Validity and reliability of a questionnaire measuring EBDPs among registered dietitian nutritionist.

BACKGROUND: There is a lack of a valid and reliable instrument that measures objective and subjective knowledge of evidence-based dietetic practices (EBDP) among registered dietitian nutritionists (RDNs). The present study aimed to develop and assess the validity and reliability of an EBDP Questionnaire (EBDPQ) with objective knowledge items (i.e., quiz items) among RDNs in the USA. METHODS: Subscales from four existing evidence-based practice (EBP) instruments were combined and modified for dietetics. Content and face validity and internal consistency were used to assess the full survey. Survey responsiveness and test-retest reliability were evaluated within the objective knowledge subscale. Content experts (n = 11) and nutrition professionals (n = 16) completed validation reviews. Doctoral students enrolled in a research course (n = 12) were used to analyse survey responsiveness. Internal and test-retest relability analyses utilised RDN participants (time point 1, n = 482; time point 2, n = 335). RESULTS: Content validation resulted in a 38-item questionnaire. Average percent agreement among face validity reviewers was 95.1%. Only the pre-validation version of the objective knowledge subscale resulted in significantly higher post-course scores (Mdn = 11.50) compared to the pre-course (Mdn = 9.75, p = 0.05). The validated instrument had excellent internal consistency (Cronbach's α = 0.91); however, the objective knowledge subscale was low (Cronbach's α = 0.41). A good degree of reliability was found between the two time points (intraclass correlation coefficient = 0.71). CONCLUSIONS: The EBDPQ demonstrated adequate validity and reliability among RDNs. Future research should assess construct validity, with the responsiveness and objective knowledge subscale requiring additional evaluation through an EBDP course.

Determinant factors associated with the use of evidence-based dietetics practice among registered dietitian nutritionists.

AIMS: There is a lack of research assessing perceived and actual evidence-based dietetics practice knowledge among registered dietitian nutritionists. This cross-sectional research examined the association between determinant factors (i.e., education attainment) and objective knowledge (i.e., quiz items) of evidence-based dietetics practices. Other determinant factors associated with perceived knowledge and skill, attitudes, behaviours and outcomes related to evidence-based dietetics practice were also assessed. Perceived knowledge items were compared to objective knowledge items to evaluate the accuracy of self-assessed evidence-based dietetics practice knowledge among dietitians in the United States. METHODS: A modified and adapted evidence-based practice survey was emailed to registered dietitian nutritionists in the United States via the Commission on Dietetic Registration database between November and December 2020. Analysis of variance assessed the relationship between highest degree held and actual knowledge of evidence-based dietetics practices. Multiple linear regression and ordinal logistic regression determined participant-level characteristics associated with survey subscales and survey items, respectively. Pearson's correlation coefficient evaluated the relationship between subjective and objective items. RESULTS: Four hundred and eighty-two dietitians completed the survey. Each increase in degree type was associated with an increase in objective knowledge score (all comparisons p < 0.001). Other determinants included recency of degree completion and peer-reviewed publications. Moderate positive associations (r = 0.35, p < 0.001) were found between subjective and objective measures. CONCLUSION: Graduate-level education, recency of degree completion and peer-reviewed publications were supportive of evidence-based dietetics practice-related outcomes. Future research should evaluate the efficacy of training, particularly among those further from their highest completed degree.

Food insecurity among older adults living in low- and middle-income countries: a scoping review.

BACKGROUND AND OBJECTIVES: Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) is expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. RESEARCH DESIGN AND METHODS: A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted and the emerging themes from the main findings were summarized using a Social-Ecological Model (SEM). RESULTS: Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last two years and utilized a quantitative approach (n=38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. DISCUSSION AND IMPLICATIONS: Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only fifteen LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.

Family medicine physicians' report strong support, barriers and preferences for Registered Dietitian Nutritionist care in the primary care setting.

BACKGROUND: Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients. OBJECTIVE: The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care. METHODS: A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis. RESULTS: Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. 'Insurance does not cover all of the ways I would like to use an RDN'. CONCLUSIONS: FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.

One-trial behavioral sensitization in preweanling rats: differential effects of cocaine, methamphetamine, methylphenidate, and D-amphetamine.

