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1.
Christina Chauvenet Molly De Marco Carolyn Barnes Alice S. Ammerman 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):416-424.e2
Background
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.Objective
This article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.Design
The authors designed and conducted semistructured interviews and focus groups with WIC participants.Participants/setting
A convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).Statistical analysis conducted
Responses were analyzed qualitatively using principles of content analysis.Results
Challenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.Conclusions
Dissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma. 相似文献2.
Brittany J. Johnson Jessica A. Grieger Thomas P. Wycherley Rebecca K. Golley 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):782-798.e6
Background
Excessive consumption of discretionary choices (nutrient-poor foods and beverages) negatively impacts on children’s diet quality and increases the risk of obesity and related chronic conditions. Dietary guidelines are complex, and simple messages based on effective dietary strategies are needed to improve population compliance with dietary guidelines.Objective
This study aimed to quantify the theoretical nutritional impact of dietary strategies targeting a reduction in discretionary choice intake in Australian children aged 2 to 18 years.Design
This study was a computer simulation dietary modeling design.Participants/setting
Participants were Australian children aged 2 to 18 years (n=2,812, population weighted N=4,770,094) from the National Nutrition and Physical Activity Survey 2011-2012.Intervention
Simulations were performed on 24-hour recall dietary intake data to model theoretical impact on nutrient profile of moderating (50% reduction), substituting (replacing 50% of discretionary choices for core foods), and reformulating (reducing target nutrients within products) mean population intake of all discretionary choices.Main outcome measures
The main outcome measures were absolute and percentage change in nutrient profile (energy, saturated fat, added sugars, sodium).Statistical analyses performed
Simulations were performed using percent adjustment calculations and “What If” analyses. Sensitivity analyses were performed adjusting parameter uncertainties.Results
Moderation (energy ?4.8% to ?19.3%, saturated fat ?10.2% to ?24.5%, added sugars ?24.3% to ?43.1%, sodium ?6.4% to ?20.3%) and substitution (energy ?9.4% to ?15.4%, saturated fat ?7.6% to ?22.5%, added sugars ?39.2% to ?42.7%, sodium ?10.8% to ?19.0%) scenarios saw the greatest reductions across energy and target nutrients, with substitution scenarios modeling a smaller impact on protein, fiber, and micronutrients compared with the moderation strategy. The reformulation scenarios showed less theoretical reductions in energy intake (?1.1% to ?12.8%), despite the differences in saturated fat (?27.5%), added sugars (?25.5%), and sodium (?9.1%), between the primary scenarios compared with base case.Conclusions
Dietary strategies to reduce discretionary choices (moderation) or replace them with core (healthy) food group choices (substitution) show good theoretical improvements in energy intake and nutritional profile. Multinutrient reformulation approaches achieve reductions in saturated fat, added sugar, and sodium. To reduce population discretionary choices intake, the dietary strategies can inform policy and food industry and consumer education action. 相似文献3.
Paolo Dionigi Rossi Sarah Damanti Carolina Nani Mauro Pluderi Giulio Bertani Daniela Mari Matteo Cesari Dario Consonni Diego Spagnoli 《Journal of the American Medical Directors Association》2019,20(3):373-376.e3
Objectives
To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.Design
Prospective, monocentric, pilot study.Setting
University hospital.Participants
Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention.Intervention
Repeated CSF taps.Measurements
All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded.Results
No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption.Conclusions/Implications
Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients. 相似文献4.
Susan M.H. Gills Garry Auld Ann Hess Susan S. Baker 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):500-506
Background
The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls.Objective
To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN.Design
Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour.Participants and setting
The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states.Main outcome measures
The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups.Statistical analysis performed
Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement.Results
No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first.Conclusion
The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development. 相似文献5.
