147 terms

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systematic review
summary of the best available research on a specific question; a synthesis of the results of several studies
meta-analysis
a systematic review with quantitative pooling of data; a statistical process that combines the findings from individual studies
randomized control trial
a study design in which people are allocated randomly to receive one of several clinical interventions, including a placebo/control group; the gold standard of experiments seeking to measure and compare the outcomes after the participants receive the interventions
quasi-experimental trial
an experimental trial that lacks one ore more of the following: random assignment (most common), pre-post test design, treatment/control groups
cross-sectional study
descriptive design in which two similar groups that differ by one variable have their present information recorded at one point in time
when is a cross-sectional design useful?
to look at numerous things at once, to look at the prevalence of something in a given population
case-control study
a design in which the investigator selects cases with a disease and appropriate controls without the disease, and obtains information on past exposure to possible etiologic factors
which study design uses OR, and what is it?
case-control study; ratio of (exposed cases x unexposed controls) / (unexposed cases x exposed controls) or ad/bc
when are case-control studies useful?
rare diseases, there's already a case ascertainment system in place, when funding and time constraints are not compatible with cohort
cohort study
a group of people are followed prospectively and subsequent status evaluations with respect to a disease or outcome are conducted to determine which initial participants' exposure characteristics ("risk factors") are associated with it
cohort
a group of people who share a common characteristic or experience within a defined period
case report/case series
a descriptive study of a single individual (report) or small group (series) in which the possibility of an association between an observed effect and a specific environmental exposure is based on detailed clinical evaluations and histories of the individual(s)
when are case reports/series useful?
when the disease is uncommon and/or the disease is caused exclusively or almost exclusively by a single kind of exposure
National Nutrition Monitoring and Related Research Act: Overall Purpose
(1) unify the planning and coordination of data collection and analysis coordination for the large number of federal agencies that monitor nutrition-related information of the US population
(2) identify health problems/trends, develop program strategies to address those that may be related to diet & public health
National Nutrition Monitoring and Related Research Act: When was it established?
1990
National Nutrition Monitoring and Related Research Act: What organizations carry out the requirements of the act?
USDA & USDHHS with additional representatives of federal agencies
National Nutrition Monitoring and Related Research Act:the responsibilities of the interagency board
develops and implements the program
National Nutrition Monitoring and Related Research Act: responsibilities of the advisory council
provide scientific and technical advice, evaluate program effectiveness
Cognitive Behavioral Theory: Goal
produce changes in the cognitive process to maintain a behavior that needs to change
Cognitive Behavioral Theory: cognitions
thoughts that occur in one's stream of consciousness ("automatic thoughts," "internal dialogue," or "self talk")
Cognitive Behavioral Theory: overview
people's behavior/feelings are influenced by their perception of events or situations, often expressed in internal dialogue; cognitive distortions = negative thoughts that inhibit behavior change; cognitive restructuring modifies the client's thinking and the assumptions and attitudes underlying these cognitions
Transtheoretical Model: Overview + the stages
identifies stages f change that individuals pass through before actualizing a change: precontemplation, contemplation, preparation, action, maintenance
Transtheoretical Model: Precontemplation + How to Handle It
the individual is unaware of under-aware that a problem exists, denies that there is a problem, or is not interested in change; focus on the benefits of change, try to motivate
Transtheoretical Model: Contemplation + How to Handle It
individual is aware of problem and intends to change eventual but has no serious thought or commitment to change; focus on highlighting the pros and overcoming the cons
Transtheoretical Model: Preparation + How to Handle It
individual is more determined to change and intends to take initial action soon but not today (e.g. maybe within 1 mo), small changes may be reported; encourage any small change and facilitate additional ones
Transtheoretical Model: Action
individual attempts to overcomet he problem by actively modifying choices, behaviors, environments, or experiences
Transtheoretical Model: Maintenance
individual consolidates and stabilizes gains made over several months to maintain the new, healthier habits and works to prevent relapse
Transtheoretical Model: Termination
the ultimate goal: changes have been maintained for 5 years
traditional nutrition counseling approach
establish rapport and then implement behavior changes related to the client's problem
activities that facilitate behavior change
(1) frame a message positively to focus on the positive aspects of change, negatively to highlight would could be lost without change
(2) assess & appropriately handle readiness to change
(3) motivational interviewing
(4) goal setting
