Evaluating a Fall Risk Assessment Tool in an Emergency Department.

INTRODUCTION: A hospital's emergency department (ED) used the Johns Hopkins fall risk assessment tool (JHFRAT), which was not developed to assess the ED patients. The ED committee recommended the memorial ED fall risk assessment tool (MEDFRAT) plus a "nursing judgment" category. However, the modified MEDFRAT needed to be evaluated before implementation. This research evaluated the modified MEDFRAT in ED patients and nurses' perception of the tool. METHODS: A two-stage quantitative design was used. Stage 1 was a chart review using both tools for patients who fell (n = 57) in the past 4 years and the control patients (n = 57). Two tools were compared using t-tests, Bland-Altman, predictive abilities, and mismatch rates. Stage 2 was the assessment of all ED patients (n = 435) seen by the ED triage nurses for 1 week using both tools. The chi-squared test and mismatch rates were used to compare the tools. Time to complete both tools and nurses' perceptions to the modified MEDFRAT were analyzed. RESULTS: Two tools were significantly different. The modified MEDFRAT had higher predictive ability and lower mismatch rates than the JHFRAT. It needed shorter time to complete and was preferred by most nurses. CONCLUSIONS: The modified MEDFRAT is adequate to use in the ED.

Look before you LEAPP™: An interprofessional approach to bedside pediatric inpatient procedures.

The Golisano Children's Hospital at Upstate Medical University is a 71 bed children's hospital within a hospital, serving nearly two million people in Central New York. Minor procedures occur daily in all children's hospitals, yet team coordination when planning for these procedures is often overlooked. LEAPP™ is a mnemonic for: Listen, Evaluate, Anticipate, Plan, and Proceed. The "Look before You LEAPP™" program was developed by a group of nurses, child life specialists, faculty, a chief resident and a fellow. LEAPP™ is a team-based program providing consistent care to all children undergoing inpatient procedures. It improves patient satisfaction and reduces procedural distress. Through LEAPP™ steps, teams are created at point of care - at the bedside or treatment room of inpatient units. Educational goals are linked to the practical goal of cooperation for good health care. The approach uses an online educational module for residents, students and nurses to introduce an innovative protocol and a planning tool.1 Pocket cards, promotional pens, and logo door-clings, purchased through grant funds (The Foundation for Upstate Medical University) were initially used to encourage participation. Pre/post observations of procedural planning and performance of the nurse, caregiver, physician, child-life specialist and independent observer included patient and family preparation, pain and anxiety, staffing and supplies, and satisfaction. Fifty procedures were assessed pre-implementation and 28 post implementation. Although satisfaction with procedures improved between pre and post LEAPP™ implementation, there were overall differences in satisfaction with procedural management and pain/anxiety control by physicians, caregivers, and staff that remained statistically significant. Interdisciplinary bedside teamwork can be used to support interprofessional education and this education can similarly be used to support improved patient outcomes.

Results of a randomized trial testing messages tailored to participant-selected topics among female college students: physical activity outcomes.

BACKGROUND: A better understanding of identifying tailoring variables would improve message design. Tailoring to a behavior that a participant selects as one they would like to work on may increase message relevance, and thus effectiveness. This trial compared 3 groups: message tailored to physical activity as a participant-selected topic (choice), message tailored to physical activity as an expert-determined topic (expert), or nontailored message (comparison). METHODS: 408 female college students received web-delivered computer-tailored messages on physical activity. Outcomes were immediate and 1-month follow-up changes in psychosocial, goal-related, and behavioral variables related to physical activity. RESULTS: Participants were predominately non-Hispanic White (73.8%). Change in self-efficacy and goal commitment at immediate follow-up and vigorous physical activity at 1-month follow-up was greater in the expert versus comparison group. Change in goal commitment at immediate follow-up was lower in the choice versus expert group. In the expert group, those choosing physical activity as their selected topic perceived the goal to be easier at immediate follow-up compared with those receiving unmatched messages. CONCLUSIONS: Findings supported tailoring to an expert-determined topic. However, based on the beneficial change in perceived goal difficulty when topics matched, future research should encourage synchrony between participant-selected topics and expert recommendations.

