Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities.

BACKGROUND: People with disabilities face heightened vulnerability to COVID-19. OBJECTIVE: This study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic. METHODS: This cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression. RESULTS: Among 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care. CONCLUSIONS: Disability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.

Associations of Vitamin B6 Intake and Plasma Pyridoxal 5'-Phosphate with Plasma Polyunsaturated Fatty Acids in US Older Adults: Findings from NHANES 2003-2004.

Previous evidence suggests a potential dual impact of aging and vitamin B6 (B6) deficiency on polyunsaturated fatty acid (PUFA) metabolism; gender may influence PUFA biosynthesis. Perturbation of PUFA compositions during B6 deficiency could be linked to age-related health outcomes. However, little is known about the interrelationships between vitamin B6, PUFA, and gender in the older population. Therefore, we investigated whether gender-specific associations of B6 intake and plasma pyridoxal 5'-phosphate (PLP) concentration, respectively, with plasma PUFA concentrations and ratios (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), EPA + DHA, EPA/AA, and (EPA + DHA)/AA) existed in older adults. We further examined the relationships of adequate B6 status (PLP ≥ 20 nmol/L) with high (above median) plasma PUFA relative to deficient B6 status. This cross-sectional study analyzed 461 participants aged ≥60 years from NHANES 2003−2004. Nutrient intakes were assessed using two 24-h recalls and supplement questionnaires. PLP and PUFA concentrations were measured. Multivariate linear regression assessed the association of B6 intake and PLP with PUFA; multivariate logistic regression evaluated the relationship of adequate B6 status with high plasma PUFA, adjusting for demographic, socioeconomic, and dietary factors; physical activity; smoking; alcohol; medication; and BMI. There were interactions between gender and B6 intake on EPA (P-interaction = 0.008) and AA (P-interaction = 0.004) only, whereas no interaction existed between gender and PLP on PUFA. PLP was directly associated with EPA (ß = 0.181, P = 0.002), DHA (ß = 0.109, P = 0.005), EPA + DHA (ß = 0.14, P = 0.002), EPA/AA (ß = 0.186, P = 0.004), and (EPA + DHA)/AA (ß = 0.13, P = 0.026). The odds of having high plasma EPA (adjusted (a) OR: 2.03, P = 0.049) and EPA/AA (aOR: 3.83, P < 0.0001) were greater in those with adequate B6 status compared to those with deficient B6 status. In conclusion, in US older adults, a higher PLP level was associated with a greater level of EPA, DHA, EPA + DHA, EPA/AA, and (EPA + DHA)/AA. Adequate B6 status was associated with high EPA and EPA/AA status. These findings suggest that sufficient vitamin B6 status may positively influence PUFA metabolism in older adults.

Gender Differences in the Associations of Plasma Pyridoxal 5'-Phosphate with Plasma Polyunsaturated Fatty Acids among US Young and Middle-Aged Adults: NHANES 2003-2004.

Vitamin B6-restricted diets and low plasma pyridoxal 5'-phosphate (PLP) status altered plasma polyunsaturated fatty acids (PUFA) compositions. Evidence suggests the role of gender in the metabolism of vitamin B6 and PUFA. However, no epidemiologic study examined the impact of gender on the relationship between vitamin B6 and PUFA status in adults. Thus, we investigated whether there were gender differences in the association of vitamin B6 intake and plasma PLP concentration with plasma PUFA concentrations and ratios (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), EPA + DHA, EPA/AA, (EPA + DHA)/AA) in US young/middle-aged adults. In total, 864 participants (20-59 years; 484 men, 380 women) from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 were used for this cross-sectional study. Nutrient intakes were estimated from two 24 h recalls and supplement questionnaires; plasma PLP and PUFA were measured. Multivariate linear regression was utilized to obtain unstandardized (b) and standardized (ß) coefficients. Covariates included demographic, socioeconomic, dietary variables, physical activity level, cigarette smoking status, alcohol consumption, prescription medication use, and BMI. There were significant interactions between gender and PLP on EPA (P-interaction = 0.004), DHA (P-interaction = 0.020), EPA + DHA (P-interaction = 0.010), EPA/AA (P-interaction = 0.002), (EPA + DHA)/AA (P-interaction = 0.004), whereas no interaction between gender and B6 intake existed. In gender-stratified analyses, in men, PLP was positively associated with EPA (ß = 0.138, b = 0.104, p = 0.0004), DHA (ß = 0.101, b = 0.058, p = 0.036), EPA + DHA (ß = 0.125, b = 0.073, p = 0.005), EPA/AA (ß = 0.144, b = 0.099, p = 0.0002), (EPA + DHA)/AA (ß = 0.123, b = 0.068, p = 0.005). However, no associations between PLP and PUFA existed in women. In conclusion, gender differences were found in the relationships between plasma PLP and plasma EPA, DHA, EPA + DHA, EPA/AA, and (EPA + DHA)/AA, with significant direct associations in men only among US young/middle-aged adults.