(5) rewards - praise, improved appearance, better lb values, reduce pain, etc - positive consequences
Motivational Interviewing: Overview
a client-centered approach for increasing the client's readiness to change eating behaviors by guiding rather than directing the client; works well for people reluctant to change
Motivational Interviewing: Principles
(1) express empathy
(2) develop discrepancy
(3) roll with resistance
(4) support self-efficacy
Motivational Interviewing: express empathy
seek to understand the client's feelings and beliefs in a noncritical, nonjudgmental manner; requires careful/reflective listening
Motivational Interviewing: develop discrepancy
discrepancy between present behavior (where the client is) and new behavior (where the client wants to be)
Motivational Interviewing: avoid arguments
prevent the client from feeling defensive and resistant to change
Motivational Interviewing: roll with resistance
acknolwedge reluctance to change and ambivalence are natural and understandable; offer new info or alternatives, or ask client for solutions
Motivational Interviewing: support self-efficacy
a person's belief in his ability to succeed with a specific task; encourage the client by offering to help or seeing the success of others in the same/similar situation (role model)
Motivational Interviewing: how to handle not ready to change - goals
(1) facilitate the client's ability to consider change
(2) identify and reduce the client's resistance and barriers to change
(3) identify behavioral steps toward change that are tailored to each client's needs
Motivational Interviewing: hot to handle not ready to change - strategies
(1) ask open-ended questions so the client can express a wider range of ideas
(2) use reflective listening to guess what the person feels, stated rather than asking
(3) affirming - alignment & normalization
(4) summarizing - the content of what the client says by covering key points
(5) elicit self-motivational statements
(6) end the session: acknowledge respectfully any lingering lack of readiness to change, be available if change is considered, and express hope/confidence in the client's ability to make changes in the future when the time is right
Motivational Interviewing: alignment & normalization
counselor tells the client that he/she understands these difficult times and it's perfectly within reason to have such reactions/feelings
Motivational Interviewing: how to handle unsure about change - goals
Build readiness to change!
(1) summarize client's perceptions of barriers and how to eliminate/circumvent to achieve change
(2) heightened self-efficacy may provide confidence
(3) discuss client's ambivalence
Motivational Interviewing: how to handle unsure about change - strategies
(1) explore ambivalence by discussing the pros & cons, discussing "what if" the change were to be made
(2) negotiate change - set goals (brad at first), consider options (have client list then choose alternative strategies/options), arrive at plan devised by client
(3) end session - ask for next step, allowing client to describe what might occur next in the process of change ("what do you plan to do between now and next visit?")
Motivational Interviewing: how to handle ready to change - goals
collaborate with the client to set goals that include a plan of action
Motivational Interviewing: how to handle ready to change - strategies
(1) identify a network to support dietary changes
(2) early identification of barriers to adherence
(3) ask client to identify markers of success
(4) avoid telling the client what to do
(5) end the session - encourage the client & reflect how the client identified this plan personally
Motivational Interviewing: how to handle first session - goals
establish the counseling relationship
Motivational Interviewing: how to handle first session - strategies
(1) environment should be conducive to privacy
(2) establish rapport - ask client how to address, light conversation (1-2 questions), move conversation to point of visit
(3) introduce subject of session, invite client to contribute
(4) complete assessment - gather ABCD's + economic data, assess readiness to change (maybe not at first session), establish dx, determine present eating habits
assessment of readiness to change
occurs once the nutrition dx is selected for intervention; use a ruler to have client select intention to change; be ready to move back and forth between the phase-specific strategies - return to asking about readiness to change if client seems confused, detached or resistant
competencies for effective intercultural counseling
1. understand the role of the culture to help establish rapport; evaluate one's own beliefs and attitudes and become comfortable w/ differences
2. remember that learning abut culture & becoming culturally competent is not a panacea for health disparities
3. culture, race, & ethnicity are distinct concepts
4. culture is mutable & multiple; any understanding of a particular cultural context is always incompletely true, somewhat out of date, and partial
5. context is critical
cultural communication styles
1. language - know several or have a translator, avoid unofficial ones & using slang
2. the context in which words are interpreted (posture, gestures, concepts of time, spatial relationships, the role of the individual w/i a group, status hierarchy of persons, setting)
3. find out how the client prefers to be addressed
4. listen sensitively
5. share control
6. accept differences
7. demonstrate sincere concern
8. respect other cultures
9. seek feedback
10. be natural and honest
eliciting self-motivational statements
1. problem recognition ("what things make you think that eating out is a problem?")
