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Luo L, Ni J, Zhou M, Wang C, Wen W, Jiang J, Cheng Y, Zhang X, Wang M, Wang W. Food Safety Knowledge, Attitudes, and Self-Reported Practices Among Medical Staff in China Before, During and After the COVID-19 Pandemic. Healthc Policy 2021. [DOI: https://doi.org/10.2147/rmhp.s339274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Luo L, Ni J, Zhou M, Wang C, Wen W, Jiang J, Cheng Y, Zhang X, Wang M, Wang W. Food Safety Knowledge, Attitudes, and Self-Reported Practices Among Medical Staff in China Before, During and After the COVID-19 Pandemic. Risk Manag Healthc Policy 2021; 14:5027-5038. [PMID: 34938138 PMCID: PMC8687682 DOI: 10.2147/rmhp.s339274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/13/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare food safety knowledge, attitudes, and self-reported practices among medical staff in China before, during, and after the COVID-19 pandemic. PATIENTS AND METHODS The questionnaire was anonymous. All respondents were Chinese medical personnel. A Chi-square contingency table was used to compare the knowledge and attitudes of Chinese medical staff before, during and after COVID-19. R statistical software (v4.0.0) was used for analysis. RESULTS A total of 1431 valid responses (57.3% from female respondents) were included in our analysis. Medical professionals were geographically distributed as follows: eastern China, 55.5%; central China, 19.7%; western China, 24.1%; Hong Kong, Macau, or Taiwan, 0.05%. Medical professionals reported that they paid greater attention to food safety after the COVID-19 pandemic compared with before the epidemic. Self-reported knowledge of and attitudes toward food safety among medical staff were significantly different before, during, and after the COVID-19 pandemic (both P<0.001). CONCLUSION After the COVID-19 pandemic, medical professionals paid increasing attention to food safety, which is a clinically important change. Because medical professionals can influence public understanding of food safety, their increased attention to this subject may enable them to promote food safety knowledge more actively in their work. This may in turn promote a better understanding of food safety and protect the health of the general public.
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Affiliation(s)
- Lin Luo
- Jiangxi Key Laboratory of Natural Products and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045, People’s Republic of China
- Hangzhou Ruolin Hospital Management Co. Ltd, Hangzhou, 310007, People’s Republic of China
- Hangzhou Kaihong Technology Co., Ltd, Hangzhou, 310059, People’s Republic of China
- Gege Medical Technology (Shanghai) Co., Ltd, Shanghai, 200082, People’s Republic of China
| | - Jie Ni
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
| | - Mengyun Zhou
- Department of Molecular & Cellular Physiology, Shinshu University School of Medicine, Nagano, 3900803, Japan
| | - Chunyi Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
| | - Wen Wen
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
| | - Jingjie Jiang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, 311300, People’s Republic of China
| | - Xingwei Zhang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
| | - Mingwei Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, People’s Republic of China
- Correspondence: Mingwei Wang; Wenjun Wang Email ;
| | - Wenjun Wang
- Jiangxi Key Laboratory of Natural Products and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, 330045, People’s Republic of China
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Nutrition care by primary-care physicians: advancing our understanding using the COM-B framework. Public Health Nutr 2019; 23:41-52. [PMID: 31736453 DOI: 10.1017/s1368980019003148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the nutrition education provided by primary-care physicians (PCP). DESIGN An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms. SETTING USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand. PARTICIPANTS Primary-care physicians. RESULTS Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations. CONCLUSIONS The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.
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Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice. Public Health Nutr 2015; 18:3051-9. [DOI: 10.1017/s1368980015000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjectivePatients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.DesignAn observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.SettingDutch general practice.SubjectsOne hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.ResultsHalf of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.ConclusionsMatching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.
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van Dillen SME, Noordman J, van Dulmen S, Hiddink GJ. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations. Eur J Clin Nutr 2013; 68:50-6. [PMID: 24169459 DOI: 10.1038/ejcn.2013.219] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVE To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. SUBJECTS/METHODS A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. RESULTS About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. CONCLUSIONS Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.
