Agreement between child and parent reports of 10- to 12-year-old children's meal pattern and intake of snack foods.

BACKGROUND: Dietary assessment in children is associated with misreporting, which is a problem with both child and parent reports. Therefore, it is of interest to study how children and parents report children's eating, respectively, although comparative studies are rare. The aim of the present article was to study the meal patterns and intake of certain snack foods of 10- to 12-year-old children as reported by the children and their parents, respectively, and to determine whether there was agreement between the child and parent reports. An additional aim was to study what factors might influence rater agreement. METHODS: School children aged 10-12years and their parents were given parallel questionnaires regarding the children's meal pattern. Matched pairs (n=147) were analysed for agreement. Descriptive statistics were used to study all variables. Rater agreement and whether agreement depends on the age and the sex of the child, the sex of the parent and household type were analysed using ordinal regression models. Correlations between the child and parent assessments were estimated as polychoric correlations. RESULTS: There was a general agreement between child and parent reports, except with respect to sweets and chocolate, where children reported less frequent consumption than the parents did (P= 0.0001). The sex of the child was a significant factor regarding consumption of in-between meals (P=0.0001) and soft drinks (P=0.01). Most children had breakfast, school lunch and dinner every day, whereas it was less common to report daily consumption of in-between meals. CONCLUSIONS: There was a general agreement between children's and parents' reports, and most children were reported to have a regular meal pattern.

Patterns of healthy lifestyle and positive health attitudes in older Europeans.

OBJECTIVES: To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii) the association between healthy lifestyle behaviors and positive attitudes to health. DESIGN: Two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a "healthy" weight and having no sleeping problems and (ii) positive health attitudes based on having positive emotional attitudes, such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0 (none of behaviors met) to 5 (all behaviors met) was calculated by summing up the individual's scores for the five healthy lifestyle items. Afterwards, each individual's index was collapsed into three levels: 0-2 equivalent to 'level 1' (subjectively regarded as 'too low'), a score of 3 equivalent to 'level 2' ('fair') and 4-5 as 'level 3' satisfactory 'healthy lifestyle' practices. The same procedure was applied to the positive health attitudes index. Multinomial logistic regression analyses by a forward selection procedure were used to calculate the adjusted odds ratio (OR) with 95% confidence interval (95% CI). PARTICIPANTS: A multi-national sample consisting of 638 older Europeans from 8 countries, aged 65-74 and 75+, living alone or with others. RESULTS AND CONCLUSIONS: Maintaining a "healthy" weight was the most frequently cited factor in the healthy lifestyles index and therefore assumed to be the most important to the older Europeans in the study; positive attitudes to health were relatively low; participants achieved a 'satisfactory' level for healthy lifestyles index (level 3) more frequently than a satisfactory level for positive attitudes to health; having a satisfactory 'healthy lifestyle' was directly related to having a satisfactory level of positive attitudes to health based on the positive health attitudes index; income and geographical location in Europe appeared to be key predictors for meeting both the recommended healthy lifestyle factors in the index and having positive health attitudes however, the composition and nature of the study sample should be taken into consideration when considering the impact of the location on healthy lifestyles and attitudes to health across Europe.

Food provision and the meal situation in elderly care - outcomes in different social contexts.

BACKGROUND: Nutritional problems concerning older people in care can be affected both by their illness and by the standard procedures surrounding food provision, for example rigid routines of food supply and ritualized mealtime situations. METHOD: The aim was to study how organizational structure and staff members' routines and actions influence activities related to food and meals in different caring context in Sweden. The qualitative methodology chosen for this study was participant observation. RESULT: Care recipients were given different opportunities concerning what, how, when and with whom to eat, depending on where their meals were served. In restaurants, older people could choose from several foods and they could also choose the time of and company for the meal. At care units with 'part-of-day' care or 'around-the-clock' care, food choices, time and company were limited, especially at the units with 'around-the-clock' care, where the most ailing older people lived. CONCLUSIONS: Food provision and the mealtime situation for the elderly are shaped by the individual's living arrangements, and the social organization surrounding it, not determined by the individual's needs and wishes, including social and cultural meanings of food and meals, which could, thereby, affect nutritional intake.

Five-day food intake in elderly female outpatients with Parkinson's disease, rheumatoid arthritis or stroke.

AIM: The aim of this study was to describe and analyse the intake of food, energy and selected nutrients in elderly outpatients, i.e. women with Parkinson's disease, rheumatoid arthritis or stroke. SUBJECTS AND METHODS: Sixty-three elderly women aged 64-88 years participated in the study. For assessing dietary intake, a repeated 24-h recall and an estimated food diary for three consecutive days were used. RESULTS: The mean age was 73.4 +/- 6.6 years. Mean reported daily energy intake was 6.4 +/- 1.7 MJ, i.e. lower than reference figures for all groups. However, looking at nutrient density, only intakes of vitamin E and folate were below recommended levels. The most frequently consumed food groups were bread, coffee, milk products, buns and cookies, and spreads. CONCLUSION: The reported energy intake among the elderly female outpatients was low. This might be explained by actual low intake and/or under-reporting. However, the intake of most vitamins and minerals, i.e. nutrient density, was adequate, with the exception of vitamin E and folate intake, which was below recommended levels. Food intake showed large variation and good diet composition, and there was a tendency towards high consumption of food items that are easily prepared and eaten.

