Analysis of Operational Characteristics and Substantiality Plan of Inpatient Diets for Foreigners in Hospitals

The objectives of this study were to analyze the operational characteristics and to explore the substantiality plan of inpatient diets for foreigners in hospitals. Questionnaires were mail-delivered to 128 hospitals, and a total of 62 questionnaires were usable with a response rate of 48.4 percent. Statistical data analysis was completed using SPSS Win 11.0 for descriptive analysis, independent t-test, and χ2 test. Results can be summarized as follows. The average number of inpatient meals for foreigners in the last 6 months were 405 and 53 for general therapeutic diets and special therapeutic diets, respectively. The rates of hospitals with an exclusive department and exclusive staff for foreign inpatients were 48.4% and 53.2%, respectively. Major nationalities of foreign inpatients were China (37.5%) and Russia (31.3%), and their major medical departments were internal medicine (43.9%) and surgery (39.0%). The number of hospitals that provided inpatient diet only for foreigners was 42 (72.4%) and influencing factors were number of permitted beds (P<0.05), an exclusive department (P<0.001), and exclusive staff (P<0.01). The main type of menu was USA·European style (61.1%), and the price of inpatient meals for foreigners was mostly \10,000~\25,000 (62.0%). As 75.9% of hospitals did not possess dietary slip manuals for foreigners, the case of preparing inpatient meals for foreigners in the form of a general therapeutic diet partially-modified according to disease was the majority (55.4%). Dietitians felt the need for nutrition management guidelines and dietary slip manuals (47.3%) as a substantiality plan of inpatient diets for foreigners. There is a need for exclusive foodservice standards for foreign inpatients in the changing medical environment.

Retraction: Phenomenology of the Experiences of Women with Thyroidectomy

This article has been retracted at the authors' request.

Phenomenology of the Experiences of Women with Thyroidectomy

PURPOSE: The purpose of this study was to identify the common themes of the experiences of women with thyroidectomies in Korea. METHODS: A descriptive phenomenological method was used in this study. The data were collected by individual in-depth interviews with six participants, and analyzed using methods presented by Colaizzi. RESULTS: Five theme clusters were derived from the data as follows: "Uninvited guest came without notice", "Feeling of confinement", "Suffering and endurance to live", "Added suffering for a woman", "The crossover of anxiety and affirmation" CONCLUSION: The results of this study can guide nurses to understand women with thyroidectomy and contribute to the nursing education program development and improvement of nursing practice.

Nutrition Care Process and Diabetes: Focus on Nutrition Diagnosis / 임상당뇨병

ADA's Nutrition Care Process (NCP) is defined as "a systematic problem-solving method that dietetics practitioners use to critically think and make decisions to address nutrition-related problems and provide safe, effective, high quality nutrition care." The NCP is a standardized process not standardized care. The NCP consists of four distinct but interrelated steps: (1) nutrition assessment, (2) nutrition diagnosis, (3) nutrition intervention, and (4) nutrition monitoring and evaluation. The second step, nutrition diagnosis, is the newest addition to the nutrition care process. The desired format for writing a nutrition diagnosis is a PES (problem, etiology, and signs and symptoms) statement. Nutritional management for diabetes patients is conducted differently by each registered dietitian and medical institution. If a nutritional diagnosis is identified by nutrition assessment in diabetes patients and the accompanying process, which includes implementation of nutrition intervention and monitoring and evaluation of the results of intervention, is standardized, high quality nutritional management through standardized language and documentation is expected to result.

Nutrient Intake and Dietary Behaviors of Patients with Functional Dyspepsia

As a disease that reduces quality of life, functional dyspepsia (FD) is associated with foods that may worsen its symptoms or cause it. The purpose of this study was to examine the nutritional status and dietary behaviors of FD patients. We investigated food intake, food intake frequency, and dietary habits of 45 FD subjects according to the Rome III Diagnosis Criteria. Average age and body mass index (BMI) were 47.7 years and 22.6 kg/m2 (males: 23.4 kg/m2, females: 22.1 kg/m2), respectively. Average energy intake was 77% of Korean Dietary Reference Intake (KDRI), and it was less than that of the Korea National Health and Nutrition Examination Surveys (KNHANES). Other nutrient intake levels were similar to the KNHANES. Energy intake proportion of carbohydrates:protein:fat was 56:18:26, and the ratio of fat intake was higher than that of the KNHANES. Beans, laver, tomato, and yogurt were consumed very frequently. In the results of meal regularity, dietary behaviors and composition of diet were relatively good. It is likely that the patient controlled their diet by eating cautiously and by reducing alcohol drinking and smoking. Our results indicate that FD patients' nutritional status by consumption of nutrients was at a level of normal healthy people and that dietary habits were better than normal adults. However, their fat intake levels were somewhat higher than normal people. Therefore, further research is required to identify the relationship between dietary intakes and FD.

