共查询到20条相似文献，搜索用时 46 毫秒
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Deana A. Hildebrand Priscilla Blevins Lillian Carl Barbara Brown Nancy M. Betts Tiffany Poe 《Journal of nutrition education and behavior》2018,50(2):118-124.e1
Objective
Use the Community Readiness Model (CRM) to develop and evaluate a contextually appropriate pilot culinary training program for school nutrition staff members.Design
Mixed methods to guide intervention development.Settings
Six school districts in rural and urban areas of a southwestern state.Participants
School nutrition staff (n = 36; female; <1 to >20 years' experience).Intervention
Pre- and post-training assessments used the CRM. Findings from the pre-assessment were used to develop the pilot culinary training intervention.Main Outcome Measure
Readiness to integrate new food preparation methods into existing practices.Analysis
The researchers used t and Wilcoxon tests to compare overall readiness and dimension scores (P ≤ .05). Thematic analysis was used to identify themes from the discussion component of the assessments.Results
Overall readiness increased from vague awareness to preparation (P = .02). Improved dimensions were knowledge of efforts (P = .004), leadership (P = .05), and knowledge of issues (P = .04). Themes included barriers, leadership, and motivation.Conclusions and Implications
The CRM was useful for developing and evaluating a contextually appropriate and effective culinary training program for school nutrition staff. Future efforts should address the provision of additional resources such as on-site chefs, small equipment grants, and engaging school stakeholders. 相似文献6.
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Wendy Demark-Wahnefried Mallory G. Cases Alan B. Cantor Andrew D. Frugé Kerry P. Smith Julie Locher Harvey J. Cohen Yuko Tsuruta Michael Daniel Rishabh Kala Jennifer F. De Los Santos 《Journal of the Academy of Nutrition and Dietetics》2018,118(4):689-704
Background
Holistic approaches are sought to improve lifestyle behaviors and health of cancer survivors long term.Objective
Our aim was to explore whether a home-based vegetable gardening intervention is feasible and whether it improves diet and other health-related outcomes among older cancer survivors.Design
We conducted a feasibility trial in which cancer survivors were randomized to receive a year-long gardening intervention immediately or to a wait-list control arm. Home visits at baseline and 1 year assessed physical performance, anthropometric indices, behavioral and psychosocial outcomes, and biomarkers.Participants/setting
Participants included 46 older (aged 60+ years) survivors of locoregionally staged cancers across Alabama from 2014 to 2016. Forty-two completed 1-year follow-up.Intervention
Cooperative extension master gardeners delivered guidance to establish three seasonal vegetable gardens at survivors’ homes. Plants, seeds, and gardening supplies were provided.Outcomes
Primary outcomes were feasibility targets of 80% accrual and retention, and an absence of serious adverse events; other outcomes were secondary and explored potential benefits.Statistical analyses
Baseline to follow-up changes were assessed within and between arms using paired t, McNemar’s, and χ2 tests.Results
This trial proved to be safe and demonstrated 91.3% retention; 70% of intervention participants rated their experience as “excellent,” and 85% would “do it again.” Data suggest significantly increased reassurance of worth (+0.49 vs ?0.45) and attenuated increases in waist circumference (+2.30 cm vs +7.96 cm) in the gardening vs control arms (P=0.02). Vegetable and fruit consumption increased by approximately 1 serving/day within the gardening arm from baseline to follow-up (mean [standard error]=1.34 [1.2] to 2.25 [1.9] servings/day; P=0.02)] compared to controls (1.22 [1.1] to 1.12 [0.7]; P=0.77; between-arm P=0.06).Conclusions
The home vegetable gardening intervention among older cancer survivors was feasible and suggested improvements in vegetable and fruit consumption and reassurance of worth; data also suggest attenuated increases in waist circumference. Continued study of vegetable gardening interventions is warranted to improve health, health behaviors, and well-being of older cancer survivors. 相似文献8.