RATIONALE: Preweanling rats exhibit robust one-trial cocaine-induced behavioral sensitization; however, it is uncertain whether other psychostimulants can also induce sensitization in young rats using the one-trial procedure. OBJECTIVE: The purpose of this study was to determine whether methamphetamine, methylphenidate, and D: -amphetamine are capable of inducing one-trial locomotor sensitization in preweanling rats. METHODS: In a series of four experiments, rats were pretreated with cocaine (30 mg/kg), methamphetamine (2-12 mg/kg), methylphenidate (5-20 mg/kg), or amphetamine (5 mg/kg) before being placed in a novel activity chamber or the home cage on PD 19. Rats were then challenged with the same psychostimulant (20 mg/kg cocaine, 1-8 mg/kg methamphetamine, 2.5-7.5 mg/kg methylphenidate, or 1-2 mg/kg amphetamine) on PD 21, with distance traveled being measured for 180 min. In a separate experiment, rats were pretreated with methamphetamine on PD 16-19 and challenged with methamphetamine on PD 21. RESULTS: Only cocaine, but not various dose combinations of other psychostimulants, was able to produce one-trial behavioral sensitization in preweanling rats. Context-dependent locomotor sensitization was also evident if rats were pretreated with methamphetamine on PD 16-19 and tested on PD 21. CONCLUSIONS: It is uncertain why only cocaine was able to induce one-trial locomotor sensitization in preweanling rats, but it is possible that: (a) the neural circuitry mediating sensitization differs according to psychostimulant, (b) cocaine is more readily associated with environmental contexts than other psychostimulants, or (c) affinity and pharmacokinetic factors may underlie cocaine's ability to induce one-trial behavioral sensitization in preweanling rats.

Early methylphenidate exposure enhances cocaine self-administration but not cocaine-induced conditioned place preference in young adult rats.

RATIONALE: Previous studies in rodents show that early exposure to methylphenidate alters later responsiveness to drugs of abuse. An interesting feature of these studies is that early methylphenidate treatment decreases the rewarding value of cocaine when measured by conditioned place preference (CPP), but the same treatment increases cocaine self-administration. OBJECTIVE: The goal of the present study was to examine the effects of early methylphenidate exposure on cocaine-induced responding using both reward paradigms. METHODS: Rats were treated with methylphenidate (0, 2, or 5 mg/kg) from postnatal days (PDs) 11 to 20, and then cocaine-induced CPP or cocaine self-administration was measured in separate groups of rats in adulthood. The CPP procedure included 8 days of acquisition training, 8 days of extinction training, and a reinstatement test. Rats were conditioned with 0, 10, or 20 mg/kg cocaine. Reinstatement was assessed after a priming dose of cocaine (10 mg/kg). For the self-administration experiment, a jugular catheter was implanted and rats were trained to press a lever reinforced with cocaine (0.25 or 0.75 mg/kg/infusion) on a fixed ratio (FR) one schedule. Rats were gradually moved from an FR1 to an FR10 schedule and, after criterion was reached, rats were placed on a progressive ratio schedule for 5 days. RESULTS: Cocaine produced robust rewarding effects as determined by both the CPP and self-administration experiments; however, early methylphenidate exposure only enhanced the reinforcing effects of cocaine on the self-administration paradigm. Interestingly, this methylphenidate enhancement was only seen in male rats. CONCLUSIONS: These data suggest that in males, methylphenidate enhances the reinforcing value of cocaine, but not cocaine-associated cues.

Most parents do not think receiving human papillomavirus vaccine would encourage sexual activity in their children.

OBJECTIVE: To determine whether parents think receiving human papillomavirus (HPV) vaccine encourages sexual activity in their children. MATERIALS AND METHODS: Parents of children 9 to 17 years old living in Georgia and South Carolina completed a 53-item questionnaire that evaluated their opinions about the HPV vaccine and their feelings about whether receiving it encourages sexual intercourse in their children. Fisher exact tests and t tests were used to identify differences between groups. RESULTS: Participants tended to be white, protestant mothers, 30 to 39 years old with private health insurance. Most parents (301/322, 93.5%) did not believe receiving the HPV vaccine would encourage their child to have sex. Parents who believed the vaccine would encourage sex were more likely to have 15- to 17-year-old children (76% vs 37%, p =.0007), were 40 years or older (62% vs 35%, p =.019), have religious objections to vaccines in general (10% vs 0.3%, p =.01) and the HPV vaccine (14% vs 2%, p =.02), and believed the vaccine would not reduce the risk of cervical cancer in their daughters (50% vs 9%, p =.001). CONCLUSIONS: Most parents do not think the HPV vaccine would actually encourage sexual activity in their children. Therefore, health care providers can be less hesitant in recommending the vaccine to young sexually naive girls. Additional education should help improve overall parental understanding about the HPV vaccine and, consequently, vaccination rates.

Parental acceptance of a mandatory human papillomavirus (HPV) vaccination program.