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Affiliation(s)
- S M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
| | | | - S van Dulmen
- 1] NIVEL, Utrecht, The Netherlands [2] Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [3] Department of Health Sciences, Buskerud University College, Drammen, Norway
| | - G J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
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van Dillen SME, van Binsbergen JJ, Koelen MA, Hiddink GJ. Nutrition and physical activity guidance practices in general practice: a critical review. PATIENT EDUCATION AND COUNSELING 2013; 90:155-169. [PMID: 23246149 DOI: 10.1016/j.pec.2012.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/17/2012] [Accepted: 10/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. RESULTS In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. CONCLUSION We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs' provision of combined lifestyle advice to overweight and obese patients seems to be rather low. PRACTICE IMPLICATIONS Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.
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Hooft van Huysduynen EJC, Hiddink GJ, van Woerkum CJM. The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to October 2008: a review. Fam Pract 2012; 29 Suppl 1:i56-i60. [PMID: 22399557 DOI: 10.1093/fampra/cmr103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. OBJECTIVE To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance practices of PCPs. METHOD A review of articles published from 1995 to October 2008 (n = 111). RESULTS It was found that 45% of the articles in this review included theories or theoretical models of behaviour change. No difference in proportion of model use was found with time. Model use differed between type of study. In 29% of the articles, the Transtheoretical Model was used. Little was found on authors' views on theoretical model applicability. CONCLUSIONS Forty-five per cent of the articles on nutrition guidance practices of PCPs published from 1995 to October 2008 included theories or theoretical models of behaviour change. It would be beneficial for nutrition behaviour change research if more researchers use theoretical models and report on applicability of the selected theory, to increase effectiveness of nutrition guidance by PCPs.
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van Dijk E, Kampen JK, Hiddink GJ, Renes RJ, van Binsbergen JJ, van Woerkum CMJ. A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007. Fam Pract 2012; 29 Suppl 1:i61-i67. [PMID: 22399559 DOI: 10.1093/fampra/cmr115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. OBJECTIVE Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. METHODS This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, van Woerkum CMJ, Fieren CJ, van t'Hof MA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29-36.) demonstrated that 'noticing patients' overweight and guidance of treatment' was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). RESULTS This analysis shows both similarity and differences in working mechanism of determinants of noticing patients' overweight and guidance of treatment between 1997 and 2007. The backbone of the mechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. CONCLUSIONS The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients' overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.
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Affiliation(s)
- Elske van Dijk
- Communication Strategies, Sub Department Communication Sciences, Department of Social Sciences, Wageningen University and Research Centre, Hollandseweg 1, Wageningen, The Netherlands
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POMEROY SE, WORSLEY A. Contribution of Australian cardiologists, general practitioners and dietitians to adult cardiac patients' dietary behavioural change. Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01332.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pomeroy SE, Worsley A. Nutrition care for adult cardiac patients: Australian general practitioners' perceptions of their roles. Fam Pract 2008; 25 Suppl 1:i123-9. [PMID: 19112086 DOI: 10.1093/fampra/cmn091] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Australia has implemented systematic managed care for patients with chronic disease. Little is known about how GPs perceive their nutrition care role in this system. OBJECTIVE To examine GPs' perceptions of their roles in the nutrition care of cardiac patients and to identify factors that influence their role. METHODS Multi-methods research design. Semi-structured interviews were conducted with a sample (n = 30) GPs Victoria, Australia. The resulting narratives were used to develop a quantitative questionnaire to survey a random sample of GPs. Principal components analysis was conducted to reduce the role items to a small number of underlying dimensions. The association between roles and demographic variables were examined using stepwise multiple regressions. RESULTS In all, 248 GPs (30% response) participated. Three main roles were established: Influencing, Coordinating and Nutrition Educator role. Together, the roles explained 54% of the total variance. Demographic variables were not associated with these roles. The majority (mean = 88%) endorsed the items which loaded on to the Influencing and Coordinating (mean = 49%) roles. Short consultation time, use of prescribed medications and perception of patient attendance at cardiac rehabilitation reduced the priority for nutrition education. CONCLUSIONS This study highlights the importance of developing more effective team care arrangements for patients with chronic disease and working with the medical education colleges to develop education resources for doctors that include an explanation of the non-pharmaceutical as well as the pharmaceutical treatment for each chronic disease condition.