The use of the pile sort method in identifying groups of healthful lifestyle behaviors among female community college students.

When encountering new or understudied populations, it is useful to build an understanding of the needs and perceptions of the target audience. This study investigated the application of the qualitative pile sort method for gaining information about nutrition and physical activity behaviors. In a pile sort, individuals make a list of topics relevant to a particular subject, and then they group these topics into related piles. This study investigated whether there was consistency in the ways in which participants grouped behaviors related to having a healthful lifestyle. Pile sorts were conducted during six focus groups among 28 female community college students (46% white; 39% had a 2-year degree or higher). A total of 74 piles of grouped behaviors were coded from the transcripts. Analyses revealed good consistency (identified nine to 12 times) for four groupings: exercise, lifestyle, how you eat, and positive foods. The pile sort method represents an activity that can be incorporated into formative research for interventions focused on complex behaviors with multiple components; in addition, this method may provide structure to counseling sessions and facilitate a better understanding of the perceptions of healthful eating and physical activity from patients' perspectives.

The Diet Quality Index-Revised: a tool to promote and evaluate dietary change among older cancer survivors enrolled in a home-based intervention trial.

OBJECTIVE: To utilize the Diet Quality Index-Revised (DQI-R) as a framework for delivering and evaluating an intervention to improve overall diet quality among older cancer survivors. DESIGN: As part of a randomized controlled trial to improve lifestyle behaviors among older cancer survivors, we sought a dietary measure that could serve as both an intervention framework and a means to evaluate global dietary quality. The DQI-R measures overall diet quality by summing 10 subscales that relate to national guidelines. At baseline, DQI-R scores were generated from three multi-pass 24-hour dietary recalls. The 6-month intervention delivered tailored feedback on individual DQI-R subscales. Dietary recalls were repeated at 6 and 12 months. SUBJECTS: Elderly (aged >or=65 years) individuals within 18 months of diagnosis of breast or prostate cancer (n=182) were randomized postbaseline measures to intervention vs attention control arms. RESULTS: Significant differences in overall diet quality were observed between arms at 6 months, with the intervention arm improving (67.6+/-12.2 to 69.8+/-13.9), and controls declining (67.5+/-12.5 to 64.6+/-14.7) (P=0.003). Significant differences were observed between arms over time in dietary diversity subscale scores: baseline and 6-month follow-up means among intervention and control arms were 4.8+/-1.3 to 4.8+/-1.4, and 4.7+/-1.2 to 4.1+/-1.1, respectively (P=0.001). CONCLUSIONS: The DQI-R served as an effective guide and evaluation tool for this diet-related randomized controlled trial. Like many interventions, our effect diminished after the intervention was complete. Future research should consider testing interventions that use the DQI-R, or other global diet-related indexes, as guides and evaluation tools over longer study periods, as well as in other populations.

Food group intake and brain lesions in late-life vascular depression.

BACKGROUND: Studies indicate that diet may be related to the occurrence of brain lesions. The cross-sectional association between food intake and brain lesion volumes in late-life depression was examined in a cohort of elderly individuals with current or prior depression. METHODS: Food intake was assessed in 54 elderly vascular depression subjects (vascular depression defined by presence of hyperintensities on brain MRI) using a Block 1998 food frequency questionnaire. Food and kilocalorie intake were determined. Brain lesion volumes were calculated from MRI. Subjects were aged 60 or over and were participants in a longitudinal study of major depression. All subjects received psychiatric assessment and treatment, and medical comorbidity assessments. RESULTS: High-fat dairy and whole grains were significantly positively correlated with brain lesion volume, while other food groups were not significantly associated with lesion volume. In multivariable analyses, controlling for age, sex, hypertension, diabetes and total kilocalories, the positive association with lesion volume remained significant for both high-fat dairy and whole grains. CONCLUSIONS: High fat dairy and whole grain consumption may be associated with brain lesions in elderly subjects with depression.

Differences in fruit and vegetable intake among categories of dietary supplement users.

