Improvements in nutrition knowledge among adults with physical disabilities: A program evaluation of the mindfulness, exercise, and nutrition to optimize resilience (MENTOR) program 2020-2021

BACKGROUND

The Centers for Disease Control and Prevention (CDC) funds a quality improvement (QI) health promotion telewellness program for adults with physical disabilities.

OBJECTIVE

The nutrition component of the parent program, Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) program, from 2020 to 2021, was evaluated to assess changes in nutrition knowledge of people with physical disabilities.

METHODS

This was a quasi-experimental program evaluation by pre-post survey of participating adults with physical disabilities. Participants attended weekly nutrition classes for eight weeks with optional one-on-one counseling with a Registered Dietitian. Participants completed pre-post General Nutrition Knowledge Questionnaire Revised (GNKQ-R) that were analyzed using paired t-tests. Participants were grouped into quartiles by pre-program GNKQ-R scores for additional comparisons. Program attendance and post-program feedback were also evaluated.

RESULTS

A total of 286 participants completed the MENTOR program, and 31% (n = 89) completed pre-post questionnaires for data analysis. Mean pre-program GNKQ-R scores were 58.4 ± 15.1 and post scores were 64.4 ± 11.3, which demonstrated a statistically significant improvement in nutrition knowledge (p < .001). Ancillary analysis revealed that participants with the lowest quartile of pre-program nutrition knowledge had the greatest improvements in their post-GNKQ-R scores (Mean change 16.4 ± 13.9). Questionnaire data revealed participants' subjective knowledge changes and their feedback on the nutrition component of the program.

CONCLUSIONS

The eight-week MENTOR program effectively improved nutrition knowledge among people with physical disabilities. This demonstrates the impact the program can have on individual knowledge levels. Additionally, these results support the implementation of the program to the broader population of people with disabilities.

Pilot evaluation of a behavioral weight loss program for adults with physical disabilities: State of Slim Everybody usability and feasibility

Background

People with physical disabilities (PWD) have a higher prevalence of obesity than populations without disability, but most evidence-based weight loss programs have not included this population. The State of Slim (SOS) program is an evidence-based weight loss program that has demonstrated success in producing weight loss in populations without disability, but it has not been adapted for or evaluated in PWD.

Methods

The SOS program was systematically adapted using the evidence-informed Guidelines, Recommendations, and Adaptations Including Disability (GRAIDs) framework. A total of 35 participants enrolled in the State of Slim Everybody program. The program was offered entirely online. Body weight, attendance, and food log completion were also tracked weekly. The program length was 16.5 h and included weekly group instruction, with optional one-on-one sessions provided upon request. Following completion, participants completed post-evaluation surveys on overall satisfaction with the program. The primary outcomes were program effectiveness (i.e., body weight), usability, and feasibility.

Results

Thirty-two out of 35 participants completed the program, representing a retention rate of 91.4%. Average weight loss was 10.9% (9.9 ± 0.7 kg (t (31) = -13.3, p =< 0.0001)). On a 1 (dissatisfied/completely useless) to 5 (very satisfied/completely helpful) Likert scale, the average score for overall program satisfaction was 4.8 ± 0.1 and program helpfulness 4.6 ± 0.1.

Conclusion

The State of Slim Everybody program demonstrated significant weight loss and good usability and feasibility in PWD. Existing adaptation frameworks can be used to create inclusive health promotion programs for adults with physical disabilities.

Adapting an evidence-based physical activity questionnaire for people with physical disabilities: A methodological process

BACKGROUND

Practitioners and researchers often adapt tools, practices, and programs to meet the needs of culturally diverse population groups, but do not consider populations with disability. While there is some research on guidelines for adapting evidence-based programs, there is no systematic process for adapting survey instruments. Rather than creating separate instruments for people with physical disabilities (PWD), it is critical that instruments are designed to capture data on people with and without disabilities for comparison purposes. Given the disproportionately high rates of physical inactivity and obesity in PWD, we developed a methodology to adapt an evidence-based physical activity instrument.

