Investigation of the multidimensional determinants of negative nutrition coping strategies and tradeoffs in adults accessing food relief: A secondary data analysis.

BACKGROUND: Multidimensional determinants influence negative nutrition coping strategies and tradeoffs in households accessing food relief. AIMS: This study examined coping strategies and tradeoffs at different levels of food insecurity from individuals accessing food relief and how these behaviors relate to experience-based food insecurity dimensions and subpopulations at risk. METHODS: A secondary analysis of cross-sectional data from the Sunshine State Hunger Survey (SSHS) was conducted. The SSHS was a paper-based, 48-question survey, including questions about coping strategies and tradeoffs, use of food assistance programs, and food security. RESULTS: Out of 616 respondents who completed the survey, 73.9% identified as food insecure while 19.1%, as food secure. The average age of participants was 59.6 years and 62.6% were female. One-way analysis of variance indicated increases in negative nutrition coping strategies and tradeoffs with increasing levels of food insecurity status. The most common coping strategy reported by those with very low food security was "Eating less so children or others have enough food," while the most common tradeoff was "Trading off medicine or medical care for food." Two-step cluster analysis identified homogeneous subgroups by behavior and demographic characteristics: (1) late adult worriers, (2) middle adult traders, and (3) middle/late adult copers. CONCLUSION: Identifying coping strategies and tradeoffs used by participants accessing food relief is a multidimensional approach to addressing determinants of food insecurity. Future research on conceptual pathways is warranted to see if experience-based food insecurity variables help to understand relationships across a continuum, including barriers and influencers.

Estimation of 24-hour urinary creatinine excretion from patient variables: A novel approach to identify patients with low muscle mass and malnutrition and relationship to outcomes.

BACKGROUND: Low muscle mass has been correlated with adverse outcomes in patients who are critically ill. Methods to identify low muscularity such as computed tomography scans or bioelectrical impedance analyses are impractical for admission screening. Urinary creatinine excretion (UCE) and creatinine height index (CHI) are associated with muscularity and outcomes but require a 24-h urine collection. The estimation of UCE from patient variables avoids the need for a 24-h urine collection and may be clinically useful. METHODS: Variables of age, height, weight, sex, plasma creatinine, blood urea nitrogen (BUN), glucose, sodium, potassium, chloride, and carbon dioxide from a deidentified data set of 967 patients who had UCE measured were used to develop models to predict UCE. The model identified with the best predictive ability was validated and then retrospectively applied to a separate sample of 120 veterans who were critically ill to examine if UCE and CHI predicted malnutrition or were associated with outcomes. RESULTS: A model was identified that included variables of plasma creatinine, BUN, age, and weight and was found to be highly correlated, moderately predictive of UCE, and statistically significant. Patients with model-estimated CHI ≤ 60% had significantly lower body weight, body mass index, plasma creatinine, and sera albumin and prealbumin levels; were 8.0 times more likely to be diagnosed with malnutrition; and were 2.6 times more likely to be readmitted in 6 months. CONCLUSION: A model that predicts UCE offers a novel method to identify patients with low muscularity and malnutrition on admission without the use of invasive tests.

The Impact of a Food Recovery-Meal Delivery Program on Homebound Seniors' Food Security, Nutrition, and Well-Being.

Food insecurity is a growing problem among seniors. A novel program was established to help mitigate the problem of food insecurity among seniors who are homebound. Volunteers recover unused prepared food donated by area hospitals, repack it into healthy meals which are delivered to program participants. To evaluate the impact of our intervention, seniors' nutritional health and social well-being were measured at enrollment and after three to five months using the following: Mini Nutritional Assessment Short Form (MNA-SF), 24-hour recall, USDA 6-Item Food Security Survey, WHO-5 Well-Being Index, and the 3-Item Loneliness Scale. Statistical analysis indicated a significant improvement in nutritional health, well-being, and loneliness; participants also increased their consumption of protein and calories. Semi-structured interviews were conducted to investigate the self-perceived impact of the program. Thematic analysis of the interviews revealed that meal recipients perceive that food recovery-meal delivery programs may improve their nutrition health, food security, and well-being.

Active Learning of the Floor of Mouth Anatomy with Ultrasound.

More emphasis is now being placed on active learning in medical education. Ultrasound is an active learning tool that can be used to supplement didactic instruction. This study describes a self-guided activity for learning floor of mouth ultrasound. Thirty-three first year medical students learned floor of mouth scan technique and ultrasound anatomy through a brief PowerPoint module. They subsequently performed the scan on a standardized patient. Each student was asked to label the floor of mouth muscles on the image he or she acquired. After the activity, the students were given a quiz on anatomic relationships of the floor of mouth. Perceptions about the activity were collected through a survey. All 33 students obtained a floor of mouth image within a three minute time limit. Twenty-four (73%) students were able to completely and accurately label the image in time. The mean score on the muscle relationships quiz was 93%. Overall perceptions were very positive with most students expressing a "high" or "very high" level of interest in incorporating similar self-guided activities within the curriculum. This study showed that it is feasible for students to learn scan technique and recognize relevant ultrasound anatomy in an independent fashion through a brief active learning module. Furthermore, the students found the activity enjoyable. The implication is that similar activities could be developed which would provide additional ways to incorporate active learning strategies.

Childhood physical abuse and aggression: Shame and narcissistic vulnerability.

This study examined narcissistic vulnerability and shame-proneness as potential mediators between childhood physical abuse (CPA) and adult anger and aggression. Participants were 400 undergraduate students, 134 of whom had a history of CPA. All participants completed self-report questionnaires assessing history of CPA, shame-proneness, narcissistic vulnerability, physical aggression, trait anger, and hostility. Results indicated abused participants were more angry and aggressive and experienced higher levels of shame-proneness and narcissistic vulnerability than nonabused participants. Multiple mediation analyses showed that narcissistic vulnerability, but not shame-proneness, partially mediated the relation between abuse and physical aggression. However, narcissistic vulnerability and shame-proneness both emerged as partial mediators between abuse and the anger and hostility variables. These findings suggest that narcissistic vulnerability and shame-proneness may function as mediators of adjustment following childhood maltreatment. Study limitations and recommendations for future research are discussed.

The Impact of a Home-Delivered Meal Program on Nutritional Risk, Dietary Intake, Food Security, Loneliness, and Social Well-Being.

Maintaining independence and continuing to live at home is one solution to manage the rising health care costs of aging populations in the United States; furthermore, seniors are at risk of malnutrition and food insecurity. Home-delivered meal programs are a tool to address food, nutrition, and well-being concerns of this population. Few studies have identified outcomes from these programs; this pilot study reviews the nutritional status, dietary intake, well-being, loneliness, and food security levels of seniors participating in a Meals on Wheels delivery service. Clients, new to the meal program, participated in pre- and postphone interviews, and 51 seniors completed the study. The survey was composed of five scales or questionnaires, and statistical analyses were conducted using SPSS. Improvements across all five measures were statistically significant after participating two months in the home-delivered meal program. Implications for further research, practice, and the Older Americans Act are discussed.