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Affiliation(s)
- Sylvia Em Pomeroy
- School of Exercise and Nutrition Sciences, Deakin University, 17 Champion Street, Black Rock, Victoria, Australia
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Visser F, Hiddink G, Koelen M, van Binsbergen J, Tobi H, van Woerkum C. Longitudinal changes in GPs' task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight. Fam Pract 2008; 25 Suppl 1:i105-11. [PMID: 19112085 DOI: 10.1093/fampra/cmn078] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND GPs play a role in prevention by giving nutrition education and advice on overweight. Over the years, GP's tasks and working environment changed. OBJECTIVE To know how task perceptions, perceptions of own ability and perceived barriers regarding nutrition education and treatment of overweight of Dutch GPs have developed from 1992 to 2007. METHODS In all, 488 GPs, first included in study in 1992, were asked in 2007 to return the Wageningen PCPs Nutritional Practices Questionnaire. Crohnbach's alphas and sum scores were calculated and differences between 1992 and 2007 were investigated using a paired t-test. RESULTS In all, 247 GPs responded (51%). 'Noticing patients overweight and guidance of treatment' did not change in GPs from 1992 to 2007. The task perception about health education and prevention did not change and the perception of daily activities shifted from the curative to the preventive side. Interest in the influence of nutrition on health increased in 2007. GPs less often managed to counsel on nutrition in daily practice. Their perceived capacity to counsel and their self-efficacy regarding overweight management declined over the years. In 2007, more GPs perceived the barriers 'lack of time' to treat overweight and to give nutrition education. The most important barrier in 2007 was lack of patient motivation. CONCLUSIONS The GPs perceived overweight and nutrition education as important and were still favourable towards prevention. However, their potential to give nutrition education or guide in treatment of overweight was not fully utilized because of decreased self-efficacy factors and perceived barriers.
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Affiliation(s)
- Femke Visser
- Netherlands Institute for Sport and Physical Activity, Bennekom.
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Maiburg BHJ, Rethans JJE, Schuwirth LWT, Mathus-Vliegen LMH, van Ree JW. Controlled trial of effect of computer-based nutrition course on knowledge and practice of general practitioner trainees. Am J Clin Nutr 2003; 77:1019S-1024S. [PMID: 12663311 DOI: 10.1093/ajcn/77.4.1019s] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nutrition education is not an integral part of either undergraduate or postgraduate medical education. Computer-based instruction on nutrition might be an attractive and appropriate tool to fill this gap. OBJECTIVE The study objective was to assess the degree to which computer-based instruction on nutrition improves factual knowledge and practice behavior of general practitioner (GP) trainees. DESIGN We carried out a controlled experimental study, using a 79-item knowledge test and 3 incognito standardized patients' visits in a pre- and posttest design with 49 first-year GP trainees. The experimental group (n = 25) received an average of 6 h of a newly developed computer-based instruction on nutrition. The control subjects (n = 24) took the standard vocational training program. RESULTS The percentage of correct answers on the knowledge test increased from 30% at pretest to 42% at posttest in the experimental group, and from 36% to 37% in the control group. Analysis of covariance, with the pretest scores as covariate, showed a significant experimental versus control group difference at posttest: 9.2% (P = 0.002). The mean percentage of correctly performed items during the 3 standardized patients' visits (assessed by checklists) showed an increase in the experimental group from 20% at pretest to 36% at posttest, whereas the control group changed from 20% to 22%. Analysis of covariance, with the pretest scores as covariate, revealed a significant group difference at posttest: 13.7% (P < 0.001). CONCLUSION The computer-based instruction proved its effectiveness, both by increasing factual knowledge and by substantially enhancing GP trainees' practice behavior on the subject of nutrition.
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Affiliation(s)
- Bas H J Maiburg
- Department of General Practice, Maastricht University, Maastricht, The Netherlands.
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Reid R, Fodor G, Lydon-Hassen K, D'Angelo MS, McCrea J, Bowlby M, Difrancesco L. Dietary counselling for dyslipidemia in primary care: results of a randomized trial. CAN J DIET PRACT RES 2003; 63:169-75. [PMID: 12493139 DOI: 10.3148/63.4.2002.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study compared the effectiveness of physician advice versus dietitian advice for a fat-reduced diet, and of dietitian advice for a fat-reduced diet versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia. A total of 111 men and women took part in this 26-week, three-group, randomized, clinical trial. The physician advice fat-reduced diet group (n = 38) and the dietitian advice fat-reduced diet group (n = 35) received dietary advice based on the American Heart Association (AHA) Step II guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38) consumed one-third cup per day of psyllium-containing cereal and was advised to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C ratio and body weight reductions over six months were -5.3%, -4.6%, and -1.9%, respectively, regardless of whether a physician or a dietitian provided advice, or whether advice was focused on a fat-reduced diet or a soluble fibre-enhanced diet. Both dietitians and physicians can help moderately dyslipidemic patients make clinically meaningful changes in blood lipid levels. Soluble fibre enhancement of the usual diet leads to similar reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on fat reduction.