OBJECTIVE

To create a methodology to adapt surveys to be inclusive of PWD and use the methodology to adapt an evidence-based physical activity survey.

METHODS

A framework was developed to adapt a physical activity survey instrument (International Physical Activity Questionnaire, IPAQ) to be inclusive of PWD. The framework, referred to as SAVe-IT, includes five steps: Step 1) Select survey instrument to adapt; Step 2) Adapt the survey instrument; Step 3) Verify adaptations with experts; Step 4) Implement pilot test; Step 5) Test the tool to confirm reliability.

RESULTS

The adapted IPAQ passed review by the expert panels and the pilot test (n = 20). Assessment of test-retest reliability (n = 30) yielded strong intraclass correlation coefficients of 0.950 for the total score for the whole sample, 0.950 for PWD (n = 15) and 0.952 for people without disability (n = 15).

CONCLUSIONS

The SAVe-IT framework resulted in the successful adaptation of the IPAQ and can be used in populations with and without physical disabilities.

A Qualitative Analysis of Experiences With Food-Related Activities Among People Living With Parkinson Disease and Their Care-Partners

Objectives: The purpose of this qualitative study was to explore factors associated with the ability of people with PD to perform food-related activities (FRAs). Methods: Eleven dyads, older adults with Parkinson disease (PD) and their care-partners (n = 22), completed virtual semi-structured interviews guided by the Social Cognitive Theory (SCT) that were independently analyzed by two coders via directed content analysis. Results: The following themes were identified-(1) Personal: perception of a healthy diet, perception of how nutrition influences PD, confidence in following a healthy diet, and barriers to performing FRA; (2) Environmental: previous sources of nutrition information and willingness to changing their diet with a registered dietitian; and (3) Behavioral: modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Discussion: Findings from this study highlight the need for nutrition intervention research to inform evidence-based guidelines in order to provide tailored education for people with PD and care-partners.

A Mixed Methods Exploration of the Impact of the COVID-19 Pandemic on Food-Related Activities and Diet Quality in People with Parkinson Disease

OBJECTIVE

The purpose of this mixed methods study was to explore the impact of COVID-19 on the ability of people with Parkinson disease (PwPs) and their care-partners to perform food-related activities (FRA) and PwPs' overall diet quality.

METHODS

Using a convergent parallel mixed methods design, PwPs and their care-partners completed virtual dyadic semi-structured interviews about their FRA during the COVID-19 pandemic. PwPs completed Food Frequency Questionnaires (FFQ) to quantify their dietary intake in the previous 12 months. Qualitative data were analyzed by two coders using thematic analysis, and quantitative data from FFQs were descriptively analyzed to calculate diet quality scores.

RESULTS

Eleven dyadic interviews revealed the following key themes: cooking more at home; changes with grocery shopping; less meals with non-household members. These changes were described to increase the care-partners' responsibilities and overall burden. Diet scores among PwPs were 73.0 ± 6.3 for the Healthy Eating Index 2015 (scale of 0-100), 29.2 ± 6.6 for the Mediterranean diet (scale of 0-55), and 10.4 ± 1.8 for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet (scale 0-15).

CONCLUSIONS

Diet scores revealed that PwPs consumed a high-quality diet during the pandemic. Findings from this study highlight the need for tailored nutrition education to support PwPs' care-partners.

"If They Don't Like You, They Are Not Going to Eat for You": Individual and Interpersonal Factors Affecting Certified Nursing Assistants' Ability to Provide Mealtime Assistance to Residents With Dementia

BACKGROUND AND OBJECTIVES

In long-term care facilities in the United States, certified nursing assistants (CNAs) provide mealtime assistance to residents with dementia, a task that substantially increases caregiver burden due to the time and attention required. The aim of this qualitative study was to explore the individual and interpersonal barriers and facilitators CNAs experience when providing mealtime assistance to residents with dementia.

RESEARCH DESIGN AND METHODS

Focus group questions were developed based on the corresponding levels of the Social Ecological Model. Using purposive sampling, 9 focus groups were conducted with 53 CNAs who had at least 1 year of experience as a CNA working with older adults. Focus groups were audio-recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach.