OBJECTIVES: The objective of this study was to determine factors that influence parent's acceptance of a mandatory school-based human papillomavirus (HPV) vaccination program. METHODS: A convenience sample of 325 parents, with children aged 9 to 17 years old, completed a 53-item survey. Survey questions targeted their opinions about HPV, the HPV vaccine, and a mandatory HPV vaccination program. chi(2) tests were used to examine relationships between survey items. RESULTS: Characteristics of parents who believed the HPV vaccine should be mandated included limited financial resources (P = .03), history of HPV-related disease (P = .04), understanding their child's susceptibility (P = .03), interest in HPV vaccination for their child (P = .0001), and knowledge that the vaccine reduces the risk of cervical cancer (P = .001). Parents of children aged 12 to 14 years old (P = .02) or who knew the vaccine reduced their child's risk of developing genital warts (P = .02) and cervical cancer (P = .001) would be more likely to comply with a mandatory HPV vaccine program. CONCLUSIONS: Certain characteristics define parents who support a mandatory HPV vaccination program. Greater education of parents and health care providers should improve vaccination uptake, which ultimately reduces morbidity and mortality from HPV related diseases.

Opinions of parents about school-entry mandates for the human papillomavirus vaccine.

OBJECTIVE: To determine parents' opinions about school-entry mandates for the human papillomavirus (HPV) vaccine. MATERIALS AND METHODS: During the summer of 2008, 325 parents, with children 9 to 17 years old, completed a 53-question survey that evaluated their opinions about vaccines, HPV and the HPV vaccine, and mandatory childhood vaccination programs. Descriptive statistics were calculated for all survey items. RESULTS: Although 89% of parents supported mandatory vaccination programs in general, only 43% thought that the HPV vaccine should be included. The main reasons for nonsupport included that it would infringe on their rights (57%), that the vaccine had not been well studied (33%), and that it had too many adverse effects (29%). Of all parents, 13% said their children had already received the HPV vaccine and 81% wanted their children to receive it. CONCLUSIONS: At this point, although most parents want their children to receive the HPV vaccine, most do not support it being mandated. The provision of more safety data to parents should help improve overall HPV vaccination rates.

Building a system for preparedness: the NYCEPCE NEST experience.

The New York Consortium for Emergency Preparedness Continuing Education grew from clinician-oriented, Web-based continuing education developed with and primarily for clinicians associated with the New York Presbyterian Healthcare System. As the consortium expanded to reach all of New York State (and beyond, via the Web), courses originally developed at Columbia were transferred to a widely advertised Web site, and the content expanded. The National Education Strategy Team supplemental funds allowed New York Consortium for Emergency Preparedness Continuing Education to consider how to overcome one of the major challenges in emergency preparation, connectivity across all sectors, and levels of the public health community. We chose to use community health centers as paradigmatic of the challenge: the clinician needs emergency preparedness competencies, but if the site at which practice takes place has no plan, those skills will not be best used; if the practice site is not connected to the community-wide plan, capacity may be duplicated or unused. If clinician, practice and community all plan, train, and practice in a common framework, the community should be much more resilient in the face of emergencies of any dimension.

Community health centers and emergency preparedness: an assessment of competencies and training needs.

Community health centers (CHCs) provide care to a large number of medically underserved Americans. As primary care providers and trusted members of their communities, CHCs need to be prepared to respond to emergency and disaster situations, as they may be relied upon for medical care and other support services. Focus groups were conducted with CHC medical directors and administrators from New York City. Participants discussed previous emergency preparedness training, future training needs, applicability of competencies, and usefulness of two training programs. Participants indicated that they had more experience with preparedness training than many of their colleagues, although participants still reported further training needs. In particular, emergency roles and responsibilities, decontamination and containment, and personal preparedness were given as needed training topics for staff. The training resources were reported to be useful and beneficial. Participants also reported that most of the competencies were appropriate for CHC clinicians. During an emergency, people want to receive care from their normal provider, and for many, that provider is a CHC. This and other research suggests that the emergency preparedness needs facing CHCs are significant and should be addressed.

Emergency preparedness training for veterinarians: prevention of zoonotic transmission.

Natural zoonotic outbreaks can cause widespread devastation, and several zoonoses can be transmitted as agents of bioterrorism. Although veterinarians can be vital in controlling the transmission of zoonotic diseases, many lack knowledge about their roles in emergency response and about zoonoses. A training session titled "Prevention of Zoonotic Disease Transmission" was provided for New York veterinarians. The training was evaluated using pre-training, post-training, and follow-up surveys, which measured increase in and retention of knowledge. Seventy-five (75) veterinary professionals participated in the training, and 91% responded on pre- and post-training surveys. The percentage of respondents who correctly answered the objective knowledge questions increased from pre-training to post-training. Furthermore, follow-up surveys demonstrated that participants were able to retain much of the information from the training session. Very little research has been found that evaluates a similar training event. As knowledge increases, additional training conferences could benefit veterinarians and supplement this research. The results of the pre-training, post-training, and follow-up surveys indicate that veterinary professionals' knowledge of zoonoses can be significantly improved after receiving training; participants found the training to be useful and requested additional training, indicating that veterinary professionals have a desire to learn about emergency preparedness topics.

Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange-based tuberculin skin testing.

INTRODUCTION: Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. METHODS: We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. RESULTS: From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9; 95% CI=10-52). CONCLUSIONS: Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.