2. concern ("what do you think will happen if you don't make a change?")
3. intention to change ("the fact that you're here indicates that at leas ta part of you thinks it's time to do something. What are the reasons you see for making a change?")
4. optimism ("what do you think about work for you if you decided to change?")
5. ask permission to discuss the possibility of change if it seems appropriate
strategies to modify resistance behavior:
reflecting, double-sided reflection, shifting focus, agreeing with a twist, reframing, self-efficacy and self-management
strategies to modify resistance behavior: reflecting
counselor identifies the client's emotion or feeling and reflects it back, allowing the client to stop and contemplate what was said ("you seem very frustrated by what your husband says about your food choices")
strategies to modify resistance behavior: double-sided reflection
counselor uses ideas that the client has expressed previously to show the discrepancy between the client's current words and previous ones ("I'm doing the best I can" 10 minutes after admitting that sometimes she just gives up and doesn't care about following the diet)
strategies to modify resistance behavior: shifting focus
counselor questions the feasibility of continuing to focus on a given barrier to change when others may be more appropriate ("are you sure that this is really the problem? Is part of the problem that ____?" getting to the root of the problem)
strategies to modify resistance behavior: agreeing with a twist
counselor offers an agreement but moves the discussion in a different direction ("most people like eating out. Now that you are retired it is easier than cooking. I can understand that. What can we do to make you feel great about eating out so that you can still follow your eating plan and keep your BG values in normal range?")
strategies to modify resistance behavior: reframing
counselor changes the client's interpretation of the basic data by offering a new perspective; counselor repeats basic observation then offers new hypothesis ("I remember how devastated you were when he died and how just cooking meals was an effort. Do you think that this happened as a kind of immediate response to his death and that you might have just decided that all of the goals were too strict at the time?" ... "Could we look at where you are now and try to find things that will work for you now to help you in following the goals we have set?"
strategies to modify resistance behavior: self-efficacy and self-management
counselor always emphasizes that future actions belong to the client and that the advice can be taken or disregarded. emphasize autonomy and competence
national health and nutrition examination survey (NHANES): purpose
a framework for describing the health status of the nation
national health and nutrition examination survey (NHANES): responsible organization
National Center for Health Statistics within the CDC in USDHHS
national health and nutrition examination survey (NHANES): survey frequency & target population
began in the early 1960s, still going on, conducted every 2 years; most recent targeted children ages 2mo-5 years, persons aged 60+, black americans, and mexican americans
national health and nutrition examination survey (NHANES): data collection methods
medical history, physical measurements, biochemical evaluation, physical signs & symptoms, diet information (FFQ, 24hr recall)
national health and nutrition examination survey (NHANES): general results
1. more evidence of low iron intake than other nutrients esp certain populations (very young, adolescents, younger women, low income, African American females)
