Ruth E. Litchfield

Quality of Life Issues for Families Who Make the Decision to Use a Feeding Tube for Their Child with Disabilities.

Qualitative research methods were used to study families who had made or were in the process of making the decision to use a feeding tube to meet the nutrition needs of their child with a disability. Data were gathered over a 2-year period through interviews with eight families. Family decision making in the context of quality of life was examined using a theoretical family systems model. Descriptive themes and issues emerged from the data that led to a greater understanding of what families face in making this decision for their child. The data can help families and professionals work in partnership before a child becomes severely malnourished or medically compromised as a result of inadequate nutrition. The themes and issues are discussed and implications for future interventions and research are presented.

Food safety knowledge, practices and beliefs of primary food preparers in families with young children. A mixed methods study.

Food preparers in families with young children are responsible for safe food preparation and handling to prevent foodborne illness. To explore the food safety perceptions, beliefs, and practices of primary food preparers in families with children 10 years of age and younger, a mixed methods convergent parallel design and constructs of the Health Belief Model were used. A random sampling of 72 primary food handlers (36.2±8.6 years of age, 88% female) within young families in urban and rural areas of two Midwestern states completed a knowledge survey and participated in ten focus groups. Quantitative data were analyzed using SPSS. Transcribed interviews were analyzed for codes and common themes. Forty-four percent scored less than the average knowledge score of 73%. Participants believe children are susceptible to foodborne illness but perceive its severity to be low with gastrointestinal discomfort as the primary outcome. Using safe food handling practices and avoiding inconveniences were benefits of preventing foodborne illness. Childcare duties, time and knowledge were barriers to practicing food safety. Confidence in preventing foodborne illness was high, especially when personal control over food handling is present. The low knowledge scores and reported practices revealed a false sense of confidence despite parental concern to protect their child from harm. Food safety messages that emphasize the susceptibility and severity of foodborne illness in children are needed to reach this audience for adoption of safe food handling practices.

Improving dietetics education with interactive communication technology.

Changes occurring in health care, education, and technology are altering dietetics education. A model of learnercentered, cooperative, distance education based on interactive online technology is described for use in a dietetic internship. Evaluation of this model includes review of key-feature exams, results of computer attitudes surveys, use of the technology by interns, exit interviews, and performance on the examination for registered dietitians. In a pilot study of the model with 8 subjects, comfort using the Internet improved significantly. Use of interactive communication technology in dietetics education has the potential to improve competency, technological aptitude, professional partnering skills, and lifelong learning skills.

The Use of a Handheld Calorimetry Unit to Estimate Energy Expenditure During Different Physiological Conditions

BACKGROUND Accurately determining rates of energy expenditure (EE) under free-living conditions is important in understanding the mechanisms involved in the development and prevention of obesity. Metabolic carts are not portable enough for most free-living situations. The purpose of this study was to compare a portable, handheld indirect calorimetry device (HealtheTech Incorporated, Golden, CO) to a metabolic cart (Physio-Dyne Instrument Corporation, Quogue, NY) during 3 different physiologic states. METHODS EE was measured by both the handheld calorimeter (5-10 minutes) and the metabolic cart (15-20 minutes) in 20 healthy subjects (18-35 years of age). Measurements were made during 3 physiologic states: (1) postabsorptive rest (REE), (2) postprandial rest (fed energy expenditure, FEE), and (3) while walking in place (activity energy expenditure, AEE). RESULTS There were no significant differences between the means of the cart vs the hand-held device for REE (mean +/- SE; kcal/d; 1552 +/- 64 vs 1551 +/- 63), FEE (1875 +/- 99 vs 1825 +/- 86), and AEE (3333 +/- 218 vs 3489 +/- 152). The range over which the techniques were tested was 1300-5000 kcal/d. The agreement between the 2 methods was excellent for REE (0.80, p < .0001), FEE (0.89, p < .0001), and AEE (0.75, p < .0002). CONCLUSIONS Compared with the metabolic cart, the handheld device provided similar estimates of energy expenditure during resting, postprandial, and physically active states. This suggests that portable indirect calorimetry devices can provide reliable and valuable information in free-living research situations for which maximal energy expenditure is <5000 kcal/d.

Relationships between Intern Characteristics, Computer Attitudes, and Use of Online Instruction in a Dietetic Training Program.

Changes in health care and educational technology instigated the use of interactive online instruction in this preprofessional training program. Cooperative learning strategies, which require the interns to interact with each other, were incorporated into the online instruction to initiate learner/instructor and learner/learner interaction. Seventy-five dietetic interns from 3 universities were randomly assigned to groups with and without online instruction. Computer attitudes and use of the technology were examined. Demographic variables and previous computer experience did not influence the use of the online instruction. However, those who reported a preference of working with others used the online instruction more (p = .05). The amount of time reported using the online instruction had a positive effect on overall computer attitude and comfort using computers. Significant improvement in self-efficacy with the World Wide Web occurred irrespective of the treatment.