Jennifer N. Hill Salva Balbale Keshonna Lones Sherri L. LaVela 《Disability and health journal》2017,10(1):114-122
Background
Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them.Objectives/hypothesis
We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning.Methods
Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data.Results
Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of ‘normalcy,’ aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip.Conclusion(s)
Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of “normality,” facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans. 相似文献9.
John E. Morley Hidenori Arai Li Cao Birong Dong Reshma A. Merchant Bruno Vellas Renuka Visvanathan Jean Woo 《Journal of the American Medical Directors Association》2017,18(6):489-494
Background
Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.Objectives
To identify simple screening programs available for primary health professionals to identify geriatric syndromes.Data sources
PubMed for the last 5 years and study authors.Results
A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.Limitations
This is an evolving area with limited information on the outcomes of intervention and possible harms.Conclusion
Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons. 相似文献10.
Ruth M. Tappen David Newman Peter Huckfeldt Zhiyou Yang Gabriella Engstrom David G. Wolf Jill Shutes Carolina Rojido Joseph G. Ouslander 《Journal of the American Medical Directors Association》2018,19(10):907-913.e1
Background
Medicare incentivizes the reduction of hospitalizations of nursing facility (NF) residents. The effects of these incentives on resident safety have not been examined.Objective
Examine safety indicators in NFs participating in a randomized, controlled trial of the INTERACT Quality Improvement Program.Design
Secondary analysis of a randomized trial in which intervention NFs exhibited a statistically nonsignificant reduction in hospitalizations.Setting
NFs with adequate on-site medical, radiography, laboratory, and pharmacy services, and capability for online training and data input were eligible.Participants
264 NFs randomized into intervention and comparison groups stratified by previous INTERACT use and self-reported hospital readmission rates.Intervention
NFs randomized to the intervention group received INTERACT materials, access to online training and a series of training webinars, feedback on hospitalization rates and root-cause analysis data, and monthly telephonic support.Measures
Minimum data set (MDS) data for unintentional weight loss, malnutrition, hip fracture, pneumonia, wound infection, septicemia, urinary tract infection, and falls with injury for the intervention year and the year prior; unintentional weight loss, dehydration, changes in rates of falls, pressure ulcers, severe pain, and unexpected deaths obtained from the NFs participating in the intervention through monthly telephone calls.Results
No adverse effects on resident safety, and no significant differences in safety indicators between intervention and comparison group NFs were identified, with 1 exception. Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain.Conclusions/Implications
Resident safety was not compromised during implementation of a quality improvement program designed to reduce unnecessary hospitalization of NF residents. 相似文献11.
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Iván De-Rosende Celeiro Sergio Santos-del-Riego Javier Muñiz García 《Disability and health journal》2017,10(1):145-151
Background
Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown.Objectives
The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants.Methods
This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week.Measures
Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status.Results
The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status.Conclusions
Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status. 相似文献13.
Julie Chor Sarah Garcia-Ricketts Danielle Young Luciana E. Hebert Lee A. Hasselbacher Melissa L. Gilliam 《Women's health issues》2018,28(5):387-392
Objectives
This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.Methods
We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12 months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti.Results
Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient–provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support.Conclusions
Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care. 相似文献14.
