Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.     

Body Fat Percentage of Children Varies According to Their Diet Composition

Objective To ascertain the association between diet composition and body fat percentage in 9- and 10-year-old children. Also, to examine the influence of gender, total energy intake, fitness, physical activity, and parental body mass on the relationship between diet composition and adiposity.Design Diet composition was assessed using the National Cancer Institute food frequency questionnaire, and adiposity was measured using the average of results determined using two skinfold equations. Fitness levels and physical activity were ascertained using the 1-mile run/walk test and a self-report 15-item scale, respectively.Subjects A sample of 262 children (162 boys and 100 girls, mean age=9.8±0.5 years) participated.Statistical analysis Regression analysis was used to determine the extent to which diet composition contributed to adiposity without statistical control for any potentially confounding variables. Partial correlations were calculated to assess the relationship between macronutrient intake and adiposity after potential confounders (gender, total energy intake, physical fitness, and parental body mass) were controlled statistically.Results Energy intake was positively related to adiposity. Fat intake, calculated as a percentage of total energy, was also positively related to adiposity, before and after control for potential confounding variables. Percentage of energy derived from carbohydrate was inversely related to adiposity, before and after controlling for potential confounders.Applications These findings indicate that the macronutrient intake of children, particularly dietary fat and carbohydrate intake, may play a role in adiposity, independent of the influence of total energy intake, gender, physical fitness, and parental body mass index.     

Influences on the Selection of Dietetics as a Career

Objective To gather information on the factors that influence students’ decisions to choose dietetics as a career.Design Self-administered questionnaires regarding the point at which career decisions were made were completed by 1,695 students in Plan IV/V dietetics programs throughout the United States.Subjects All Plan IV/V dietetics programs that reported greater than five graduates in the academic year 1989 to 1990 were selected from the 1990-1991 Directory of Dietetic Programs for the sample population. Of the 156 schools that were mailed questionnaires, responses were received from 84 schools (54%). Almost 90% of the students were women, 10.6% were men.Statistical analyses Data were analyzed using the Statistical Package for the Social Sciences. A χ² analysis was used to examine the relationship between point of decision and factors that influenced career choice, including people who influence career choice.Results The majority of students (55%) questioned reported making their career decision in college. Students rated interest in nutrition (96.3%) and job enjoyment (93.8%) as factors that were important in their decision to pursue a career in dietetics. College catalogs were rated by 48.3% of the students as being either useful or very useful in helping them make their career selection. With respect to gender differences, women rated a diverse work environment as being very important to their career decision more frequently than men (χ²=15.44, P<.01). Women were more likely than men to rate part-time work opportunities as being very important (χ²=26.75, P<.001); and selected working with people as being very important to their career decision (χ²=17.59, P<.01).Conclusions Findings identified that recruitment strategies need to be audience specific. Because career decision making appears to occur during one of three time frames (high school, college, or work experience), recruitment activities should be developed to specifically target students at these times. One way to increase the exposure of students to the profession of dietetics is for registered dietitians to give guest lectures in introductory college courses and high school upper-class courses in health, home economics, and biology. The use of university/college catalogs as effective marketing tools should also not be underestimated.Data suggest that gender differences exist in factors that influence persons to choose dietetics as a career. To increase the number of men who pursue careers in dietetics, future research should be designed to more fully explore gender differences, so that strategies to recruit more men into the profession can be developed. J Am Diet Assoc. 1997: 97;254–257.     

The induction of operational tolerance is not prevented by simultaneous administration of cyclosporin A1

In this study, the effect of combining anti-CD4 monoclonal antibody (mAb) and cyclosporin (CyA) therapy at the time of transplantation was examined. A mouse cardiac allograft model was used. Anti-CD4 mAb administered perioperatively induces long-term survival. The addition of a short course of CyA given subcutaneously in a regimen of either a high-dose treatment or a standard dose treatment to the anti-CD4 mAb treatment protocol did not have a detrimental effect on graft survival. Despite having no significant effect on graft survival, the addition of CyA to the treatment protocol did result in a significant decrease in the level of IL-2 present in the hearts 7 days after transplantation. The decrease in IL-2 production was directly related to the presence of CyA in vivo. When CyA treatment was continued throughout the period during which unresponsiveness to the graft is induced by anti-CD4 mAb therapy, 50 % of the grafted hearts were rejected once the CyA was discontinued. In conclusion, the combined use of anti-CD4 mAb therapy and CyA did not have a negative effect on graft survival in this model when the two agents were used concurrently at the time of transplantation. Received: 2 October 1996 Received after revision: 31 January 1997 Accepted: 5 February 1997     

Genetics: Changing Health Care in the 21st Century

Advances in human genetics are rapidly changing the scope of information and care that can be provided to health care consumers. By the year 2005 it is expected that the entire human genome will be mapped and all 70,000–100,000 genes will be identified. Currently, there are more than 5,000 known single-gene disorders. With the movement of specialized health services into the primary care setting, nurses increasingly will need to be knowledgeable about genetic disorders, screening/diagnostic tests, and implications for health care. In addition, the management of genetic information raises issues of informed consent, privacy and confidentiality, truth telling and disclosure, and nondiscrimination.