RESULTS

CNAs reported individual skills, training, and personal characteristics that affected their ability to provide mealtime assistance. At the interpersonal level, CNAs identified their relationships with residents, residents' family members, and other health care professionals as factors that affect their ability to provide mealtime assistance.

DISCUSSION AND IMPLICATIONS

These findings provide evidence for strategies that administrators can utilize to reduce caregiver burden by improving the mealtime experience. First, CNAs need adequate training, particularly to develop communication skills. Developing verbal communication skills may improve interpersonal relationships between CNAs and residents' family members and other coworkers. Developing nonverbal communication skills may foster an improved relationship between CNAs and their residents with dementia. Future research should evaluate interventions that seek to improve these skills to determine their impact on the mealtime experience.

Visceral adiposity index and its association with Dietary Approaches to Stop Hypertension (DASH) diet scores among older adults: National Health and Nutrition Examination Surveys 2011-2014

BACKGROUND & AIMS

The visceral adiposity index (VAI) has been shown to be a reliable estimate of visceral adiposity, but little is known about its association with specific dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet, particularly in older adults. Many studies have shown the DASH diet to be beneficial for cardiometabolic health. The purpose of this study was to investigate the relationship between DASH diet scores and the VAI in older adults using a nationally representative dataset.

METHODS

Using the National Health and Nutrition Examination Surveys (NHANES) from 2011 to 2014, data from 508 community-dwelling older adults were examined, and dietary intake was evaluated using the Dixon's DASH diet index. Using multiple linear regression analysis, the relationship between VAI and DASH diet score was assessed while controlling for demographic variables.

RESULTS

Participants' average DASH diet score was 2.41 (SE = 0.07), and the average VAI was 1.55 (SE = 0.08). The results suggest a significant inverse relationship between the DASH diet and VAI (β = -0.19, t = -2.73, p = 0.009).

CONCLUSIONS

Results of this study suggest that protective properties of the DASH diet pattern may be due in part to its inverse relationship with visceral adiposity. This information supports practitioners' use of the VAI with older adults in addition to providing nutrition counseling with the DASH diet to reduce patients' cardiometabolic risk.

Dietary Supplement Use is High among Individuals with Parkinson Disease

OBJECTIVES

To assess the present use of dietary supplements among the Parkinson disease (PD) population and to determine which dietary supplements are most commonly taken.

METHODS

This cross-sectional study used an online questionnaire that was administered to individuals with PD via support group Web sites. Dietary supplement users also were asked whether they spoke with a healthcare professional about their supplement use.

RESULTS

Of the 205 respondents, 83.4% reported taking at least 1 dietary supplement. Although 94 different types of dietary supplements were identified, >50% of participants taking dietary supplements took multivitamins, vitamin D, and vitamin B₁₂ (52.6%, 74.3%, and 56.1%, respectively). Respondents reported taking coenzyme Q10, Mucuna pruriens, folate, vitamin B₁₂, vitamin B₆, melatonin, and N-acetylcysteine most commonly for PD. Among supplement users, 29.2% did not discuss their supplement use with a healthcare practitioner.

CONCLUSIONS

The results of this study demonstrate a high prevalence of dietary supplement use among individuals with PD, in addition to a wide variety of supplements being taken. This study's findings also indicate the need for better dialog between patients and healthcare practitioners regarding the use of dietary supplements.

The long road to health reform requires bipartisan leadership

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress.

Barriers To Serving The Vulnerable: Thoughts Of A Former Public Official

In an environment of limited resources, the question of who is deserving and undeserving of assistance becomes critical. Policymakers' biases about whether a health condition is self-inflicted, as well as their perceptions about whether treatments are truly effective, play a major role--often unstated--in the allocation of resources.