Nicole Larson Qi Wang Katherine Grannon Susan Wei Marilyn S. Nanney Caitlin Caspi 《Journal of nutrition education and behavior》2018,50(2):125-132.e1
Objective
Evaluate the impact of a grab-and-go component embedded within a larger intervention designed to promote School Breakfast Program (SBP) participation.Design
Secondary data analysis.Setting
Rural Minnesota high schools.Participants
Eight schools were enrolled in the grab-and-go only intervention component. An at-risk sample of students (n = 364) who reported eating breakfast ≤3 d/wk at baseline was enrolled at these schools.Interventions
Grab-and-go style breakfast carts and policies were introduced to allow all students to eat outside the cafeteria.Main Outcome Measures
Administrative records were used to determine percent SBP participation (proportion of non-absent days on which fully reimbursable meals were received) for each student and school-level averages.Analysis
Linear mixed models.Results
School-level increases in SBP participation from baseline to the school year of intervention implementation were observed for schools enrolled in the grab-and-go only component (13.0% to 22.6%). Student-level increases in SBP participation were observed among the at-risk sample (7.6% to 21.9%) and among subgroups defined by free- or reduced-price meal eligibility and ethnic or racial background. Participation in SBP increased among students eligible for free or reduced-price meals from 13.9% to 30.7% and among ineligible students from 4.3% to 17.2%.Conclusions and Implications
Increasing access to the SBP and social support for eating breakfast are effective promotion strategies. 相似文献15.
Alison C. Spence Karen J. Campbell Sandrine Lioret Sarah A. McNaughton 《Journal of the Academy of Nutrition and Dietetics》2018,118(9):1634-1643.e1
Background
Dietary intakes of young children are likely to be important determinants of their short- and long-term health, yet there are few longitudinal dietary studies of this age group, and no previous assessments of diets before age 2 years compared with national dietary guidelines.Objective
This study aimed to compare vegetable, fruit, and discretionary food intakes of children aged 9 months to 5 years to dietary guidelines, and to assess differences in intakes by socioeconomic status and tracking of intakes across early childhood.Design
This study analyzed longitudinal data from the Melbourne Infant Feeding Activity and Nutrition Trial Program early childhood lifestyle intervention trial, and is the first study to compare diets of children younger than age 2 years to national dietary guidelines.Participants/setting
Participants were 467 children in Melbourne, Australia, aged 4 months at baseline (study conducted 2008-2015).Main outcome measures
Multiple 24-hour recalls with parents were conducted at child ages 9 months, 1.5 years, 3.5 years, and 5 years.Statistical analyses performed
Intakes of vegetables, fruits, and discretionary foods were compared with Australian Dietary Guidelines. Differences by socioeconomic status and tracking of intakes of each food group were assessed by multivariable linear regression.Results
Few children (<10%) met guidelines for discretionary food intakes at any age. Most children (≥90%) met vegetable and fruit guidelines at 9 months, but thereafter rates of adequate intakes reduced substantially. Children of higher socioeconomic status consumed diets closer to guidelines for most food groups at most ages. Tracking of intakes was apparent across ages, with the strongest and most consistent tracking for discretionary foods.Conclusions
This study shows that diets of Australian children participating in this lifestyle intervention trial were suboptimal from early life. The evidence of differences by socioeconomic status and tracking from age 9 months, particularly for discretionary foods, highlights the importance of research and action to support appropriate introduction of complementary foods during the first year of life, and of focusing these efforts on disadvantaged groups. 相似文献16.
Heidi J. Silver Kelsey Jones Pratt Michelle Bruno Joe Lynch Kristi Mitchell Sharon M. McCauley 《Journal of the Academy of Nutrition and Dietetics》2018,118(1):101-109
Background
Malnutrition is present in 30% to 50% of hospitalized patients aged 60 years or older. As few as 3.2% of patients identified as high risk have a malnutrition diagnosis documented by medical providers. The Malnutrition Quality Improvement Initiative (MQii) aims to reduce the burden of hospital malnutrition by improving the process and delivery of care.Objective
To evaluate implementing the MQii toolkit of best practice resources for screening, diagnosis, documentation, and timeliness of malnutrition care.Design
This 6-month prospective pilot included a 3-month intervention with training and education modules tailored to type of practitioner and integrated into existing teaching and clinical workflow.Participants/setting
Forty-five health care professionals from geriatric, general medicine, and general surgery units at Vanderbilt University Hospital during January to June 2016.Main outcome measures
Malnutrition knowledge by 30-item questionnaire; electronic medical record (EMR) documentation; and timeliness of malnutrition screening, diagnosis, intervention, and discharge planning.Statistical analyses
Analysis of variance was used to test change over time.Results
Malnutrition knowledge score increased 14%, from 39% to 53% (P=0.009). All patients whose nutrition screen indicated they were malnourished/high risk had registered dietitian nutritionist diagnosis of malnutrition documented in the EMR. The proportion who had medical provider (physician, nurse practitioner, or physician assistant) malnutrition diagnosis documented in the EMR increased 11.6%, from 26.7% to 38.3% (P=0.08). About 95% of malnourished/high risk patients had a documented intervention addressing malnutrition. Inclusion of malnutrition care in the discharge plan increased 4.8%, from 70.0% to 74.8% (P=0.13).Conclusions
This pilot study demonstrated feasibility of implementing the MQii resources to improve malnutrition knowledge and professionals’ skills relevant to screening, diagnosis, intervention, and timeliness of malnutrition care. By optimizing the process and delivery of malnutrition care, it is expected that the quality of clinical care provided to older adults with malnutrition or at high malnutrition risk will improve. 相似文献17.