Clinical Nutrition Service at Medical Centers in Seoul

The purpose of this study was to investigate the status of clinical nutrition services at various medical centers in Seoul, Korea. A questionnaire was distributed to the departments of nutrition at 44 hospitals in Seoul on July 2009. Nutritional screening carried out at a rate of 59.1% at the medical centers, and a significant difference was found according to the type of center, from 100% in tertiary hospitals to 18.8% in normal hospitals. On annual average, the numbers of inpatients, inpatients for malnutritional screening, inpatients with malnutrition, and inpatients for malnutrition management were 15,169.5, 10,870.9, 2,224.8, and 1,546.2, respectively. On average the group nutrition education was done 36.1 times/year for diabetes, 8.2 times/year for cancer, and 1.9 times/year for renal disease, and the numbers of participants 423.1, 95.1, and 31.5, respectively. On average the individual nutrition education of inpatients with diabetes was done 135.4 times/year for ordered-type, and 119.3 times/year for unordered-type, 106.2 times/year for paid-type, and 148.5 times/year for unpaid-type. The mean fee for education and counseling was the highest for peritoneal dialysis (73,090.9 won) but the lowest for heart disease (23,609.1 won). On average the individual nutrition education of outpatients with diabetes was done 234.6 times/year for ordered-type, and 2.5 times/year for unordered-type, 204.4 times/year for paid-type, and 32.7 times/year for unpaid-type. The mean fee for education and counseling was also the highest for peritoneal dialysis (63,500.0 won) but the lowest for heart disease (21,336.4 won). To implement more effective clinical nutrition service, a national medical insurance imbursement policy should be urgently instituted such that diseases left as unpaid are covered by health insurance, including all nutrition-related disease.

Validation of the Developed Nutritional Screening Tool for Hospital Patients

Malnutrition has been associated with higher hospital costs, mortality, rates of complications and longer length of hospital stay. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those require much time and labor to administer and may not be applicable to a Korean population. Therefore, the aim of this study was to develop nutritional screening tool for Korean inpatients. Then we compare nutritional screening tools that developed and previously described. Seven hundred sixty-four patients at hospital admission were screened nutritional status and classified as well nourished, malnutrition stage 1 or stage 2 by the KNNRS (Kyunghee Neo Nutrition Risk Screening), PG-SGA (Patient-Generated Subjective Global Assessment) and NRS-2002 (Nutritional Risk Screening-2002). The KNNRS, PG-SGA and NRS-2002 respectively classified 28.7%, 51.3%, 48.5% of patients as malnourished status. Compared to the PG-SGA, the KNNRS had sensitivity 60.7% (95% CI 54.2-67.0) and specificity 81.2% (95% CI 75.3-85.2). Agreement was fair between KNNRS and PG-SGA (k = 0.34). Compared to the NRS-2002, the KNNRS had sensitivity 57.8% (95% CI 53.4-60.9) and specificity 64.4% (95% CI 60.2-69.8). Agreement was poor between KNNRS and NRS-2002 (k = 0.18). These result should include that the KNNRS and PGS-GA have clinical relevance and fair concordance. However the rate of malnourished patients by KNNRS were less than by PG-SGA. For more effectivity of nutritional screening and management, the criteria of KNNRS would be better revised.

Nutrition Assessment of Older Subjects in a Health Care Center by MNA (Mini Nutritional Assessment)

