Reinforcement Effects of Social Network Intervention during Nutritional Supplementation in Frail Older Adults.

INTRODUCTION: Chronic undernutrition and a homebound state are corelated and are both important components of frailty. However, whether social network intervention combined with protein supplementation is an effective strategy to prevent functional decline among frail older adults is unclear. METHODS: 150 frail older adults participated in a 3-month, 3-armed, community-based clinical trial and were randomly assigned to one of 3 groups: high-protein supplementation (additional 27 g of protein/day), the Social Nutrition Program (additional 27 g of protein/day and social network intervention), or a control group. Those assigned to the Social Nutrition Program group received individual counseling from 1 dietitian and 1 social worker during 6 home visits and were encouraged to participate in 4 sessions of community-based cooking activities, the social kitchen program. Primary outcomes were changes in Physical Functioning (PF) and the Timed Up and Go (TUG) test and were assessed at 0 months (baseline), 1.5 months (interim), and 3, 6, and 9 months (postintervention). RESULTS: Compared with the control group, participants in the Social Nutrition Program showed an average improvement of 2.2-3.0 s in the TUG test and this improvement persisted for 3 months after the end of the program (post hoc p ≤ 0.030). The Social Nutrition Program also increased PF by 1.3 points while the control group showed a 1.4 point reduction at the end of the program (post hoc p = 0.045). Improvement in PF and TUG results was primarily observed for the socially frail subgroup of older adults in the Social Nutrition Program group rather than the physically frail subgroup. Frequency of leaving home functioned as a mediator (p = 0.042) and explained 31.2% of the total effect of the Social Nutrition Program on PF change. CONCLUSION: Our results indicate that social network intervention combined with protein supplementation can improve both the magnitude and duration of functional status among frail older community-dwelling adults.

Knowledge, Self-Efficacy, and Perceived Barriers on the Low-Iodine Diet among Thyroid Cancer Patients Preparing for Radioactive Iodine Therapy.

The purposes of the study were to assess knowledge, self-efficacy, and perceived barriers on a low-iodine diet among thyroid cancer patients and to identify strategies for nutrition education. A self-administered questionnaire was developed based on a review of literature and pilot-tested. A total of 121 female thyroid cancer patients participated in a survey and 117 responses were used for data analysis. An average knowledge score of the thyroid cancer patients was 4.5 point (available score: 0-10 point). Majority of the respondents knew that seaweeds such as lavers, brown seaweeds, and sea tangles contain large amount of iodine. However they mistook the low iodine diet as a low salt diet and were not aware of foods and seasonings that are allowed on the low iodine diet. While self-efficacy related to consuming various fruits and vegetables, to choosing potatoes and sweet potatoes for snacks, and restricting consumption of eggs, milk and milk products, and processed foods was rated highly, self-efficacy for preparing foods without using sea salts was rated low. The self-efficacy score increased as their interest on the dietary life and perceived cooking skills were greater. Most perceived barriers toward practicing the low iodine diet were related to preparation of the low iodine menus. As their interest in the dietary life and cooking and perceived cooking skills were greater, the patients perceived barriers on practicing the low iodine diet less. While the patients showed higher self-efficacy and lower barrier perception on selecting foods low in iodine and restricting food high in iodine, they showed lower self-efficacy and higher barrier perceptions on preparing low iodine meals. Clinical dietitians should recognize the gap between what the patients should know and what they really know and identify strategies on how to improve self-efficacy and reduce perceived barriers on the low iodine diet. Recent literature and the findings of the study reveal that incorporating cooking classes into nutrition education for thyroid patients is effective to enhance self-efficacy and to reduce perceived barriers on the low iodine diet.

Age at diagnosis is an independent predictor of small renal cell carcinoma recurrence-free survival.

PURPOSE: Controversy exists as to the influence of age at diagnosis on prognosis in patients with renal cell carcinoma. We investigated the relationship between age at diagnosis and disease recurrence after surgery in patients with small renal cell carcinoma. MATERIALS AND METHODS: Of the 1,196 patients who underwent curative surgery for renal cell carcinoma between 1989 and 2005 at our institution 490 with renal cell carcinoma 4 cm or less were included in our study. Patients were stratified into 3 subgroups according to age at diagnosis, including 40 years or less in 93, 41 to 60 years in 253 and greater than 60 years in 144. Clinical and pathological variables at diagnosis were compared and survival analysis was performed. RESULTS: A total of 17 patients (3.5%) experienced disease recurrence and 9 (1.8%) died of metastatic renal cell carcinoma during followup. Higher Fuhrman nuclear grade was associated with older age at diagnosis (p = 0.001). Histological subtypes were associated with age categories (p = 0.016). The overall recurrence-free survival rate was 97.2% and 92.4% at 5 and 10 years, respectively. The 10-year recurrence-free survival rate was 100% for patients 40 years old or younger, 95.7% for those 41 to 60 years old and 79.0% for those older than 60 years (p = 0.002). Multivariate analysis revealed that age at diagnosis and Fuhrman grade independently predicted recurrence-free survival (p = 0.027 and <0.001, respectively). CONCLUSIONS: Age at diagnosis was an independent predictor of recurrence-free survival after curative surgical treatment in patients with small renal cell carcinoma. Our results suggest that older patients with small renal cell carcinoma should be more closely followed after surgery than younger patients.