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Kichler J.C.,Medical College of Wisconsin | Kaugars A.S.,Marquette University | Maglio K.,Nutrition Services | Alemzadeh R.,Medical College of Wisconsin
Health Psychology | Year: 2012

Objectives: The present study examined four methods of assessing diabetes adherence (self-report, diary measure, electronic monitoring, and provider rating) within a population of youth with Type I Diabetes Mellitus (T1DM). Methods: Comparisons were conducted among the four methods of assessing diabetes adherence. Associations among the seven different measures of blood glucose monitoring (BGM) and HbA1c were examined. An exploratory stepwise regression analysis was conducted to determine the best predictors of glycemic control (i.e., Hemoglobin A1c; HbA1c) while controlling for relevant demographic variables. Results: The adherence measures appeared to be interrelated. The relationships between many of the BGM measures and HbA1c demonstrated a medium effect size. The Self Care Inventory (SCI) adjusted global score was the strongest predictor of HbA1c, even after taking the demographic variables into account. Conclusions: The SCI is a robust, easy-to-use, and cost-efficient measure of adherence that has a strong relationship to HbA1c. Demographic variables are important to examine within the context of different methods of assessing adherence. The research methodology utilized to assess both general diabetes adherence and more specific behavioral measurements of BGM should be clearly documented in future studies to ensure accurate interpretation of results. © 2011 American Psychological Association.

Cormack B.E.,Nutrition Services | Bloomfield F.H.,University of Auckland
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2013

Objective: To determine whether purposely designed nutritional guidelines for extremely low birthweight (ELBW; birth weight <1000 g) babies result in protein intakes that meet international consensus recommendations, and whether this results in improved growth from birth to discharge. Design: A prospective cohort study of nutritional intakes and growth in ELBW babies. Setting: A tertiary neonatal intensive care unit in New Zealand. Patients: 100 ELBW babies who survived for the first month of life, 50 before the introduction of the guideline (Lo Pro) and 50 after (Hi Pro). Intervention: Introduction of a nutritional guideline aimed at increasing protein intakes to meet international consensus recommendations. Main outcome measures: Weekly protein intakes over the first month of life and growth until discharge. Results: Hi Pro babies had significantly higher protein intakes in the first month of life than Lo Pro babies (mean (SD), 3.8 (0.3) vs 3.3 (0.4) g/kg.day, p<0.0001) and a significantly greater growth velocity (GV) over the first 30 days after regaining birth weight (19.5 (5.0) vs 16.2 (5.4) g/kg.day, p<0.002). Hi Pro babies had a significantly lesser Z-score change between birth and discharge than Lo Pro babies for weight (0.0 (1.2) vs -0.9 (1.1), p=0.001), length (-0.8 (0.8) vs -1.2 (1.1), p=0.02) and head circumference (-0.2 (1.1) vs -1.1 (1.6), p<0.001). Conclusions: Simple, standardised nutritional guidelines can result in recommended protein intakes for ELBW babies being achieved and result in increased GV. Downward crossing of centiles between birth and discharge, common in ELBW babies, is significantly reduced for weight, length and head circumference.

Hawker J.A.,Monash University | Walker K.Z.,Monash University | Barrington V.,Nutrition Services | Andrianopoulos N.,Monash University
Journal of Human Nutrition and Dietetics | Year: 2010

