Microbiological analysis of food contact surfaces in child care centers.

A study of six child care centers was conducted to assess the microbiological quality of three food contact surfaces (one food serving surface and two food preparation surfaces) and one non-food contact surface (diaper changing surface) to determine the effectiveness of cleaning and sanitization procedures within the facilities. Aerobic plate counts (APCs) and Escherichia coli/coliform counts of 50-cm(2) areas on all surfaces were determined using standard microbiological swabbing methods. Samples were taken three times a day (preopening, lunchtime, and following final cleanup) twice per month for 8 months in each child care center (n = 288 sampling times). Mean log APCs over the survey period were 1.32, 1.71, 1.34, 1.96, 1.50, and 1.81 log CFU/50 cm(2) for the six centers. Mean log coliform counts were 0.15, 0.40, 0.33, 1.41, 0.28, and 1.12 CFU/50 cm(2) for the same centers. Coliforms were detected in 283 of 1,149 (24.7%) samples, with counts ranging from 1 to 2,000 CFU/50 cm(2), while E. coli was detected in 18 of 1,149 (1.6%) samples, with counts ranging from 1 to 35 CFU/50 cm(2). The findings of this study demonstrated that the extent of bacterial contamination was dependent on the center, time of day, and the area sampled. While no direct correlation between contamination and illness can be made, given the high risk of food-borne illness associated with children, microbial contamination of food contact or non-food contact surfaces is an aspect of food safety that requires more attention. Emphasis on training and the development of modified standard sanitation operating procedures for child care centers are needed to reduce potential hazards.

Model for multicultural nutrition counseling competencies.

A model for multicultural nutrition counseling competencies for registered dietitians was developed and tested. Six hundred four registered dietitians who were members of The American Dietetic Association Public Health Nutrition Practice Group or directors of dietetic internships and didactic programs in dietetics were selected by a stratified random sample method and were mailed a survey. Respondents rated each of 46 competencies using a Likert scale to delineate how essential each competency will be for entry-level dietitians in the next 10 years. Of the 60% who responded (n=363), 94.4% met the study selection criteria. Most were white (85.7%), spoke English as their primary language (96.8%), and had a master's degree (64.4%). Many (37.9%) worked in community/public health facilities or organizations, and 50.4% provided nutrition counseling or education to clients culturally different from themselves. Exploratory principal components analysis extracted 3 factors with 28 competencies loading on them: multicultural nutrition counseling skills, multicultural awareness, and multicultural food and nutrition knowledge. Subjects responded similarly whether or not they provided nutrition counseling to culturally different clients. Secondary analysis revealed no significant interaction or differences between how bilingual dietitians and those of color scored items in the 3 factors. The resulting model is a guideline that can be used by educators to enhance dietetics education and training and by public health nutritionists as a basis for self-evaluation and selection of continuing education opportunities to enhance their multicultural nutrition counseling competence.

Pressure area management in an orthopaedic setting.

Pressure area care for patients who have undergone a hip replacement is extremely difficult as patients' mobility tends to be restricted because of fear of dislocation. Orthopaedic surgeons influence the positional changes and techniques utilized by nurses in the postoperative period. This article reviews factors that prevent early rehabilitation and highlights methods of pressure relief for this patient group. Alternating-pressure mattresses are a main source of pressure-relieving equipment. A pilot study using the Nimbus II mattress was carried out to establish the role of alternating-pressure mattresses in the postoperative management of patients undergoing elective/emergency hip replacement surgery. None of the patients in the pilot study suffered prosthetic dislocation and 87% did not develop pressure sores. Three patients did develop a grade 2 pressure sore postoperatively. The results reinforce the use of alternating-pressure mattresses in the postoperative management of patients undergoing hip replacement surgery.

Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.

OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

Functional roles of today's public health nutritionist.

This study found that functional roles of public health nutritionists in eight southeastern states differed significantly on the basis of education, dietetic registration status, years of experience, and type and level of service. Subjects (n = 992) were mailed a 95-item questionnaire with three parts: demographic, professional practice, and grant-writing experience. Results based on a 59% response rate indicated that most of the 14 functional roles studied were practiced in accordance with guidelines presented in Personnel in Public Health Nutrition for the 1980's. Only two roles, counselor and educator, were performed somewhat inconsistently. Personnel with bachelor's degrees did have more counseling responsibilities than those with more advanced degrees. However, nonregistered dietitians also had more counseling responsibilities than did registered dietitians. Direct care providers had fewer educator responsibilities than did personnel with administration/management job responsibilities. All personnel reported research responsibilities that increased with advanced education, training, years of experience, and type and level of service. We found that beyond-entry-level personnel had more administrative and policy-setting responsibilities, which is consistent with The American Dietetic Association's Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians (1990). We conclude that, with the exceptions of the counselor and educator roles, public health nutrition practice is consistent with personnel guidelines.

Public health nutrition practices to prevent low birth weight in eight southeastern states.

This study was conducted to identify current public health nutrition practices for the prevention and treatment of low-birth-weight (LBW) infants in eight southeastern states. Nutrition personnel (n = 1,054) were mailed a 51-item questionnaire with three parts that sought information on the respondents' professional backgrounds and employment status and on practice and standards of care for women before and during pregnancy and of LBW infants. Results based on a 62% response rate indicated 73% had worked in public health nutrition for 2 to 9 years, 56% were direct care providers, and 51% had bachelor's degrees. Only 40% of respondents indicated that their agencies had prepregnancy nutrition intervention protocols, whereas 89% indicated that they had high-risk pregnancy screening protocols and 91% indicated that they had high-risk treatment protocols. More than 91% indicated that their treatment protocols included guidelines for weight gain, preparation of nutrition care plans, and assessment of dietary and biochemical factors, health behavior, and obstetric history. Only 73% indicated inclusion of assessment of educational level. Nutritionists saw high-risk pregnant women (or those at risk for preterm labor) slightly more frequently during pregnancy than they saw low-risk women; however, the range (0.9 to 3.8 vs 0.5 to 2.3) and average (2.0 vs 1.2) number of visits for both groups differed only slightly. Nutritionists counseled women and charted in the medical record more frequently than they used nutrition care plans. To reduce LBW, nutritionists should implement treatment protocols and monitor high-risk women closely. The relationship between pre-pregnancy nutrition interventions and birth weight should be investigated.