Allison M. Lacko Barry M. Popkin Lindsey Smith Taillie 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):400-415
Background
Despite interventions to improve the nutrition of grocery store purchases, also referred to as at-home (AH) foods, by participants in the Supplemental Nutrition Program (SNAP), little is known about what proportion of participants’ intake is from AH foods and how the dietary quality of AH food compares with participants’ away-from-home (AFH) food. Although recent research indicates SNAP participants have dietary quality that is slightly worse than that of income-eligible nonparticipants, it is unknown whether this is attributable to AH or AFH consumption.Objective
The objective of this study is to examine differences in self-reported dietary intake by food source for SNAP participants compared with income-eligible nonparticipants using 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES).Design
This study included data from the NHANES, a cross-sectional, nationally representative survey of the United States population.Study participants
This study included 2,523 adults with low incomes (≤130% of the federal poverty level) in NHANES (2011-2014).Main outcome measures
Self-reported intake of calories, solid fats, added sugars, and servings of nonstarchy vegetables, whole fruits, and whole grains was assessed by food source in SNAP participants and income-eligible nonparticipants.Statistical analysis
Multivariate linear regression was used for each outcome, controlling for relevant sociodemographic characteristics. Data were stratified by food source, including grocery stores, sit-down restaurants, and fast food.Results
SNAP participants had a higher intake of solid fats and added sugar from AH foods than nonparticipants. Added sugar from AH food accounted for 15.3% of total calories consumed by SNAP participants, compared with 11.8% for nonparticipants (P<0.001). SNAP participants consumed fewer calories from sit-down restaurants, but both groups consumed similar amounts of calories from fast food. Consumption of nonstarchy vegetables, whole fruits, and whole grains was low for both groups.Conclusions
SNAP participants had poorer diet quality from consumption of AH food than did nonparticipants. Future research should focus on interventions to improve the healthfulness of grocery store purchases as a mechanism to improve dietary quality of SNAP participants. 相似文献6.
7.
Teresa Botigué Olga Masot Jèssica Miranda Carmen Nuin Maria Viladrosa Ana Lavedán Sandra Zwakhalen 《Journal of the American Medical Directors Association》2019,20(3):317-322
Objective
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors.Design
This was a cross-sectional study.Setting and Participants
The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years.Measures
Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected.Results
Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio.Conclusions/Implications
The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes. 相似文献8.
Thierry Bautrant Michel Grino Corinne Peloso Frédéric Schiettecatte Magali Planelles Charles Oliver Caroline Franqui 《Journal of the American Medical Directors Association》2019,20(3):377-381
Objectives
To determine whether environmental rearrangements of the long-term care nursing home can affect disruptive behavioral and psychological symptoms of dementia (BPSD) in residents with dementia.Design
Prospective 6-month study.Setting
The study was conducted before (phase 1) and after (phase 2) environmental rearrangements [skylike ceiling tiles in part of the shared premises, progressive decrease of the illuminance at night together with soothing streaming music, reinforcement of the illuminance during the day, walls painted in light beige, oversized clocks in corridors, and night team clothes color (dark blue) different from that of the day team (sky blue)].Participants
All of the patients (n = 19) of the protected unit were included in the study. They were aged 65 years or older and had an estimated life expectancy above 3 months.Measures
Number and duration of disruptive BPSD were systematically collected and analyzed over 24 hours or during late hours (6:00-12:00 pm) during each 3-month period.Results
There was no significant change in the patients' dependency, risk of fall, cognitive or depression indexes, or treatment between phase 1 and 2. Agitation/aggression and screaming were observed mainly outside the late hours as opposed to wandering episodes that were noticed essentially within the late hours. The number of patients showing wandering was significantly lower over 24 hours during phase 2. The number of agitation/physical aggression, wandering, and screaming and the mean duration of wandering episodes were significantly (P = .039, .002, .025, and .026 respectively) decreased over 24 hours following environmental rearrangements. Similarly, a significant reduction in the number and mean duration of wandering was noticed during the late hours (P = .031 and .007, respectively).Conclusions
Our study demonstrates that BPSD prevalence can be reduced following plain environmental rearrangements aimed at improving spatial and temporal orientation. 相似文献9.
Angela R. Fertig Katie A. Loth Amanda C. Trofholz Allan D. Tate Michael Miner Dianne Neumark-Sztainer Jerica M. Berge 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):818-830
Background
Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families.Objective
The present study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients than pre-prepared meals.Design
Data for the study came from the National Institutes of Health–funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an 8-day observation window.Participants/setting
In this study, investigators followed 150 families with children aged 5 to 7 years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota.Main outcome measures
The main outcomes were participants’ self-reports of whether they served fruits, vegetables, and whole grains at a meal, and reports were made within hours of the meal.Statistical analyses performed
Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner, or a snack and whether it was a weekend meal.Results
For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (P<0.001). Meals that were partly home-cooked were the most likely to contain whole grains (P<0.001). Restaurant meals were more likely to contain vegetables than pre-prepared meals (P<0.001) but were equally likely to contain fruits and/or whole grains as pre-prepared meals.Conclusions
Interventions or initiatives that encourage fully or partly home-cooked meals may help families incorporate nutritious foods into their diets. In addition, evaluations of potential strategies to increase the likelihood of supplementing pre-prepared and restaurant meals with nutritious meal ingredients warrants further investigation. 相似文献10.
