoral neck fracture patients, with a greater number of dietitians working in the metropolitan area responding to the survey. The Dietitians working in this area are implementing a great variety of screening methods, with a large number using non‐validated screening tools. Clearer guidelines for health professionals involved in femoral neck fracture aftercare would be beneficial to standardise care in this area. A useful first step for dietitians would be to advocate for the use of evidence‐based practice resources in selection of site and age appropriate nutrition screening tools.     

Potentials and pitfalls for nutrition counselling in general practice

This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theories (predominantly the Stages of Change Model). General practitioners can play an important role in cardiovascular risk reduction by giving nutrition counselling to patients at elevated cardiovascular risk. Unfortunately, general practitioners perceive barriers that may limit their nutrition counselling practices. Some of these barriers may be overcome using computer and Internet technologies. Computerized reminders for preventive services, and websites with reliable high-quality information may prove to be valuable additions to usual care. Cooperation with dietitians may also lead to improvements in nutrition counselling in general practice. For example, general practitioners could use their unique position to create awareness and motivation among patients. They could subsequently refer motivated patients to dietitians for detailed personal dietary advice.     

Knowledge,attitudes, and behaviors of dietitians and nurses regarding meat

Dietitians and nurses frequently respond to client questions regarding nutrition; however, only limited research data are available on the information they provide to consumers about the controversial issue of meat in the diet. This study was designed to determine the level of knowledge of dietitians and nurses regarding meat, and to compare the attitudes and meat consumption patterns of the two groups. Mailed surveys were returned by 457 Missouri dietitians and 581 nurses. Dietitians were more knowledgeable about meat than nurses; only 80% of the nurses identified beef as an important source of iron, compared with 98% of the dietitians. More dietitians than nurses correctly estimated the calorie content of 3 oz of beef, although the majority of both dietitians and nurses overestimated the calories in meats. Both nurses and dietitians reported decreasing their own consumption of pork, eggs, beef, and cheese over the past three to five years and increasing their consumption of chicken and fish; however, nurses reported greater dietary changes. In contrast to nurses, dietitians believed that information from meat industry groups was useful. Almost all dietitians agreed with the statement that beef could be part of a healthful diet. Overall, dietitians appeared to view the concept of meat as a part of a healthful diet more favorably than did nurses.     

Parents’ perceptions of the role of schools in tobacco use prevention and cessation for youth

The purpose of this study was to examine Ohio parents’ perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. A 46-item questionnaire was based on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Surveys (n = 800) were sent to a stratified random sample of parents of junior high and high school aged students and 57% responded. Parents were supportive of smoking prevention activities, but almost two-thirds believed their child’s school should get parents’ input. Furthermore, mothers/step-mothers were more likely than fathers/step-fathers to agree that the school had a role in smoking prevention activities. The majority of parents were also supportive of smoking cessation activities. However, only 8% of parent respondents supported schools providing nicotine gum or patches to students trying to quit smoking. Overall, the majority of parents were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction. Schools have the opportunity to impact student smoking through prevention and cessation activities. Schools need to know that parents are supportive of these activities and want to be included in the process of implementing effective prevention or cessation programs.Jodi Wyman is a Research Assistant, James H. Price, Professor of Public Health, Timothy R. Jordan, Assistant Professor of Public Health, and Susan K. Telljohann, Professor of Health Education, all are affiliated to University of Toledo, Toledo, OH, USA; Joseph A. Dake is Assistant Professor of Health Education, Wayne State University, Detroit, MI, USA.     

临床营养师与近代临床营养

在近代医学发展的过程中，逐步形成专门从事临床营养治疗的营养师。营养师遍布所有与饮食营养相关的领域，对保证患者乃至健康人营养具有至关重要的作用。国内因历史原因，营养师队伍薄弱，没有与营养师相关的立法，管理紊乱，影响治疗效果。我国已从2000年起实行营养师资格考试制度，目前正在制订《营养改善法》，相信在未来的临床营养治疗中，临床营养师将发挥更大的作用。     

Clinical validation of a nutritional risk index

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.John M. Prendergast, MD, MPH is Medical Director, Program on Aging, Mercy Hospital, Pittsburgh, PA 15219; Rodney M. Coe, PhD is Professor, Department of Community Medicine, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center (GRECC), VA Medical Center, St. Louis, MO 63104; M. Noel Chavez, PhD, RD is Assistant Professor, Department of Community Health Sciences, School of Public Health, University of Illinois, Chicago, IL 60612; James C. Romeis, PhD is Associate Professor, Center for Health Services, Education and Research, St. Louis University and Coordinator, Health Services Research and Development, VA Medical Center, St. Louis, MO 63104; Douglas K. Miller, MD is Assistant Professor, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO 63104; Fredric D. Wolinsky, PhD is Professor, Department of Sociology, Texas A&M University, College Station, TX 77843.This project was supported in part by grant #84-017 from the Veterans Administration and by K07-AG-00302 and K04-AG00328 from the National Institute on Aging.     

