Provision of mouth-care in long-term care facilities: an educational trial.

OBJECTIVES: This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities. METHODS: Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties. RESULTS: Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents. CONCLUSIONS: A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

Canadian dietitians' views and practices regarding obesity and weight management.

OBJECTIVE: To provide insight into Canadian dietitians' attitudes and practices regarding obesity and weight management. DESIGN: Cross-sectional mail survey of a stratified random sample of members of Canadian dietetic associations. SUBJECTS: A total of 514 dietitians (74% of those surveyed), 350 (69%) of whom actively counselled overweight/obese clients. MEASUREMENTS: Participants received a questionnaire to assess dietitians' attitudes regarding obesity and overweight, views regarding their role in weight management, counselling practices, and the criteria used to judge success. Demographic variables were collected. RESULTS: Most dietitians believed that obesity contributes to morbidity and mortality, and that small weight losses produced important health benefits. However, 80% agreed that health indicators other than weight loss should be the focus of obesity management, and 55% specifically recommended that clients not weigh themselves. Instead, weight management was promoted by recommending healthy eating and increased physical activity. Three-quarters agreed that they are the profession best trained to manage obesity but two-thirds believed their time would be better spent preventing rather than managing obesity. Dietitians most valued education received from on-the-job support and mentoring from other dietitians. Participants reported wanting to learn more about motivational and behavioural modification counselling techniques. CONCLUSIONS: Canadian dietitians follow a lifestyle approach to weight management. Studies are required to formally assess the effectiveness of various aspects of this approach.

A survey of the use of low microbial diets in pediatric bone marrow transplant programs.

A survey was used to determine the use of low microbial diets for pediatric bone marrow transplantation patients at hospitals in Canada and the northwestern United States. Five out of 7 hospitals responding to the survey provided a low microbial diet to this population to reduce the potential risk posed by food pathogens. Two hospitals prepared their low microbial diet in a separate kitchen using aseptic techniques. One hospital provided a diet consisting of well-cooked foods or foods containing a minimum number of pathogen-forming units. Another hospital focused on safe food-handling guidelines, avoiding foods associated with foodborne illness. A final hospital reported using a modified house diet that excluded fresh fruits and vegetables. Various guidelines were used to determine when to initiate and discontinue the low microbial diet. These guidelines included criteria such as a specific day relative to transplantation and a patient's absolute neutrophil count. Results indicate that most hospitals acknowledge the potential for food to cause infection in patients with compromised immune systems by imposing dietary restrictions to limit pathogen exposure.

Development of a validated food frequency questionnaire to determine folate intake.

The aim of this study was to develop and validate a food frequency questionnaire (FFQ) to assess the folate intake of women of childbearing age (between 18 and 45 years). An FFQ containing 140 foods that have the potential to contribute significantly to folate intake was developed. The FFQ was pretested by comparing it with three-day food records completed by 20 women living in Vancouver, British Columbia. The 140-item FFQ overestimated mean daily folate intake (546 +/- 145 mg/day versus 385 +/- 151 mg/day with three-day food records); the two methods were not correlated (r = 0.359, p = 0.143). The FFQ was revised to better represent usual folate intake, and the 140 items were reduced to 81. The 81-item FFQ was validated with 17 women who completed the FFQ and a seven-day food record over four weeks. The mean daily folate intakes were 421 +/- 136 mg/day and 376 +/- 87 mg/day for the FFQ and the food records, respectively; the two methods were significantly correlated (r = 0.512, p = 0.036). This study resulted in a validated FFQ that can be used as an instrument to determine folate intakes in similar populations.