2. most groups meet calorie recommendations & protein is mostly adequate
3. most nutrients accurate except low ca, vit a, vit c
4. roughly 1/4 adult males & females obese, more females than males
nationwide food consumption survey: purpose
discover the kinds and amounts of foods people eat, describe their food consumption behavior, determine intake adequacy, and use info to develop nutrition policies
nationwide food consumption survey: responsible organizations
USDA started, now part of national nutrition related research program
nationwide food consumption survey: survey frequency & target population
10 year intervals from 1936-1988, general population
nationwide food consumption survey: data collection methods
household survey w/ 7d food recall, individual survey w/ 1d food intake recall + 2d food diary
nationwide food consumption survey: general results
1. 1/2 household diets=good 1965, down 10%
2. 1/5 diets=poor 1965, up 6%
3. low income americans over time experienced lower milk but higher cheese/frozen milk dessert consumption; lower f&v but higher bakery product consumption other than bread
continuing survey of food intake of individuals (CSFII): purpose
monitor the nutritional adequacy of the american diet; measure effect of food fortification on intake; track trends; develop guidelines and programs
continuing survey of food intake of individuals (CSFII): responsible organization
USDA
continuing survey of food intake of individuals (CSFII): survey frequency & target population
every 5 years; in 2002 merged w/ NHANES to become What We Eat in America (see below); everyone, children included starting in 1989
continuing survey of food intake of individuals (CSFII): data collection methods
1. early on: dietary history, 24hr recall
2. later on expanded to 2d fod diary
continuing survey of food intake of individuals (CSFII): general results
1. our consumption of grians & meats increasing
2. intakes > RDA for A, protein, C, thiamin, riboflavin, niacin, folate, b12, phosphorus, iron
3. intakes < RDA for B6, E, Ca, Mg, Zn
4. increased proportion of people overweight
5. shift to lower fat, higher CHO diet
6. increased fruit consumption, decreased vegetable
diet and health knowledge survey (DHKS): purpose
link individual attitudes and knowledge about healthy eating to reported food choices and nutrient intakes from CSFII
diet and health knowledge survey (DHKS): responsible organizations
USDA
diet and health knowledge survey (DHKS): survey frequency & target population
every 5 years since 1989; general population
diet and health knowledge survey (DHKS): data collection methods
sames as CSFII (once 24hr recall, now 2d food diary via interview)
National Food & Nutrition Survey (NFNS) / What We Eat in America: purpose
link food intake data to health status to explore the relationships between dietary indicators and health status
National Food & Nutrition Survey (NFNS) / What We Eat in America: responsible organizations
USDHHS does the sample design & holds the data; USDA collects the surveys & maintains the dietary data
National Food & Nutrition Survey (NFNS) / What We Eat in America: survey frequency & target population
continuous, released every 2 years since 2002; general population
National Food & Nutrition Survey (NFNS) / What We Eat in America: general results
same as CSFII:
1. our consumption of grians & meats increasing
2. intakes > RDA for A, protein, C, thiamin, riboflavin, niacin, folate, b12, phosphorus, iron
3. intakes < RDA for B6, E, Ca, Mg, Zn
4. increased proportion of people overweight
5. shift to lower fat, higher CHO diet
6. increased fruit consumption, decreased vegetable
nutrition screening initiative: purpose, responsible organizations, & when was it founded?