Urinary 1-hydroxypyrene as a biomarker of polycyclic aromatic hydrocarbons exposure of workers on a contaminated site: influence of exposure conditions

The aim of the study was to determine the exposure levels of workers to polycyclic aromatic hydrocarbons on gasworks sites by the measurement of urinary 1-hydroxypyrene. Start-shift and end-shift urine samples were taken every day during an entire week (Monday to Friday), once in November and a second time in June. Four groups of workers were selected according to their activity. Increased exposure was only found among volunteers involved in the remediation of a site, 0.16 to 2.31 mumol/mol creatinine in non-smokers. The median of the non-smoker referent group was 0.02 mumol/mol creatinine (95% confidence interval, 0.01 to 0.04). Smokers had greater exposure levels than non-smokers in every group. Within and between variability was around 200%. Assessment of the exposure of persons on contaminated soil is possible, with the condition that the exposed subjects come in direct contact with the soil.

Infection and the epidural space: a case report

An epidural infection is a rare and extremely dangerous complication of epidural anesthesia. This case report describes an epidural infection following the use of a continuous lumbar epidural anesthetic. This patient was fortunate, in that the infection did not result in neurologic sequelae and required only long-term intravenous antibiotic therapy. With the increasing use of epidural analgesia and anesthesia, it is important that anesthetists are aware of such a complication in this commonly used technique. This article will review the incidence, pathophysiology, symptomatology, diagnosis, and treatment of epidural infections. Factors relating to epidural infections (equipment use, fever, septicemia and viremia, and duration of catheterization) are also discussed.

Laryngospasm-induced pulmonary edema

Laryngospasm is one of the more common forms of airway obstruction encountered by an anesthetist. Therapy usually is straightforward, with resolution of the obstruction normally occurring within minutes. In some cases, however, the patient's vigorous inspiratory efforts may lead to a rapidly deteriorating form of pulmonary edema. Two cases are presented that are quite typical of the development of this complication. The etiology, recognition and management of this form of non-cardiac pulmonary edema is discussed.

Pediatric day-care surgery: a 30-year hospital experience

Over a 30-year period (may 1955 to December 1985), day care surgery was performed on 39,654 patients at the Winnipeg Children's Hospital (WCH). Up to 51% of all pediatric surgical cases and 59% of elective pediatric cases, involving more than 50 different procedures, were performed annually on a day-care basis. The overall incidence of postoperative problems and admission to hospital was 1.5% and 1.1%, respectively. A unique preoperative home visiting program by nurses was demonstrably effective in reducing late cancellations by 75%. The WCH experience adds further evidence that day-care surgery in a pediatric hospital is safe and effective for a large proportion of infants and children requiring operation.

Effects of a viral laryngotracheitis on the epithelial barrier of chicken airways

The effects of a virus infection on the barrier function of tracheal epithelium were compared to the effects of a chemical agent (methacholine) which selectively increases membrane permeability, and both were compared to controls. The disruption of the airway epithelium induced by the virus infection caused an increased permeation of horseradish peroxidase (HRP) through this barrier. Methacholine enhanced HRP uptake from the airway lumen to the blood as compared to controls. Visualization of HRP in the tracheal epithelium by transmission electron microscopy correlated with the radioimmunoassay measurements in the blood. Serial anti-HRP antibody titers were measured by a competitive binding technique. The antigen permeation induced by methacholine was associated with an enhanced anti-HRP antibody production. The larger increase in antigen permeation seen with the viral infection was associated with depressed anti-HRP titers. It was concluded that viral disruption of the airway epithelial barrier may contribute to an increased uptake of orally inhaled antigens. The relationship, however, between the increased antigen penetration consequent to the viral infection and the development of allergy remains unclear.

The innervation of smooth muscle in the primary bronchus of the chicken

The innervation of the primary bronchus of the chicken was studied with in vitro pharmacological techniques and with the electron microscope. The primary response of the smooth muscle to field stimulation is relaxation of the muscle and this is not blocked by adrenergic blocking agents. Excitatory cholinergic innervation can be demonstrated when the muscle is partially relaxed. Examination of the ultrastructure of the muscle and nerves shows numerous axon profiles filled with large granular vesicles of the type associated with nonadrenergic or purinergic neurotransmission. Agranular vesicles characteristic of cholinergic innervation are also seen but there is no evidence of adrenergic innervation to the smooth muscle. The smooth muscle cells show connections of the nexus type. These findings indicate that the primary bronchus of the chicken has a dominant inhibitory system and this is nonadrenergic in type.