Early childhood diet: recommendations of pediatric health care providers

With the abundance of literature on cardiovascular disease (CVD) prevention during childhood, recommendations for restricted dietary sodium and fat intakes during infancy and childhood are both advocated for preventive health care and criticized because the safety is undetermined. Dietitians, nurse practitioners, and pediatricians were surveyed to determine what dietary recommendations they give to parents and what source of information most influenced their decisions. A fourth group, pediatricians with particular expertise in nutrition, were surveyed as well. The overall response rate was 76%, with a total usable sample of 252. In all professional groups, 54% had no preference for any one commercially prepared formula. More importance was given to sodium content than to fat composition of formulas. On the choice of whole, low-fat, or non-fat milk for both 1- and 6-year-old children, professional groups differed significantly. Dietitians and the subgroup of pediatricians with nutrition expertise were more likely to recommend milk with higher fat content than other professional groups. Recommendations for both sodium- and fat-modified diets for children depended on CVD risk, and opinions varied between groups. Pediatricians and nurse practitioners were more likely to recommend dietary modifications for children with higher CVD risk. The variation in dietary recommendations within and between professional groups strongly indicates the need for research on the safety and efficacy of dietary restrictions in childhood.     

Advancing practice: Using nutrition information and technology to improve health—the nutrition informatics global challenge

Aims: The unique combination of technology, information and nutrition has been utilised in health care for decades. As technology and effective use of health data evolve, the field of ‘nutrition informatics’ is positioned to advance best practices of nutrition care delivered by registered dietitians and dietetic technicians registered. The present paper reviews the opportunities. Methods: A narrative review was constructed with reference to the literature. Results: Evolution of the use of digital health care in the USA is on an aggressive timeline because of regulations, which provide financial incentives to eligible professionals and hospitals who can prove ‘meaningful use’ of certified health‐care technology. While adoption and use of electronic health records has occurred at the international level for decades, only recently have American adoption rates increased. Health‐care providers are adjusting to rapid cultural changes, which support the interoperability of health data. The dietetics profession must move in tandem with this transition to digital care. This requires implementation and development of nutrition standards, vocabularies and quality measures, which support exchange of pertinent nutrition data critical to patient care and wellbeing. All dietetic professionals need to appreciate the paradigm shift in health care. Conclusions: Dietitians who are involved with informatics will help with this transition through their work with systems implementations, understanding competencies necessary for successful integration of digital nutrition and using electronic nutrition data for research.     

Mental health case management as a locus for HIV prevention: Results from case-manager focus groups

HIV infection among people with severe mental illness (SMI) is a growing concern, and interventions have been designed to address HIV prevention among these individuals. However, little is known about the preparedness of mental health providers to support these interventions. This study concentrated on mental health case management as a locus for HIV-prevention services. Focus groups of case managers were conducted to learn participants' motivation to adopt HIV-prevention services and barriers/facilitators to such adoption. Participants reported they would be motivated to offer HIV prevention if services were to be presented in the context of existing client relationships and case-management tasks. Barriers and facilitators were discussed at client, provider, and community levels, and recommendations for training were offered. Findings have implications for diffusion of HIV-prevention services in case management, and the line of questioning in focus groups provides a basis for learning about other behavioral health service contexts as loci for disease prevention.During the time of research, Dr Encandela was Assistant Professor at the University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa.Wynne S. Korr, PhD, was Professor at University of Pittsburgh School of Social Work, Pittsburgh, Pa, during the time of research. Dr Korr is now Dean and Professor at the University of Illinois School of Social Work, Urbana, Ill.Kathleen Hulton, MPH, was Graduate Student Assistant at University of Pittsburgh, Pittsburgh, Pa, during the time of research. Ms Hulton is now with the University of Massachusetts at Amherst, Northampton, Mass.