Amanda Walch Philip Loring Rhonda Johnson Melissa Tholl Andrea Bersamin 《Journal of nutrition education and behavior》2019,51(3):318-325
Objective
To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women.Design
Cross-sectional study that measured traditional food intake; participation in food-sharing networks; presence of a hunter or fisherman in the home; the preference, healthfulness, and economic value of traditional foods; and financial barriers to obtaining these foods.Participants
Purposive sample of 71 low-income Alaska Native women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance in Anchorage, AK.Analysis
Bivariate and multivariate regression analyses.Results
Traditional foods contributed 4% of total daily calories. Given a choice, 63% of participants indicated that they would prefer half or more of the foods they ate to be traditional (ie, not store-bought). The majority of participants (64%) believed that traditional foods were healthier than store-bought foods. Of all participants, 72% relied on food-sharing networks for traditional foods; only 21% acquired traditional foods themselves. Participants who ate more traditional foods preferred traditional foods (B?=?.011 P?=?.02).Implications for Research and Practice
Traditional food intake was low and findings suggested that Alaska Native women living in an urban setting prefer to consume more but are unable to do so. Future research might examine the effect of enhancing social networks and implementing policies that support traditional food intake. 相似文献11.
12.
Colleen M. Heflin Claire E. Altman Laura L. Rodriguez 《Disability and health journal》2019,12(2):220-226
Background
Households with a disabled adult are disproportionately food insecure, yet the mechanisms linking food insecurity to disability are under-specified.Objective
To develop and empirically examine a model of the potential pathways connecting specific types of disability with food insecurity.Methods
With pooled, repeated cross-sectional National Health and Nutrition Examination Survey data (1999–2014) including 38,354 participants, we ran probit models to estimate the probability of being food insecure as a function of different sets of disability measures and our control variables. We explored the extent to which these patterns differed for prime-aged individuals (19–59) from those age 60 and older.Results
Work-limiting disabilities, functional limitations, and trouble managing money were associated with an increased likelihood of food insecurity for both prime-aged and older individuals, net of other forms of disability. Mobility limitations, trouble seeing, and trouble hearing increased the likelihood of food insecurity for prime-aged individuals only.Conclusion
These findings suggest that disabilities are associated with food insecurity through multiple pathways. Revised public health and policy solutions are needed to address the high rates of food insecurity among those with disabilities. 相似文献13.
Matthew J. Landry Fiona M. Asigbee Sarvenaz Vandyousefi Erfan Khazaee Reem Ghaddar Jessica B. Boisseau Benjamin T. House Jaimie N. Davis 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):760-768
Background
No studies have assessed the relationship between diet quality, using the Healthy Eating Index (HEI), and adiposity, physical activity, and metabolic disease risk factors in a Hispanic college population.Objective
To assess associations between diet quality and adiposity, metabolic health, and physical activity levels in a Hispanic college freshman population.Design
This was a cross-sectional study. Measurements were obtained during a 4-hour in-person visit and included demographic information via questionnaire, height, weight, waist circumference, body mass index, body fat via BodPod, hepatic fat, visceral adipose tissue (VAT) and subcutaneous adipose tissue via magnetic resonance imaging, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and lipids via blood draw from fasting subjects, physical activity (ie, step counts per day and time spent in different intensity levels) via 7-day accelerometry, and dietary intake via three to four 24-hour dietary recalls. Dietary quality was calculated using the HEI-2015.Participants/setting
Hispanic college freshmen (n=92), 18 to 19 years, 49% male, who were enrolled at University of Texas at Austin from 2014 to 2015.Main outcome measures
Main outcome measures were diet quality and adiposity, metabolic health, and physical activity levels.Statistical analyses performed
Linear regressions determined if dietary quality is related to adiposity, metabolic, and physical activity outcomes. A priori covariates included sex, body fat, and body mass index percentile (for metabolic models), and moderate and vigorous physical activity (MVPA, for adiposity and metabolic models).Results
The average HEI-2015 total score was 54.9±13.4. A 1-point increase in HEI score was associated with 1.5 mL lower VAT (P=0.013); 8 minutes per day higher light activity (P=0.008), and 107 more step counts per day (P=0.002); and 0.10 μg/mL lower insulin (P=0.046) and 0.5 U lower HOMA-IR (P<0.001).Conclusion
Results suggest that small improvements in diet quality may be positively associated with a reduction in metabolic disease risk, during a critical time period in a young person’s life. 相似文献14.