Neuromuscular structure and function in the airways

The smooth muscle and the neural pathways of the airways have many similarities to the muscle and innervation of the gastrointestinal tract, as expected from their common embryological origin. The smooth muscle and its innervation vary in structure and function from species to species and extrapolation from one species to another may not be valid. In the human trachea and main stem bronchi the smooth muscle has numerous cell-to-cell connections of the nexus or gap junction type. The principal nervous pathways in the human airways are excitatory, which is cholinergic, and inhibitory, which is nonadrenergic or purinergic. Adrenergic nerves have not been demonstrated in the smooth muscle, but may be present in the ganglions that are found around the trachea and bronchi. Possible defects in the innervation may lead to alterations in the intrinsic activity, of the smooth muscle and be responsible for certain reactive states of the smooth muscle.

A simple technique for the utilization of postmortem tracheal and bronchial tissues for ultrastructural studies

Human tracheal and bronchial tissues were taken from autopsy cases within five hours of death. The tissue was placed in a modified Krebs-Henseleit solution at either 37 degrees C. or 7 degrees C. A combination of 95 per cent oxygen and 5 per cent carbon dioxide was bubbled through the Krebs-Henseleit solution. Two hours after equilibration of the tissue in the bath at 37 degrees C. and electrical field stimulation was applied to the tissue and, if the tissue was physiologically active, it was utilized for further studies. At the termination of these studies the tissue was processed for electron microscopy. Control tissue was taken directly from the same area as the test tissue and was processed for electron microscopy without immersion in the Krebs-Henseleit solution. The tissue, after immersion in the Krebs-Henseleit solution for at least three hours, showed evidence of substantial recovery from the period of anoxia.

Uptake and transport of exogenous proteins by respiratory epithelium

The tracer proteins, horseradish peroxidase and ferritin, placed in the trachea of guinea pigs were taken up by epithelial cells and transported to the extracellular space. The interval between the introduction of the tracer proteins into the lumen of the trachea and the morphologic demonstration of the porteins in the extracellular space or within the basal portion of the cells was between 30 and 60 minutes. The proteins were transported in vesicles and no penetration of the epithelial intercellular tight junctions was found. The intercellular tight junctions were made permeable to horseradish peroxidase by anesthetic ether and this permeable epithelium was compared to the vesicle type transport. Transepithelial transport of proteins is a possible mechanism for the introduction of antigenic material into the subepithelial lymphoid tissue and this transport may also be of importance in the late onset type of asthma.

Constrictive pericarditis with dwarfism in two siblings (mulibrey nanism)

Two siblings with marked dwarfism, now 11 and 19 years of age, have been followed from infancy. The girl had frequent episodes of pneumonitis and presented at age 4 years with hepatic enlargement and ascites which proved to be due to constrictive pericarditis. The boy presented with growth failure and pseudohydrocephalus. He had fibrous dysplasia of the tibia and a pathologic fracture; acute hepatic congestion followed physical activity at age 13 years and led to the diagnosis of constrictive pericarditis. Muscle function was normal, there was no evidence for a primary liver disorder, and mental development was normal so that the coined word "mulibray" seemed inappropriate. Pericardiectomy produced only partial improvement; both patients have hepatic enlargement and continue to need diuretics. A third patient with dwarfism, frequent respiratory infections, and pericardial calcification has certain features of the syndrome.

Obstruction of superior vena cava after the Mustard procedure for transposition of the great arteries. Conservative management of chylothorax

Chylothorax may be produced by superior vena cava (SVC) obstruction, a recognized complication of the Mustard operation for trasposition of the great arteries. The chylothorax may be reduced by keeping the subject in the upright position. Conservative management is an alternative to repeat operation. This syndrome must be recognized, as it can be confused with congestive heart failure. Severe chylothorax may develop insidiously because of progressive SVC obstruction after the immediate postoperative period.