Promoting and Evaluating Competence in On-Line Dietetics Education

Professional organizations, such as the American Dietetic Association are challenged to assure competency of their practitioners. Competency includes higher-level skills such as critical-thinking, cooperative work, effective communication, and use of lifelong learning resources. Information literacy via computer technology is a key component of competency, which needs to be included in dietetic education and training. This dietetic internship examined use of online technology to develop competency using the key-feature exam. Seventy-five dietetic interns from three different programs were divided into those with (n = 44) and without (n = 31) online instruction, to which pre- and post- test key feature exams were administered. Those with online instruction had greater improvement (P < 0.05) on key-feature exams in nutrition support and pediatric nutrition. Competency is complex and difficult to assess, thus tools to better assess the comprehensive scope of practitioner competency are needed. The key-feature exam may be a tool to assess and verify practitioner competency in dietetics professionals.

Impact of travel distance on WISEWOMAN Intervention attendance for a rural population.

OBJECTIVE The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) is a program designed for financially disadvantaged women ages 40-64 and funded by the Centers for Disease Control and Prevention (CDC). This study investigates the role that travel distance plays in determining whether these women will attend an intervention program. METHOD Women in the Iowa WISEWOMAN program were offered an optional health care education program. Distance from the womans house to the intervention class site was calculated for participants from October 2002 through July 2005 resulting in 787 women. A generalized additive model is used in determining the combined effects of distance, demographic variables, and lifestyle variables on whether women in the study attend the intervention session or not. RESULTS Distance plays an important role in attendance, although its impact depends on the age of the woman and the setting (urban or rural) of the intervention. In particular, older rural women were much more likely to attend if the intervention was close to home. CONCLUSION The probability of attendance is affected by many factors, but travel distance appears to play an important role, particularly for older rural women.

A Summative Evaluation of a Food Safety Social Marketing Campaign "4-Day Throw-Away" Using Traditional and Social Media

Foodborne illnesses remain a common problem in the United States. Focus group results indicated that lack of knowledge and improper handling of leftovers were common among food preparers in families with young children. The USDA-recommended storage time for leftovers was used to develop and conduct a food safety social marketing campaign, 4 Day Throw Away using both traditional and social media. A procedural model for developing a theory-based nutrition education intervention and the Health Belief Model were used to design, implement, and evaluate this campaign. The #4 mascot made numerous public appearances (in person and TV) to convey the 4 Day Throw Away message; 10000 magnets were distributed; and 500 posters with tear-off note card were posted in the traditional campaign. Magnets and note card directed recipients to a website (4984 visits) with food safety information about leftovers. The social media campaign included 4 YouTube videos (11759 views); a Facebook page (166 users with over 21240 post views); and 51 followers on Twitter. The use of multiple media channels increased awareness and intention to change health behaviors especially among parents of children 10 and younger. Both traditional and social media methods in the 4 Day Throw Away campaign reached the intended audience suggesting that interventions using a mix of media channels broaden the reach and potential for intended behavior change.

Leftovers and Other Food Safety Information for iPhone/iPad Application (“Smartphone” Technology)

Foodborne illness continues to be a public health concern in the United States (US). Each year, an estimated 48 million Americans (1 in 6) become ill, 128,000 are hospitalized, and 3,000 die from foodborne illness. Clostridium perfringes is cited as causing 1,606 outbreaks (second highest) and Bacillus cereus caused 164 outbreaks (sixth highest) in which a pathogen was known as the causative agent. Both of these pathogens have been associated with improper cooling and storage of leftover food. To educate consumers on safe food handling practices in their homes, The Partnership for Food Safety Education has developed the Fight BAC! messages of clean, separate, cook, and chill. One of the Healthy People 2020 objectives focuses on increasing the proportion of consumers who follow these key food safety practices (clean, separate, cook, chill). Leftover food safety involves properly chilling and reheating (cooking) food when appropriate. Children are at heightened risk for foodborne illness and are disproportionately affected by 4 foodborne microorganisms: Campylobacter, E.coli O157:H7, Listeria, and Salmonella. This heightened risk for foodborne illness is a result of undeveloped immune systems and lower body

Nutrition education delivered at the state fair: are your portions in proportion?

Overweight and obesity afflict an estimated 64% of adults in the United States’-an 8% increase in the past decade.’ Recent reports indicate no change in physical activity; people are just as inactive now as they were 10 years In contrast, caloric intake, the other side of the energy balance equation, has increased in the past 20 years. A 200 kcallday per capita increase occurred between 1977-1978 and 1994-19966*7; a 300 kcal/day per capita increase occurred between 1985 and 2000.8 The US food supply currently provides an additional 500 kcal/day per capita compared with the 1 9 7 0 ~ . ~ T h e abundant food supply makes food inexpensive, allowing retailers to entice consumers with larger portions at a lower price. Thus, portion sizes in the retail food industry have ball o ~ n e d , ~ ~ ’ ~ encouraging excessive caloric intake.”-’3 In addition, Americans are eating out more often, spending 47% of their food budget on meals outside the home in the 1990s versus 34% in the 197Os.l4 Americans are also experiencing portion distortion at home. One-third of 107 commonly consumed foods increased significantly in portion size in just 5 years; the majority were grains, cereals, and beverages.’5 Continuous exposure to larger portions, home and retail, not only encourages overeating but also leads to portion distortion. . . . . . . . . . . . . . . . . . . . . . . . . . . . .