Anupam Chandra Parvez A. Rahman Amelia Sneve Rozalina G. McCoy Bjorg Thorsteinsdottir Rajeev Chaudhry Curtis B. Storlie Dennis H. Murphree Gregory J. Hanson Paul Y. Takahashi 《Journal of the American Medical Directors Association》2019,20(4):444-450.e2
Objectives
Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF.Design
Retrospective cohort study.Setting
Ten independent SNFs affiliated with the post-acute care practice of an integrated health care delivery system.Participants
We evaluated 6032 patients who were discharged to SNFs for post-acute care after hospitalization.Measurements
The primary outcome was all-cause 30-day hospital readmission. Patient demographics, medical comorbidity, prior use of health care, and clinical parameters during the index hospitalization were analyzed by using gradient boosting machine multivariable analysis to build a predictive model for 30-day hospital readmission. Area under the receiver operating characteristic curve (AUC) was assessed on out-of-sample observations under 10-fold cross-validation.Results
Among 8616 discharges to SNFs from January 1, 2009, through June 30, 2014, a total of 1568 (18.2%) were readmitted to the hospital within 30 days. The 30-day hospital readmission prediction model had an AUC of 0.69, a 16% improvement over risk assessment using the Charlson Comorbidity Index alone. The final model included length of stay, abnormal laboratory parameters, and need for intensive care during the index hospitalization; comorbid status; and number of emergency department and hospital visits within the preceding 6 months.Conclusions and implications
We developed and validated a risk-prediction model for 30-day hospital readmission in patients discharged to a SNF for post-acute care. This prediction tool can be used to risk stratify the complex population of hospitalized patients who are discharged to SNFs to prioritize interventions and potentially improve the quality, safety, and cost-effectiveness of care. 相似文献15.
Jennifer L. Schwartz Jacqueline A. Vernarelli 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):482-489
Background
The Dietary Guidelines for Americans (DGA) provide a framework for food and nutrition programming in the United States as well as the foundation for individualized dietary guidance. Public utilization of the DGA, specifically the MyPyramid or MyPlate tool, is not well studied.Objective
The objective of this study was to evaluate the relationship between public knowledge of the 2010 DGA assessed by use of the MyPyramid or MyPlate dietary plan and various markers of diet intake (including dietary energy density and Food Patterns Equivalents Database component scores) in US adults.Design
The National Health and Nutrition Examination Survey (NHANES) is a large, cross-sectional survey conducted continuously to monitor the health and nutritional status of US residents. The sampling design of NHANES allows for collection of a nationally representative sample.Participants/setting
Data from a nationally representative sample of 3,194 adults>18 years with 1 complete day of dietary recall data during the 2011-2014 NHANES were used for this study. During NHANES, participants were asked about knowledge and use of the MyPyramid or MyPlate plan.Main outcome measures
Mean daily dietary intake was compared between MyPyramid or MyPlate users and nonusers.Statistical analyses performed
Multivariable regression models were then used to evaluate the relationship between use of MyPlate or MyPyramid and various food pattern components consumed daily. Models were adjusted for age, sex, race or ethnicity, education, household size, family income (using NHANES-provided poverty-to-income ratio), smoking status, beverage energy density, and physical activity.Results
Subjects who reported using the MyPyramid or MyPlate plan had better diets than subjects who had not tried the MyPyramid or MyPlate plan. Users of MyPyramid or MyPlate had significantly lower dietary energy density (1.8 vs 1.9 kcal/g, P=0.0003) and significantly fewer servings of refined grains (5.9 vs 6.5 oz equivalents, P=0.0007) but more servings of whole grains (1.1 vs 0.8 oz equivalents, P=0.007), more dark green and leafy vegetables (P=0.006), and lower intake of added sugars (18 vs 21 tsp, P=0.0005) and solid fats (34 vs 39 g, P<0.0001) after adjusting for age, sex, race or ethnicity, education, household size, family income (using NHANES-provided poverty-to-income ratio), smoking status, beverage energy density, and physical activity.Conclusion
In this nationally representative sample, reported use of MyPyramid or MyPlate was associated with more healthful dietary intakes. Future intervention studies are needed to explore facilitators and barriers for using MyPlate as well as the impact of MyPlate use on dietary intake behaviors. 相似文献16.