Limited Agreement on Etiologies and Signs/Symptoms among Registered Dietitian Nutritionists in Clinical Practice.

BACKGROUND: Clinical studies that establish the reliability and validity of nutrition diagnoses are absent from the literature. OBJECTIVE: The purpose of this study was to assess the reliability and validity of the diagnoses, etiologies, and signs/symptoms within the clinical practice of registered dietitian nutritionists (RDNs). DESIGN: Nine pairs of RDNs randomly selected adult patients to diagnose. The two RDNs in each pair independently assessed nutritional data from the same patient. Each RDN chose one nutrition diagnosis and rated the presence or absence of the etiologies and signs/symptoms. Clinical reliability was determined with percentage of agreement for the diagnoses, and percentage agreement, kappa coefficient, and the proportions of positive agreement (p(pos)) and negative agreement (p(neg)) for the etiologies and signs/symptoms. Clinical validity was calculated according to a clinical diagnostic validity score for etiologies and signs/symptoms. RESULTS: These RDNs practiced either in an acute-care facility (n=10; 58.8%), ambulatory/outpatient facility (n=3; 17.6%), or both (n=4; 23.5%). Nutrition diagnoses were selected for 316 patients. Two raters selected the same diagnosis for 121 patients (38% agreement). Agreement was moderate (κ=0.54) for etiologies and at the lower end of substantial (κ=0.63) for signs/symptoms. For etiologies p(pos)=0.71 and p(neg)=0.78 and for signs/symptoms p(pos)=0.82 and p(neg)=0.79, indicating that the raters agreed on the presence of each as well as the absence. The overall clinical diagnostic validity score for etiologies was 0.33 and for signs/symptoms was 0.44, signifying they were not characteristic of the diagnoses. CONCLUSIONS: Although RDNs knew a nutrition problem was present, they were in poor agreement as to the most important diagnosis, etiologies, and signs/symptoms. The lack of agreement indicated inconsistencies in determining a primary diagnosis among these RDNs.

Malnutrition is prevalent among hemodialysis patients in Jeddah, Saudi Arabia.

Malnutrition (MN) in hemodialysis patients (HDP) is prevalent worldwide. How-ever, data regarding the nutritional status among HDP living in Jeddah, Saudi Arabia, is lacking. The purpose of this study was to detect MN in HDP at the Jeddah Kidney Center, with an inexpensive nutritional assessment protocol consisting of anthropometric body mass index (BMI), triceps skin fold (TSF), mid-arm muscle circumference (MAMC) and biochemical (albumin) blood measurements and the seven-point subjective global assessment (SGA). A cross-sectional study assessed 269 HDP for MN through a questionnaire, SGA and anthropometric and biochemical measurements. Spearman's rank correlation coefficients were determined between SGA and anthropometric and biochemical measurements as well as the relative odds of MN. Statistical significance was P <0.05. These HDP were 48.7% moderately and 6.3% severely malnourished. Albumin, BMI, TSF and MAMC correlated positively with the seven-point SGA (r s = 0.16, P = 0.007; r s = 0.33, P <0.001; r s = 0.29, P <0.001; and r s = 0.34, P <0.001, respectively). Those HDP who were female (Odds ratio [OR] = 2.04, P = 0.036), older (≥55 years) (OR = 1.70, P = 0.087), uneducated (OR = 1.80, P = 0.072), with a lower BMI (<18 kg/m²) (OR = 2.00, P = 0.077) and thinner TSF (OR = 1.45, P = 0.041) had a greater risk of MN. The high prevalence of MN was detected with an inexpensive protocol. Women with thinner TSF were more likely to be malnourished. The implementation of this protocol is warranted along with dietary education and counseling to decrease MN in HDP.

Knowledge of Florida nurses and dietitians regarding dietary supplements.

BACKGROUND: Health care professionals should exhibit competency about dietary supplements to support the high number of Americans taking these products. OBJECTIVES: To evaluate the knowledge of Florida nurses and dietitians regarding dietary supplements. METHODS: Florida nurses (n=600) and dietitians (n=600) were randomly selected to participate in a self-reported online survey. The actual knowledge of these professionals regarding nutrient-based and herbal supplements was evaluated by a quiz. RESULTS: Data of 89 dietitians and 64 nurses were analyzed using independent sample t-test and Pearson's correlation. The actual knowledge of both professionals revealed a mean correct score of 12.98+/-6.16 (maximum score=30). Dietitians had a significantly greater knowledge of dietary supplements when compared to nurses (P=0.000). Both professionals were more knowledgeable on nutrient-based supplements than herbal. CONCLUSIONS: Both groups had a fairly low knowledge of side effects of dietary supplements and their interactions with common medications, and seem to require additional education in this area. Focused training can be designed to improve professionals' knowledge about dietary supplements.