BACKGROUND: People who choose to take dietary supplements are often classified as having a healthful lifestyle; however, it is probable that several health behavior patterns exist among users. OBJECTIVE: Data from the North Carolina Strategies to Improve Diet, Exercise, and Screening study (N = 727) were used to identify and describe five different categories of dietary supplement use and evaluate how these categories are associated with both quantity and quality of fruit and vegetable consumption. DESIGN: Five nonoverlapping dietary supplement use categories were created and descriptive demographic statistics were compared. Least-squares means were calculated for knowledge and fruit and vegetable quality and quantity measures. Logistic regression was performed to calculate adjusted odds ratios to examine associations among the dietary supplement use categories and the fruit and vegetable measures, using nonusers as the reference category. RESULTS: Demographic profiles and dietary intake varied among the dietary supplement categories. People reporting both a multivitamin/multimineral and a single supplement (Multi Plus category) and any nonvitamin/nonmineral products (Herbals category) were more likely to be consuming more vegetables and higher-quality fruits and vegetables than those not taking any dietary supplements (Nonusers category), whereas people taking multivitamins/multiminerals only (Multis category) had patterns that were more consistently similar to those not taking any dietary supplements (Nonusers). CONCLUSIONS: Study participants exhibited dietary supplement use patterns that were associated with differences in fruit and vegetable consumption. Simply characterizing people as users and nonusers will not capture critical demographic and dietary differences and will likely further cloud investigations of diet-disease relationships.

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites.

OBJECTIVE: To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN: Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS: Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Student's t tests. RESULTS: Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS: Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.

Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer.

OBJECTIVE: To explore colorectal cancer survivors' beliefs about diet, dietary supplements, health, and cancer in relation to beliefs of a similar group without colorectal cancer. DESIGN: In-depth, semistructured, open-ended interviews were used to examine perceptions. PARTICIPANTS: Twenty-two participants (10 colorectal cancer survivors and 12 from a comparison group) from the North Carolina Strategies for Improving Diet, Exercise, and Screening Study. ANALYSIS: Verbatim interview transcripts were coded and analyzed. Comparisons were made between colorectal cancer survivors and the comparison group. RESULTS: Three main themes emerged: the influence of significant life events on dietary change, concerns about contaminants in the food supply, and a lack of physician guidance in dietary supplement selection. CONCLUSION AND IMPLICATIONS: The experience of colorectal cancer is significant and may lead to dietary change among some survivors, but these findings do not suggest that it is necessarily more influential than other life events. Participants sought to control diet (for coping or survival) and also felt that diet cannot be controlled (due to the contamination of the food supply). Although many lacked guidance from physicians about dietary supplements, they were comfortable making their own decisions to self-treat. Enhanced understanding of the themes that guide selection of diet and dietary supplements can provide a context for dietitians in practice and researchers conducting behavioral interventions.

The influence of health behavior clusters on dietary change.

BACKGROUND: The goal of this study was to identify cancer preventive health behavior clusters and to determine if clusters responded differently to a year-long intervention to increase fruit and vegetable consumption. METHODS: The North Carolina Strategies for Improving Diet, Exercise, and Screening (NC STRIDES) is a health communications intervention (n = 595) among colorectal cancer survivors and a comparison population. Cluster analysis was used to identify nonoverlapping groups based on fruit and vegetable intake (servings/day), physical activity (minutes/day), multivitamin use (yes/no), and body mass index (kg/m2). Logistic regression was performed to assess positive change in fruit and vegetable servings, using the healthiest cluster as the reference group. RESULTS: Five clusters were formed; they differed significantly by health behaviors and demographics. Clusters 1 and 2 (those following the "Healthy Choices" and "Eating Well" patterns) were eating more than 5 A Day before the intervention (8.6 and 6.9 servings/day), and did not show any increase. Cluster 3 ("Physically Active") reported an increase of 1.3 servings/day to reach 5.4 servings/day, and Clusters 4 and 5 ("Average Americans" and "Most Challenged") improved one serving/day for final intakes of 5.2 and 5.0 servings/day. CONCLUSIONS: These findings illustrate some differences in magnitude of response to a fruit and vegetable intervention based on health behavior profiles. Creating clusters or other categories from baseline health behaviors may help to further improve targeting and/or tailoring in health promotion interventions.

Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study.

BACKGROUND: Dairy, fruit, and vegetable intakes may be associated with functional limitations and disability through their role in muscle function, osteoporosis, and prevention of the oxidative damage associated with aging and chronic disease. OBJECTIVE: The associations between dairy, fruit, and vegetable intakes and functional limitations and disability were examined in African Americans and whites (baseline age: 45-64 y; n=9404) in the Atherosclerosis Risk in Communities (ARIC) Study. DESIGN: Logistic regression analyses were used to ascertain the associations between usual dairy, fruit, and vegetable intakes obtained at baseline by using a food-frequency questionnaire and lower-extremity function, activities of daily living (ADLs), and instrumental ADLs (IADLs) self-reported approximately 9 y later in models stratified by race and sex. RESULTS: Baseline dairy, fruit, and vegetable intakes tended to be inversely associated with impaired lower-extremity function, ADLs, and IADLs approximately 9 y later, particularly in African American women. For example, in African American women, baseline dairy intakes were inversely associated with impaired ADLs and IADLs [odds ratio (95% CI): 0.60 (0.40, 0.90) and 0.69 (0.48, 0.98), respectively [corrected] in the 3rd versus the [corrected] 1st tertile of intake (P [corrected] for trend<0.05]. Combined baseline intakes of fruit and vegetables were also inversely associated with impaired lower-extremity function, ADLs, and IADLs [odds ratio (95% CI): 0.67 (0.47, 0.95), 0.52 (0.36, 0.76), and 0.64 (0.45, 0.90), respectively; P for trend<0.05]. CONCLUSIONS: Dairy, fruit, and vegetable intakes may be inversely associated with functional limitations and disability. Further research is needed to ascertain the effect of diet on subsequent functional limitations and disability.

Pros and cons of proposed interventions to promote healthy eating.

The increased prevalence and costs associated with the obesity epidemic have made preventive efforts a public health priority. Public health has historically relied on a series of targeted regulations, taxes, and education efforts to curb epidemics, and will rely on similar strategies to combat obesity. We argue that interventions targeted at youth are relatively easy to justify on economic grounds due to the additional protections that this group requires, but that justification for government interventions aimed at curbing obesity among adults requires additional evidence that private markets are not functioning properly. We then present seven proposed intervention strategies to promote healthy eating, and use an economic framework to discuss the relative merits of the interventions. This evaluation will allow policymakers to make more informed decisions concerning the relative merits of these strategies in combating the obesity epidemic.

The effect of participation in the WIC program on preschoolers' diets.

OBJECTIVE: To evaluate nutrient, food intake, and snacking behavior by participation in the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program. STUDY DESIGN: Secondary data analysis of a nationally representative cross-sectional survey conducted by USDA in 1994 to 1996 and 1998. METHODS: Statistical analysis was performed correcting for sample design effects and weighting for children in two income groups (<130%, n=1772 and 130% to 185% of poverty, n=689). RESULTS: Among WIC participants, the prevalence of snacking was significantly lower (68%) compared with nonparticipants (72%) (chi(2)=5.9, P=.01). For those <130% of poverty, WIC had a beneficial effect on the intake of fat, carbohydrates, added sugar, and fruit from the total diet as well as on added sugar from snacks. These were independent of food stamp participation. For those with higher incomes, the beneficial effects were limited to added sugar, iron density, and fruit intake for the total diet. A similar significant effect of decreased added sugar intake from snacks was also seen. CONCLUSIONS: Our results are in line with previous research showing beneficial effects of WIC participation among preschoolers, primarily for nutrients targeted by the program. This study shows that the effect can reach beyond those targeted nutrients.

A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: the Lifestyle Index.