Elderly people comprise an increasing proportion of the population, and nutritional impairments may contribute to health problems among this group. This study was conducted to evaluate the nutritional status by Mini-Nutritional Assessment (MNA) and to identify relationships among anthropometric measurements, biochemical indicators, bone Mineral Density (BMD) and MNA results among older adults (> or =65 yrs, n=98, 66.7+/-2.5 yrs; M=52, F=46, BMI 24.5+/-2.8 kg/m2) at a Health Care Center. A dietitian administered MNA and collected anthropometric measurements (weight, height, waist circumference), biochemical indicators (albumin, hemoglobin, hematocrit, TLC, glucose, lipids) and the BMD (spine, femur, F=46). Subjects were grouped into a normal nutrition group (0~2 risk factors of malnutrition) and a high risk of malnutrition group (>=3 risk factors of malnutrition) based on their risk factor status for malnutrition. The risk factors for malnutrition include age > or =65 years, PIBW <90%, albumin <3.5 g/dl, TLC <1,500%, Hgb <14 g/dl (men), Hgb <10 g/dl (women), loss of appetite and weight loss 1~3 kg/last 3 months. In addition, subjects were grouped into a normal, osteopenia and osteoporosis group by BMD. We found that 12% of the subjects were at risk of malnutrition (MNA score, 21.4+/-2.1) and that 88% were well nourished (27.3+/-1.5) according to the MNA. Full-MNA scores were positively and significantly (p<0.05) associated with BMI, mid-arm circumference (MAC), calf circumference (CC), albumin and hemoglobin, respectively. The full-MNA score of the high risk of malnutrition group (23.0+/-3.8) was lower than that of the normal nutrition group (27.0+/-2.1) (p<0.05). In addition, the Full-MNA score was negatively associated with the risk factor of malnutrition (r=-0.35, p=0.0004). We found that 39.1% of the subjects had osteoporosis, 45.7% had osteopenia and 15.2% were normal according to their BMD. The MNA score of osteoporosis group (24.58+/-3.3) was lower than that of the normal (27.4+/-1.1) and osteopenia group (26.9+/-1.5) (p<0.05). These results suggested that MNA can be useful as a nutritional screening tool of older adults in Health Care Centers.

Analysis of Hospital Foodservice Management and Health Insurance Coverage of Inpatient Meals in Seoul

The objectives of this study were to explore hospital foodservice management and to investigate conditions related to health insurance coverage of inpatient meals. A questionnaire was distributed to the nutrition departments of 44 hospitals in Seoul on July 2009. The average kitchen area was 0.5 m2, and centralized distribution systems were in place. Partition walls from contamination zones, separate work tables to prevent cross-contamination, exclusive areas for preparing tube feeding, and split carts with refrigerated and convection heat settings were largely used in tertiary hospitals. Most dietitians did meal rounds (93.2%) and surveyed for patient satisfaction (86.4%). The major theme of QI (Quality Improvement) was menu management (31.8%). The health insurance fees for meals were 4,938.9 won for a general diet, 5,199.8 won for a therapeutic diet, 4,067.0 won for tube feeding, 9,950.0 won for sterilized diet, and 18,383.4 won for diets not covered by health insurance. The prices for general and therapeutic diets were significantly lower in hospitals compared to tertiary or general hospitals (P<0.001). The cost composed of 48.3% food, 44.0% labor and 7.7% overhead for general diets and 47.9%, 44.5% and 7.6% for therapeutic diets. In the case of health insurance coverage for patient meals, the number of items applied to general diets averaged 2.8 out of 4 and for therapeutic diets it averaged 1.9 out of 3. To reform the health insurance coverage system for patient meals, it is urgent that the qualified level of patient meals is presented from a national viewpoint, and monitoring should be performed consistently by developing the evaluation tools.

Antioxidant Vitamins and Lipid Peroxidation in Patients with Cervical Intraepithelial Neoplasia

The purpose of this study was to investigate the implications of dietary intake and the level of plasma antioxidant, lipid peroxidation, and antioxidant capacity in Korean women with cervical intraepithelial neoplasia (CIN). From October 2002 to March 2003, 58 patients diagnosed with CIN (confirmed with colposcopy directed biopsy) and 86 patients without any cervical disease as control group were enrolled in the study at the Department of Gynecology cancer center at Samsung Cheil Hospital. The intake of antioxidant vitamins in both groups exceeded the amount recommended by the Korea RDA, 7th edition. The plasma concentration of Vitamin C was significantly lower in the CIN group (0.36 mg/dL) than in the control group (0.48 mg/dL) (p<0.05). The two groups showed similar plasma concentrations of beta-carotene, alpha-tocopherol, and retinol. The average concentration of malondialdehydes in the CIN group, 7.23 mmol/mL, was significantly higher than in the control group, 5.18 mmol/mL (p<0.01). The total radical trapping antioxidant potential concentration of plasma was significantly higher in the CIN group (1.15 mM) than in the control group (1.25 mM) (p<0.05). These results suggest that there is a possible correlation between cervical intraepithelial neoplastic processes and changes in the plasma antioxidative system.