Practices, attitudes, and beliefs regarding dietary supplements among Florida's dietitians and nurses.

This study investigated the practices, attitudes, and beliefs of Florida's nurses and dietitians regarding dietary supplements (DS). Eighty-nine dietitians and 64 nurses responded to a self-reported online survey about nutrient-based supplements, defined as nutrients taken to supplement the diet for enhancing health, and herbal supplements, defined as plants used for enhancing health rather than food seasoning. Personal use of nutrient-based supplements for treatment of a health condition was higher among nurses (67%) than dietitians (42%) (p <. 05). However, dietitians recommended nutrient-based supplements more often than nurses (p <. 05). Both groups used fewer herbal than nutrient-based supplements (p <. 001). More nurses than dietitians believed herbal supplements to be effective (p <. 05). Practice trends regarding DS identified among Florida's dietitians and nurses can be a reference for states and countries in which the number of older adults is growing.

Preferences of registered dietitians and nurses recommending artificial nutrition and hydration for elderly patients.

OBJECTIVE: The study was designed to identify how the beliefs and perceptions of registered dietitians (RDs) affect their decisions to propose artificial nutrition and hydration (ANH) for elderly patients as compared with nurses. DESIGN: A questionnaire consisting of demographic information, 13 belief statements, and eight patient scenarios requiring ANH was mailed to RDs (n=1,500) and nurses (n=1,500) throughout Florida. Thirteen statements, rated on a 5-point Likert scale, addressed beliefs that influence ANH decisions. Eight scenarios of patients, without an advance directive or surrogate decision maker, were created with variations in age, cognition, and emotion. For each scenario, participants selected a treatment, ANH or hydration, and responded: recommend; not recommend; undecided; or recommend a trial period; if no improvement, stop treatment. STATISTICAL ANALYSES PERFORMED: To establish reliability and validity, the instruments were pilot-tested with a group of RDs and nurses. Cross tabulations with chi2 tests compared the distribution of responses to the belief statements and scenarios. Statistical significance was P<0.05. RESULTS: Responses to the belief statement, "when in doubt, feed" differed significantly (P<0.001) between RDs and nurses, all other belief statements were not significantly different. In all eight scenarios, significantly more (P<0.001) RDs recommended ANH than did nurses. CONCLUSIONS: RDs clearly endorsed feeding when in doubt; therefore, they recommended ANH more than nurses. Nurses, who hesitated to feed when in doubt, were more diverse with their recommendations, either recommending a trial or not recommending ANH. A philosophical difference related to feeding was apparent between RDs and nurses and may affect consistent and quality care in patients without an advance directive or surrogate decision maker.

Medical and psychosocial experiences of family caregivers with children fed enterally at home.

BACKGROUND: Pediatric home enteral nutrition (HEN) studies that evaluate the psychosocial aspects of caregiving are limited. Overlooking the psychosocial needs of the caregiver may result in negative outcomes such as lack of adherence to the HEN regimen. This study determined whether caregivers report psychosocial situations more frequent and difficult to manage than medical situations. METHODS: A questionnaire, which identified 10 psychosocial and 10 medical issues related to pediatric HEN, was mailed to 150 caregivers (37 responded), who rated the statements for frequency and difficulty. Each statement was ranked from most frequent/difficult to least frequent/difficult by mean cross-product score (frequency x difficulty). To indicate overall burden, a medical total composite score (MTCS) and a psychosocial total composite score (PTCS) were calculated by summing the cross-products of the respective problems. Paired t tests compared MTCS to PTCS and also the psychosocial frequency means and difficulty means to the same for the medical problems. RESULTS: Of the top 10 problems, 7 were psychosocial, whereas 3 were medical. Caregivers reported incidences of psychosocial problems more frequently (p < .003) than medical problems, and they had more difficulty (p < .001) with the psychosocial situations than with the medical ones. The PTCS was significantly higher (p < .001) than the MTCS. CONCLUSIONS: The psychosocial situations were perceived as causing a greater burden and greater difficulty in coping with everyday life. Health professionals need to understand and address the psychosocial difficulties of the caregiver in order to provide support for the caregiver and promote positive growth and development of the child.

Position of the American Dietetic Association: Functional foods.

It is the position of the American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to define further the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, the government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, from both phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronutrient and micronutrient content alone. Analyzing the content of other physiologically active components and evaluating their role in health promotion will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.