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Background
Empathic care is fundamental in healthcare settings and is associated to several positive outcomes for care workers (i.e. burnout, compassion satisfaction) and patients (i.e. therapeutic alliance, trust, wellbeing). Yet, studies showed a decrease in empathy in care workers, which is argued to be a product of personal distress. Thus, interventions should aim at enhancing empathy in care workers working for vulnerable populations to ensure optimal client-carer relationships.Objectives
The current study investigates the effectiveness of the serious game “The world of EMPA” in enhancing empathy in care workers for people with disabilities, and tests the effect of personal distress on empathy change post intervention.Methods
We conducted a superiority parallel randomized controlled trial (RCT) and tested 224 participants in two conditions: the experimental group (n?=?111) played a serious game and the control group (n?=?113) read a digital information package about disabilities. Participants were assessed on empathy and personal distress prior to and after the intervention.Results
Main results showed that the serious game did not significantly enhance empathy in care workers, whereas reading a digital information package yield a significant decrease in empathy. Exploratory analysis showed that the serious game decreased significantly personal distress in care-workers.Conclusions
This study showed that while the serious game “The world of EMPA” did not enhance empathy, it resulted in a decrease in personal distress in care workers for people with disabilities. Further evidence should corroborate these findings to unveil the mechanisms of this intervention and the long-term effects on personal distress. 相似文献19.
Jean Woo Ruby Yu Jason Leung 《Journal of the American Medical Directors Association》2018,19(3):223-228
Objectives
To examine individual items of the SARC-F in predicting adverse outcomes.Design
Prospective cohort study.Setting
Community-dwelling older people in Hong Kong SAR China.Participants
A total of 4000 men and women aged 65 years and over, stratified in 3 age groups (65–69, 70–74, 75+ years of age).Measurements
Information was collected by questionnaire, on sociodemographic details, lifestyle habits, cognitive function using the Mini-Mental State Examination, depression using the Geriatric Depression Scale, SARC-F, and physical limitation in daily activities. Physical performance measures include chair stand and walking speed. Adverse outcomes included physical limitation, lower limb strength using repeated chair stands, slow walking speed, length of hospital stay, and mortality. Predictive ability of each item of the SARC-F was assessed using receiver operating characteristic curve. Stepwise model was used to assess incremental predictive ability.Results
The overall ranking of the questions in order of highest predictability in terms of area under the curve values were strength, climb stairs, assistance in walking, rise from a chair, and falls. The first 3 questions individually predicted all the adverse outcomes, and in stepwise models of the individual questions, a combination of these 3 questions gave the highest area under the curve values.Conclusions
The 5-item SARC-F may be shortened to 3 items (strength, climb stairs, and assistance in walking) in rapid screening for sarcopenia in clinical practice. 相似文献20.
Adam Whitworth 《Disability and health journal》2018,11(4):568-575