Background: Growing requirements to train more dietetic students greatly increase the teaching burden on clinical supervisors. This may be reduced if students can develop basic nutrition assessment skills before they commence clinical placement. To test achievement of these skills by Australian dietetic students, a preclinical objective structured clinical examination (OSCE) was developed. Performance at this OSCE was then compared with the performance at first clinical placement. Methods: An OSCE was developed to test preclinical skills during the third year of a 4-year dietetic degree. Learning outcomes relating to nutritional assessment skills were assessed via a 1-h preclinical examination. Student application of these skills was then assessed after the first clinical placement, when performance was compared with the results at the preclinical OSCE. Results: One hundred and ninety-three students completed the preclinical OSCE and first clinical placement during the period 2002-2007. A strong relationship was observed for individual student scores at the OSCE and the score achieved at the end of clinical placement (β = 0.66; 95% confidence interval = 0.46-0.86; P < 0.0001). This relationship was maintained even when outliers were removed. No specific year effect was apparent. Conclusions: A third-year preclinical dietetic OSCE was found to be a valuable method of formative assessment for assisting dietetic students with the preparation for their first clinical placement. It aided the early identification of those students who are likely to do less well on their first clinical placement. © 2010 The Authors. Journal compilation © 2010 The British Dietetic Association Ltd.

Kumar P.R.,University of Calgary | Fenton T.R.,Nutrition Services | Fenton T.R.,University of Calgary | Shaheen A.A.,University of Calgary | Raman M.,University of Calgary
Journal of Parenteral and Enteral Nutrition | Year: 2012

The purpose of this study was to document vitamin D status in home parenteral nutrition (HPN) patients and determine if oral vitamin D supplementation has a substantial effect. Methods: A retrospective chart review of eligible adults enrolled in the Southern Alberta Home Parenteral Nutrition program (n = 15) for a minimum of 6 months was conducted. Serum measurements of 25OHD were recorded and patients were categorized by vitamin D status as follows: sufficient; insufficient; deficient with respective levels of 25OHD ≥75 nmol/L, 27.5-75 nmol/L, and ≤27.5 nmol/L; and mixed. Results: Five of 15 patients had insufficient vitamin D status throughout the study period; all had short bowel syndrome. Nine were in the mixed category; 1 was consistently sufficient, and no one was consistently deficient. Patient demographics were similar between the insufficient and mixed groups. There were no significant differences in health outcomes between the insufficient and mixed vitamin D status groups. The median (interquartile range) dose and duration of vitamin D3 supplementation for the insufficient group was 5000 IU/d (4,000-7,143) for 1,175 (1,145-1,578) total days compared to 3,000 IU/d (1,000-7,143) for 1,529 (111-1,980) days for the mixed group. Conclusions: Most patients receiving HPN had insufficient vitamin D status. When prescribed high doses of oral vitamin D, patients did not consistently achieve appropriate 25OHD levels. Alternate routes of vitamin D supplementation in patients receiving HPN should be considered. Large multicenter prospective studies are needed to best characterize the relationship between vitamin D dosing for HPN patients and vitamin D status. © 2012 American Society for Parenteral and Enteral Nutrition.

Alexander A.G.,University of California at Riverside | Grant W.L.,Nutrition Services | Pedrino K.J.,Nutrition Education Manager | Lyons P.E.,University of California at Riverside
Obesity | Year: 2014

Objective Study the effects of multiple exercise and nutritional educational interventions on adverse body mass index (BMI) gain of BMI sub-groups of predominately Hispanic six through eight year-old children at high risk for obesity. Methods BMI and demographic data were recorded at baseline and six months later in 749 first and second grade public school children at four elementary schools. Two schools (intervention group) received 150 min of extra physical education classes, weekly cooking classes, a structured nutritional curriculum, and parental counseling. BMI changes were calculated for each student and compared by BMI percentile subgroups using the two tailed T-test. Results No statistical BMI differences occurred between intervention and control group children below the 25th percentile. Significance differences in BMI gain were noted from the 25th to the 50th percentile (P = 0.027), 50th-75th percentile (P = 0.045), and 75th-95th percentile (P = 0.00007), but not for the 95th-98th percentile (P = 0.288), 98th and above (P = 0.223), or both obese groups combined (P = 0.085). Conclusions Nutritional education and exercise can prevent but not treat obesity in predominately Hispanic first and second grade children. BMI subgroups should be studied to avoid masking differing outcomes of obese and nonobese children. © 2013 The Obesity Society.

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