BACKGROUND: Extensive studies have revealed the importance of a healthy lifestyle and the role of each lifestyle factor in health. However, lifestyle factors have rarely been studied simultaneously. The authors propose an integrated approach to summarize total healthfulness of lifestyles and to enhance understanding of lifestyle patterns across countries. METHODS: The authors created an overall measure of lifestyle called the Lifestyle Index (LI), integrating diet, physical activity, smoking, and alcohol use to provide a global tool of monitoring healthfulness and patterns of lifestyles. Using the LI, the authors conducted a cross-national comparison between China (n = 8352) and the United States (n = 9750). RESULTS: The LI effectively reflected the healthfulness of lifestyle components in both countries. The mean of the LI scores was slightly higher in China than the US. Scores of diet quality, physical activity, and smoking were higher in China, but scores of alcohol behavior were higher in the US. Similar lifestyle patterns but different unhealthy behaviors were identified in these countries. CONCLUSIONS: An assessment of total healthfulness of lifestyles and a better understanding of lifestyle patterns across countries using the LI can provide practical guidance to developing and targeting public health promotion activities to improve global public health.

The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States.

A composite measure of diet has been preferred to an index of a single nutrient or food in the area of dietary assessment. However, the lack of such a tool for cross-national comparisons has restricted the ability to compare diet quality between countries using an overall measure of diet. In this study, we created a tool called the Diet Quality Index-International (DQI-I) for global monitoring and exploration of diet quality across countries. The major categories of the index components are variety, adequacy, moderation and overall balance. Using the tool, this research presents a cross-national comparison of diet quality between China and the United States, incorporating comparable national in-depth diet data. The mean of the DQI-I score was slightly higher in China than in the United States. By major categories of the DQI-I, dietary variety was better achieved in the U.S. diet; moderation and overall balance of intakes were better accomplished in China. The DQI-I was successful in capturing variability in intakes of food and nutrients in both countries. Some distinct patterns of poor quality diet in each country were also identified. As demonstrated in this study, the DQI-I provides an effective means of cross-national comparative work for global understanding of diet quality. Furthermore, the dietary problem areas identified by the DQI-I may be useful in guiding the development of programs to improve public health.

The effect of weight change on nursing care facility admission in the NHANES I Epidemiologic Followup Survey.

Data from the first National Health and Nutrition Examination Survey Epidemiologic Followup Survey were used to examine whether weight change was associated with an increased relative risk of nursing care facility admission. Hazard ratios were calculated with Cox proportional hazards models and stratified by overweight status at baseline. Moderate and large weight loss was associated with an increased risk of nursing care facility admission in overweight and non-overweight subjects. Large weight gain was associated with an increased relative risk in only overweight subjects. In the process of functional decline that results in nursing care facility admission, weight loss may be a sign of acute illness, starvation, or aging. Preventing weight loss may help delay this process of decline. In overweight subjects, preventing weight gain may also be important in delaying this process of decline.

Weekend eating in the United States is linked with greater energy, fat, and alcohol intake.

OBJECTIVES: To determine if macronutrient consumption for the U.S. population is greater on weekend days than weekdays. RESEARCH METHODS AND PROCEDURES: The nationally representative 1994 to 1996 Continuing Survey of Food Intakes by Individuals was used for this analysis. Dietary intake was assessed using two independent days of dietary recall data. Ordinary least squares multivariate analysis was used to analyze dietary outcome variables to explore the effect of weekend day vs. weekday intake. RESULTS: This study's results indicate that statistically significant dietary intake differences occur for different days of the week but not for all age groups--nor for all nutrients. The average American, 2 years and older, consumes 82 kcal more per day on each weekend day (Friday through Sunday) than they do on weekdays (Monday through Thursday). These overall increases in dietary intake are significant for the overall sample and are largest for the 19- to 50-year-old age group; among this age group, the weekend day increase (vs. weekday) is 115 kcal/d. The increased proportions of energy from fat and alcohol consumed on weekends are greater for this adult age group by 0.7% and 1.4%, respectively, whereas the proportion of energy from carbohydrate decreases 1.6%. DISCUSSION: The effects of weekend days on nutrient intake are substantial and should be considered in future clinical and population-based interventions and in dietary monitoring and research in the U.S.