1. provide screening procedures and checklists for the elderly
2. AND, American Academy of Family Phycisions, National council on Aging
3. 1990
nutrition screening initiative: target population
older americans
nutrition screening initiative: screening tools develped through the initiative
determine your health checklist w/ levels 1&2
nutrition screening initiative: features containing within the screening tools
1. self administered = DETERMINE (Disease, Eating poorly, Tooth loss&mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight gain/loss, Needs assistance in self-care, Elder years above age 80)
2. level 2 obtained by physician, nurse, dietetics professional: medical dx, chronic illness, medication, dentition, bowel habits, alcohol/drug abuse, eating disorders, emotional/psychological conditions, height&weight
healthy people 2020: purpose
provide science-based, 10-year national objectives for improving the health of all americans
healthy people 2020: responsible organization & target population
USDHHS; all americans
healthy people 2020: leading health indicators (12)
1. access to health services
2. clinical preventive services
3. environmental quality
4. injury & violence
5. maternal, infant & child health
6. mental health
7. nutrition, physical activity & obesity
8. oral health
9. reproductive & sexual health
10. social determinants
11. substance abuse
12. tobacco use
healthy people 2020: nutrition objectives (22)
1-2. improve quality of foods & beverages consumed by children
3-4. improve quality of foods & beverages in & american access to retail outlets
5-6. increase primary care office visits w/ nutrition education or counseling, inc BMI checks
7. increase worksite wellness
8-11. improve the weight status of the nation
12-13. reduce household food insecurity/hunger
14-19. increase f&v, wg, Ca consumption; reduce SFA, sodium, solid fat consumption
20-22. reduce iron deficiency among children, pregnant women, children of childbearing age
dietary guidelines for americans: purpose
address the increasing national concern for the rise in overweight, obesity, and chronic diseases/certain cancers; health promotion and disease prevention
dietary guidelines for americans: responsible organization & target population
USDHHS & USDA; all americans 2+ years old including those at increased risk of chronic disease
dietary guidelines for americans: 9 focus areas
1. adequate nutrients w/i calorie needs
2. weight management
3. physical activity
4. encourage f&v, wg, ff/lf milk or equivalent products
5. fat
6. carbs
7. Na & K+
8. alcoholic beverages
9. food safety
myplate: purpose
present an easy guide for healthful eating to promote health and disease prevention
myplate: repsonsible organization & target population
USDA; healthy people >2yrs, miplato for spanish speaking americans
Dietary Reference Intakes: purpose
develop intake guidelines to promote optimal health and lower risk of nutrient deficiencies --> prevention of nutrition-related disease
Dietary Reference Intakes: responsible organization & target population
Food & Nutrition Board of the Institute of Medicine; all healthy americans 2+, individualized by age&gender; EAR for populations, others for individuals
Dietary Reference Intakes: different types
AI, EAR, RDA, UL
Dietary Reference Intakes: AI
adequate intake: a nutrient recommendation based on observed or experimentally determined approximation of nutrient intake by a group(s) of healthy people when sufficient scientific evidence is not available to calculate RDA or EAR
Dietary Reference Intakes: EAR
estimated average requirement; the average requirement of a nutrient for healthy individuals; the amount of a nutrient at which approximately 1/2 individuals would have their needs met, used for population adequate intake not individual
Dietary Reference Intakes: RDA
recommended dietary allowance; the amount of a nutrient needed to meet the requirements of almost all (97-98%) of the healthy population of individuals for whom it was developed, used for individuals not populations
Dietary Reference Intakes: UL
tolerable upper intake level; reduce the risk of adverse/toxic effects from consumption of nutrients in concentrated forms - either alone or combined with others but not in food, or from enrichment/fortification; the highest level of daily nutrient intake that is unlikely to have any adverse health effects on almost all individuals in the general population
child & adult care food program: purpose
provide nutritious meals and snacks to infants, young children & adults receiving day care services, as well as infants/children in emergency shelters
child & adult care food program: target population
infants, children, adults receiving day care at childcare centers, family day care homes, homeless shelters
child & adult care food program: services provided / eligibility
commodities or cash to help centers serve nutritious meals that meet federal guidelines / anyone?