Juliana P. Antonio Roberta A. Sarmento Jussara C. de Almeida 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):652-658
Background
The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control.Objective
To evaluate the relationship between diet quality and glycemic control.Design
Cross-sectional study with consecutive enrollment from 2013 to 2016.Participants
Outpatients with type 2 diabetes treated at a university hospital in southern Brazil.Main outcome measures
Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin.Statistical analyses
A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake.Results
A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group.Conclusions
Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes. 相似文献17.
Gretchen A. Benson Abbey Sidebottom Joy Hayes Michael D. Miedema Jackie Boucher Marc Vacquier Arthur Sillah Safa Gamam Jeff J. VanWormer 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):585-598
Background
Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.Objective
To investigate the efficacy of a registered dietitian nutritionist–led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.Design
A randomized controlled trial in which participants were assigned to a control or intervention group.Participants/setting
One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.Intervention
For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.Main outcome measures
Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.Statistical analysis
Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.Results
A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.Conclusions
ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care. 相似文献18.
Jose M. Cancio Emili Vela Sebastià Santaeugènia Montse Clèries Marco Inzitari Domingo Ruiz 《Journal of the American Medical Directors Association》2019,20(4):456-461
Objectives
To assess the impact of hip fracture (HF) on health care expenditures and resource use.Design
Observational, retrospective study. An administrative registry was used to obtain sociodemographic, clinical, and expenditure data of patients treated in centers all over Catalonia (North-East Spain).Setting and participants
Male and female patients aged 65 years or older admitted to a Catalonian hospital due to hip fracture (HF) between January 1 2012, and December 31, 2016.Measures
The study data set included the expenditure and frequency of using nonemergency transport, rehabilitation, skilled nursing facility, specialist visits, admissions to the emergency department, hospitalization, pharmacy, and primary care. The patient status at each time point included living at home, staying in hospital, staying in a skilled nursing facility, institutionalized in a nursing home, and death.Results
The record included 38,628 patients (74.4% female) with a mean [standard deviation (SD)] age of 84.9 (7.07) years. The average expenditure per patient during the first year after hospital admission was €11,721.06, the index hospitalization being the leading expenditure (€4740.29). Expenditures related to hospitalization and skilled nursing facility remained higher than preinjury throughout the 3 years following HF. Three years after the index admission, 44.9% of patients had died, 39.7% were living in their homes, 14.2% were in a nursing home, 0.9% were in a skilled nursing facility, and 0.3% were in hospital. The expenditure of hospitalizations, primary care, and visits to the emergency department increased few months before the HF.Conclusions
In patients hospitalized for HF, the expenditure per patient decreases after hospital discharge but the use of healthcare resources is not restored to preinjury values. The increase of expenditures associated with primary care services, hospitalization, and emergency department services during the few months preceding hospital admission suggests a decline of health status in these patients. 相似文献19.
Background
This research deals with the way people create discourses around disability, which shape the community's concept of disability.Objective
The purpose of this article is to find out how the community configures "disability", in particular by understanding the ideas, needs and strategies that the community uses towards people with disabilities. Specifically, different roles have been involved, such as professionals, volunteers, family members and citizens. The final aim is intervening on the discourses that can contrast the full personal fulfilment of people with disabilities and social inclusion.Methods
This paper relates to discursive psychology's theoretical references and makes use of the Methodology of Textual Analysis. The tools we used include investigation protocols specially designed to detect text both through manual "pencil and paper" and computerized denominations.Results
The results show that those who are in direct contact with people with disabilities (volunteers and family members) are more exposed to treating them as disabled, making the deficit coincide with the person and also have a more judgemental approach.Conclusions
From the results obtained we can see which practices can be activated to facilitate the network between the various roles in order to implement inclusive interventions and help those more exposed to prejudices. 相似文献20.
Hanna-Maria Roitto Hannu Kautiainen Ulla L. Aalto Hannareeta Öhman Jouko Laurila Kaisu H. Pitkälä 《Journal of the American Medical Directors Association》2019,20(3):305-311