A Change of Serum Folate and Vitamin B12 Concentrations of Maternal and Umbilical Cord Blood during Pregnancy / 대한지역사회영양학회지

Folate and Vitamin B12 are essential nutrients important during pregnancy. This study was conducted to evaluate the folate and vitamin B12 nutritional status of Korean pregnant women and to investigate the relationship between maternal-umbilical cord serum folate and vitamin B12 levels and pregnancy outcomes. Dietary intakes of the pregnant women were estimated by 24 hour-recall (3 times). Serum folate and vitamin B12 levels in maternal blood and umbilical cord of 27 pregnant women at 1'st-, 2'nd-, 3'rd- trimester and delivery were measured by RIA (radioimmuno assay), respectively. Means of folate and vitamin B12 intake were 283.53 +/- 58.01 microgram/day and 2.99 +/- 1.32 mg/day, respectively. Maternal mean serum folate levels of the trimester and delivery were 9.75 +/- 3.60 ng/ml, 10.46 +/- 4.63 ng/ml, 10.71 +/- 4.14 ng/ml and 15.05 +/- 7.04 ng/ml. Those maternal levels were significantly lower than that of umbilical cord blood (23.99 +/- 9.42 ng/ml). Serum vitamin B12 levels of maternal trimester and delivery were 479.07 +/- 137.56 pg/ml, 310.96 +/- 137.56 pg/ml, 308.22 +/- 74.65 pg/ml, and 295.67 +/- 93.36 pg/ml, which were significantly lower than those of umbilical cord blood (500.13 +/- 185.60 ng/ml). This finding indicates that the uptake of folate and vitamin B12 in the fetus may be due to an active placental transport mechanism. Maternal serum level correlated positively with those of umbilical cord blood, showing that folate and vitamin B12 concentration of umbilical cord blood might be affected by maternal status. There was no significant correlation between the serum folate levels in maternal-umbilical cord blood and the pregnancy outcomes. However, maternal vitamin B12 level at 1'st trimester was significant positive correlation between the gestational age except for birth weight and weight gain.

Selenium, Manganese, Copper and Zinc Contents in Serum of Patients with Cervical Intraepithelial Neoplasia / 대한지역사회영양학회지

The purpose of this study was to investigate the implications of dietary intake and the level of serum micronutrients (Se, Mn, Cu, Zn), lipid peroxidation, and antioxidant capacity in Korean women with cervical intraepithelial neoplasia (CIN). From October 2002 to March 2003, 50 patients diagnosed with CIN (confirmed with colposcopy directed biopsy) and 50 patients without any cervical disease as the control group were enrolled in the study at the Department of Gynecology Cancer Center at Samsung Cheil Hospital. Animal fat intake in CIN group was significantly higher than that of the control group, but plant protein intake in the CIN group was significantly lower than that of the Control group. Energy and zink intakes were similar in the two groups. The serum concentration of antioxidant minerals in the CIN group were not signifi-cantly different from the control group. The total radical trapping antioxidant potential concentration of plasma was sig-nificantly lower in the CIN group (1.12 mM) than in the control group (1.25 mM)(p < 0.05). But MDA (malondialde-hyde) of serum was significantly higher in the CIN group (7.60 mM) than in the control group (4.99 mM)(p < 0.005). The serum selenium concentration of the control group showed significant positive correlation with the MDA level (r = 0.311). These findings are suggestive of protective roles for healthy dietary habit including increasing antioxidant nut-rients and decreasing intake of fat.

Retinol, beta-Carotene, and alpha-Tocopherol Concentrations in Maternal-Umbilical Cord Plasma and Their Relationships to Pregnancy Outcome / 대한지역사회영양학회지

The purpose of this study was to evaluate the intake of antioxidant vitamins and plasma concentrations of those in 60 maternal-infant pairs (30 in normal term delivery group, NT; 30 in preterm delivery group, PT). We also investigated the relationship between vitamin levels of maternal-umbilical cord plasma and pregnancy outcome. Mean energy intakes of NT and PT pregnant women were 93.2% and 85.4%, and their protein intakes were 113.3% and 110.9 % of the recommended dietary allowance (RDA), respectively. While vitamin A intakes were only 51.2% and 39.6% of the RDA in NT and PT pregnant women. The vitamin E intake was about 50% of the RDA (NT 6.27 mg, PT 7.78 mg). The levels of retinol in maternal plasma of NT and PT were 1.51 micronmol/l and 1.43 micronmol/l, respectively. The retinol levels in umbilical cord plasma in NT and PT were 0.72 micronmol/l and 0.61 micronmol/l, respectively. The level of beta-carotene in maternal plasma of NT was 0.49 micronmol/l, significantly (p < 0.01) higher than that of PT (0.31 micronmol/l). The beta-carotene of umbilical cord plasma of NT and PT were 0.02 micronmol/l and 0.01 micronmol/l, respectively. The plasma alpha- tocopherol of maternal of NT and PT were 29.51 micronmol/l and 27.17 micronmol/l, respectively. The alpha-tocopherol of umbilical cord plasma of NT and PT were 4.16 micronmol/l and 3.80 micronmol/l, respectively. The antioxidant vitamin levels retinol, beta-carotene, and alpha-tocopherol) in maternal plasma were significantly higher (p < 0.0001) than those in umbilical cord plasma. However, there was no correlation between the vitamin levels in maternal plasma and those in umbilical cord plasma. The maternal plasma beta-carotene level showed a positive correlation to gestational age. Also Apgar score at 1 min produced a positive correlation to maternal plasma beta-carotene level.