child & adult care food program: funding/responsible organization
USDA FNS
food stamp program (SNAP): purpose
provide benefits to low-income people that they can use to buy food to improve their diets
food stamp program (SNAP): target population
any age
food stamp program (SNAP): services provided
assistance, e.g. food stamps
food stamp program (SNAP): eligibility
households in 48 contiguous states + DC that meet certain tests, including resource/income tests
food stamp program (SNAP): funding/responsible organization
USDA FNS
commodity supplemental food program: purpose
provide no-cost monthly supplemental food packages composed of commodity foods to populations perceived to be at nutritional risk
commodity supplemental food program: targe tpopulation
children 5-6yrs old, postpartum nonbreastfeeding mothers, seniors
commodity supplemental food program: services provided
food packages; nutrition ed often available through extension service programs
commodity supplemental food program: eligibility
130-185% poverty guideline
commodity supplemental food program: funding / responsible organization
USDA FNS
Title III Elderly Nutrition Program of the Older Americans Act: purpose
address problems of food insecurity, promote socialization, promote healthy & well-being of older persons through nutrition & related services
Title III Elderly Nutrition Program of the Older Americans Act: target population
old people, esp those w/ greatest social & economic need
Title III Elderly Nutrition Program of the Older Americans Act: services provided
grants to state agencies on aging to support congregate and home-delivered meals for people 60+
Title III Elderly Nutrition Program of the Older Americans Act: eligibility
1. congregate meals: 60+ & their spouses of any age OR <60 w/ disabilities residing in facilities occupied primarily by the elderly where congregate meals are served or at home w/ older persons
2. home-delivered nutrition services: 6-+ homebound + their spouses of any age OR <60 w/ disability
Title III Elderly Nutrition Program of the Older Americans Act: funding/responsible organization
administration on aging w/i USDHHS
How they're related: title III elderly nutrition program of the older americans act, meals on wheels, child & adult care food program
TIII funds meals on wheels, adult care food programs may be eligible
expanded food and nutrition education programs (EFNEP): purpose
assist limited resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritional sound diets and to contribute to their personal development and the improvement of the total family diet and nutritional well-being
expanded food and nutrition education programs (EFNEP): target population
americans of all ages w/ limited resources (income below poverty guideline)
expanded food and nutrition education programs (EFNEP): services provided
nutrition education for adults and youths including skills in food production, prep, storage, safety, budgets, government assistance, physical activity, etc.; 10-12+ lessons via peer educators & volunteers w/ some mass media efforts
expanded food and nutrition education programs (EFNEP): eligibility
<185% federal poverty guidelines; automatically qualify if they participate in any federal assistance program
expanded food and nutrition education programs (EFNEP): funding/responsible organization
USDA
expanded food and nutrition education programs (EFNEP): how this ties in to other programs
related to child care & after school programs (lessons can be held there)
meals on wheels: purpose
provide national eladership and end senior hunger
meals on wheels: target population
seniors in need of meals (some programs will serve non-seniors, too)
meals on wheels: services provided
meals to seniors, somea t congregate locations and others at individual homes when mobility is limited
meals on wheels: eligibility
60+ OR physically/mentally incapacitated OR unable to prepare nutritious meals/have no one to do it for you
meals on wheels: funding/responsible roganizations
USDHHS (administration on aging), partners (Bank of America, Barilla, Curel, Merck, MetLife, Walmart, etc.) and contributions
the emergency food assistance program (TEFAP): purpose
commodities are made available to local emergency food providers for preparing meals for the needy or for distribution of food packages
the emergency food assistance program (TEFAP): target population
low-income households
the emergency food assistance program (TEFAP): services provided
surplus commodity foods are provided for distribution
the emergency food assistance program (TEFAP): eligibility
low income households at 150% of the federal poverty guidelines
the emergency food assistance program (TEFAP): funding/responsible organization
USDA FNS
area agencies on aging: purpose
provide commodity and cash assistance to programs providing meal services to older adults
area agencies on aging: target population
older adults
area agencies on aging: services provided
nutritious meals for older adults through congregate dining or home-delivered meals
area agencies on aging: eligibility
no income standard applied
area agencies on aging: funding/responsible organizations
USDHHS administers through state & local agencies; USDA deals with cash and commodity assistance
senior farmers market nutrition program: purpose
provide fresh, nutritious, unprepared, locally grown fruits, vegetables and herbs from farmers' markets, roadside stands, and community-supported agriculture programs to low-income seniors
senior farmers market nutrition program: target population
low income adults 60+ years old
senior farmers market nutrition program: services provided
coupons for use at authorized farmers' markets, roadside stands and CSAs; some foods not eligible (dried fruits/vegetables, potted plans and herbs, wild rice, honey, nuts, maple syrup, cider, molasses)
senior farmers market nutrition program: eligibility
low-income seniors with household incomes not exceeding 195% of the federal income poverty guidelines
senior farmers market nutrition program: funding/responsible organization
USDA FNS
National Food & Nutrition Survey (NFNS) / What We Eat in America: data collection methods
same as CSFII