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Affiliation(s)
- Robert Reid
- Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Canada
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Carson JAS, Gillham MB, Kirk LM, Reddy ST, Battles JB. Enhancing self-efficacy and patient care with cardiovascular nutrition education. Am J Prev Med 2002; 23:296-302. [PMID: 12406484 DOI: 10.1016/s0749-3797(02)00518-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Provision of medical education that develops nutrition knowledge and self-efficacy is critical if physicians are to incorporate nutrition in preventive care. We studied the impact of a cardiovascular nutrition module on the knowledge, attitudes, and self-efficacy of fourth-year medical students and the relationship of these attributes to patient care practices. METHODS Based on national practice guidelines and learner needs, an educational intervention consisting of two web-based cases, pocket reference cards, and classroom discussion was developed and implemented. Knowledge, attitudes, and self-efficacy were measured at the beginning and end of the 4-week ambulatory care rotation for 40 control and 156 experimental students. Performance in patient care was approximated using a self-report; chart audits were performed for a subset of students. CONCLUSIONS Knowledge scores of experimental students increased significantly from a mean of 10.3 to 14.4 (p<0.001), while the change for control students from 9.2 to 9.8 was not significant (p=0.20). The increase in self-efficacy scores from 26.2 to 35.7 in the experimental group (p<0.001) was twice that of the increase from 25.8 to 29.9 in the control group (p=0.001). Small but significant increases in attitude scores were similar for both groups. Limited data on student performance revealed that students with greater cardiovascular nutrition self-efficacy were more likely to address nutrition with cardiovascular patients. CONCLUSIONS Incorporation of cardiovascular nutrition concepts in an ambulatory care rotation including use of computer-based cases improved student knowledge and self-efficacy, which may translate to increased frequency of future physicians addressing nutrition with patients.
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Affiliation(s)
- Jo Ann S Carson
- Department of Clinical Nutrition, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, USA.
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Hebert JR, Ebbeling CB, Ockene IS, Ma Y, Rider L, Merriam PA, Ockene JK, Saperia GM. A dietitian-delivered group nutrition program leads to reductions in dietary fat, serum cholesterol, and body weight: the Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:544-52. [PMID: 10333775 DOI: 10.1016/s0002-8223(99)00136-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effectiveness of a dietitian-based nutrition counseling and education program for patients with hyperlipidemia. DESIGN A 4-session program implemented as a complement to a randomized physician-delivered intervention. SUBJECTS/SETTING From 12 practice sites of the Fallon Clinic, 1,162 subjects with hyperlipidemia were recruited, 645 of whom had data sufficient for our primary analyses. INTERVENTION Two individual and 2 group sessions conducted over 6 weeks. MAIN OUTCOME MEASURES Total and saturated fat levels; serum low-density lipoprotein cholesterol levels; and body weight, measured at baseline and after 1 year. STATISTICAL ANALYSES Multiple linear regression was used to evaluate changes in outcome measures. RESULTS After 1 year, there were significant reductions in outcome measures for subjects attending 3 or 4 nutrition sessions vs subjects attending fewer than 3 sessions or those never referred to a nutrition session. Reductions (mean +/- standard error) in saturated fat (measured as percent of energy) were 2.7 +/- 0.5%, 2.1 +/- 0.5%, and 0.3 +/- 0.1%, respectively. These reductions correspond to roughly a 22% relative change from baseline in those attending 3 or 4 sessions. Corollary reductions were observed for total fat (measured as percent of energy): 8.2 +/- 1.4%, 5.0 +/- 1.4%, and 0.7 +/- 0.4%; low-density lipoprotein cholesterol: 0.48 +/- 0.11 mmol/L, 0.13 +/- 0.11 mmol/L, and 0.02 +/- 0.03 mmol/L; and body weight: 4.5 +/- 0.9 kg, 2.1 +/- 0.8 kg, and 1.1 +/- 0.2 kg. The specified changes were additive to those of the physician-delivered intervention. APPLICATIONS/CONCLUSIONS This investigation provides empirical data demonstrating the effectiveness of a dietitian-delivered intervention in the care of patients with hyperlipidemia.
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Affiliation(s)
- J R Hebert
- Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA
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