Antioxidant Vitamins Intake and Antioxidant System in Exfoliated Cervicovaginal Cells of the Patient with Cervical Intraepithelial Neoplasia / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the dietary intake of antioxidant vitamins, the level of antioxidant vitamins (retinol, beta-carotene, alpha-tocopherol), lipid peroxidation, and the capacity of antioxidants in exfoliated cervicovaginal cells by lavage technique in normal women and patients with cervical intraepithelial neoplasia (CIN) in Korea. METHODS: The study included 56 patients with histopathologically diagnosed CIN and 63 healthy women as control in the Department of Gynecology Cancer Center in Samsung Cheil Hospital and Women's Healthcare Center between December 2002 and March 2003. Data on dietary intake were collected with semiquantitative frequency questionnaire method. Retinol, beta-carotene and alpha-tocopherol were assayed with high pressure liquid chromatography (HPLC). The levels of lipid peroxidation (MDA) and antioxidant capacity (TRAP) were determined by fluorometric method and inhibition assay method. RESULTS: The intake of antioxidant vitamins in both groups exceeds the amount recommended by the Korea dietary recommendation 7th ed, which was relatively good. Cervicovaginal cells beta-carotene levels were found to be significantly decreased (p<0.001), and alpha-tocopherol, and retinol levels were significantly increased in patients with CIN as compare with controls (p<0.05). The average concentration of cervicovaginal cellular malondialdehydes (MDA) in the patients was significantly higher (p<0.001) than the control group and total radical trapping antioxidant potential (TRAP) concentration was significantly lower than the control group (p<0.001). CONCLUSION: This study demonstrates that the levels of in situ beta-carotene, alpha-tocopherol, retinol, malondialdehydes, and total radical trapping antioxidant potential concentration were measurable in samples of exfoliated epithelial cells obtained by cervicovaginal lavage technique. These findings support to hypothesis that changes of cervicovaginal cellular antioxidants vitamins lipid peroxidation may have an etiologic role in the pathogenesis of cervical intraepithelial neoplasia.

Iron Status Indices of Maternal, Umbilical Cord, Placenta and Birth Weight / 대한지역사회영양학회지

The purpose of this study is to assess the maternal iron status during pregnancy and to evaluate the relationships between the iron indices of maternal, umbilical cord serum, placenta and pregnancy outcomes. Venous bloods samples were drawn from 54 pregnant women just before delivery and cord bloods of their newborn babies were collected immediately after birth. And also, placental tissues were extracted. We investigated the difference of the iron status indices of maternal, umbilical cord serum and placental tissue between two gestational age group (PT group, NT group : preterm delivery and normal term delivery at 34.9wk and 39.0wk of mean gestational length, respectively) and also assessed correlations of iron status indices of maternal, umbilical cord serum and placenta tissue. And lastly, we related between birth weight and iron status indices of maternal, umbilical cord serum and placental tissue. The concentrations of maternal serum ferritin and of placental iron were significantly higher in PT group (32.1 +/- 21.1 ng/ml, 68.5 +/- 16.7microgram / g), than those of NT group (20.8 +/- 11.6 ng / ml, 53.2 +/- 17.4 microgram / g) respectively (p < 0.001). However the serum ferritin of umbilical cord were significantly higher in NT group (PT : 109.4 +/- 65.7 ng/ml, NT : 147.0 +/- 56.8 ng / ml) than those of PT group (p < 0.05). Our results showed that a negative association between birth weight (r=-0.361) and maternal serum ferritin and that a positive association between birth weight and umbilical cord serum ferritin (r=0.261). Despite not a significant difference, there was tendency that highest concentration of maternal serum ferritin was associated with the lowest birth weight. These findings indicate that birth weight of newborn is dependent of multiple factors such as maternal iron status during pre-pregnancy, body size, general nutritional status. Although for women who enter pregnancy with low iron stores, enough intakes of iron during pregnancy could produce undesirable pregnancy outcome. Therefore we suggest for successful pregnancy outcome and delivery differential iron supplementation program will be carried out individual pregnant women on the basis of pre-pregnancy nutritional status.