Meals and snacks among elderly self-managing and disabled women.

AIM: The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients. SUBJECTS: Elderly women, both self-managing (n=139) and disabled (n=63; with Parkinson's disease, rheumatoid arthritis or stroke), aged 64-88 years, and living at home participated. METHODS: A repeated 24 h recall and an estimated food diary for three consecutive days were used. RESULTS: The eating events defined by the women that were categorised as meals contributed 74% of the total daily energy intake, while snacks contributed 22-23%. The meals that the women had defined as dinner, was the most energy dense meal. The frequency of eating events not defined by the women, was 30-34%, but contributed only 3-4% of the total daily energy intake. The disabled women had a significantly lower energy content in meals and most snacks, compared to the self-managing women. CONCLUSION: The main conclusion was that elderly women still living at home had their meals distributed during the day and that these meals were characterised by individuality and flexibility.

Food and nutrient intake in a group of self-managing elderly Swedish women.

BACKGROUND: With the increasing numbers of elderly women living at home, there is an interest to investigate the dietary intake of this group. OBJECTIVE: To investigate the food and nutrient intake in a group of self-managing elderly women in Sweden. DESIGN: A 3-day self-reported food diary and a repeated 24-h dietary recall were used. The study comprised 135 single-living or married/cohabiting women (mean age 79.5 8.0 years). RESULTS: Mean energy intake for the whole group was 6.8 1.9 MJ, and low energy figures were obtained in all age groups indicating some possible under-reporting with a calculated EIrep/BMRest of 1.24 0.36 for the whole group. Overall, energy and nutrient intake was similar in the different age groups (64-68 yrs, 74-78 yrs and 84-88 yrs). Reported intakes of vitamin D (4.8 2.7 mg), tocopherol (5.9 2.2 mg), iron (8.5 2.9 mg), folate (200 8.7 mg) and selenium (29 11 mg) were low compared to recommended intakes. Only minor differences between women in different household types were found. The women reported a variety of food items in their diet. CONCLUSIONS: Overall, the results from this study indicate that self-managing elderly women report low energy figures, but have a sufficient intake of most nutrients. However, there is a tendency that the oldest women, i.e. 84-88 yrs have lower intakes.

Reasons among older Swedish women of not participating in a food survey.

OBJECTIVES: To (a) examine participation rate as a function of municipality, age group and living status; and (b) investigate the main reasons for exclusion and declining as stated by the women themselves. DESIGN: Analysis of participation rate and content analysis of statements given in phone calls explaining exclusion or declination from a project in which 24 h recalls and food-diaries were used. SUBJECTS: Self-managing Swedish women (n=505) were systematically selected from a stratified random sample covering single living and cohabiting women aged 64-68, 74-78 and 84-88 y living in three municipalities. RESULTS: No significant differences were found among included and declining women when municipalities and living status was analysed, but significantly more women in the oldest group were excluded (P>0.01). Among those in their 80s living at home, the usual reasons for exclusion were illness, disability or dementia, and many lived in institutions for old people. The four most used explanations to decline participation were 'lack of time', 'tired, fragile, sick or having bad memory', 'not willing to participate in scientific studies' and 'too old and nothing to contribute'. CONCLUSIONS: The participation rate was, compared with other food surveys in the older generation, fairly good, especially among those in their 80s. However, the most active and the very ill and disabled did not participate. SPONSORSHIP: The Swedish Council for Social Research, the Swedish Council for Forestry and Agricultural Research, the Swedish Foundation for Health and Care Sciences and Allergy Research and Uppsala University.

Meals and energy intake among elderly women--an analysis of qualitative and quantitative dietary assessment methods.

OBJECTIVE: The objective of this study was to analyse whether a qualitative method, in relation to traditional dietary assessment methods, was adequate to establish sufficient energy intake and energy content in separate meals in a population of elderly women. METHODS: One hundred and thirty-five elderly women, aged 63-88 years, living at home from three communities in mid-eastern Sweden participated in the present study. The quantitative methods used were a combination of repeated 24-h recall and a 3-day estimated food diary. The qualitative method used was the Food-Based Classification of Eating episodes model (FBCE). RESULTS: The mean intake of energy estimated by the 5-day registration was 6.8 +/- 1.9 MJ. The total number of eating events was 5.22 +/- 1.04 per day. On a group level, FBCE was useful to describe the diet among a group of elderly women; however, on an individual level, some complete meals were low or very low in energy, due to small portion sizes. CONCLUSION: The main conclusion was that a qualitative method, such as FBCE, must be supplemented with a dietary assessment method giving the energy intake to ensure that it is sufficient, especially when studying groups at risk for malnutrition.

Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects.

A controlled cross-sectional study with the aim of studying oral health in patients with type 2 diabetes was carried out in a health care district in Sweden. The study included 102 randomly sampled diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area, treated at the same Public Dental Service clinics. Oral conditions were measured at clinical and X-ray examinations. Diabetes-related variables were extracted from medical records. Diabetic patients suffered from xerostomia (dry mouth) to a significantly higher degree than non-diabetic controls did (53.5 vs. 28.4%; P=0.0003). Sites with advanced periodontitis were more frequent in the diabetic group (P=0.006) as were initial caries lesions (P=0.02). Diabetic subjects showed a greater need of periodontal treatment (P=0.05), caries prevention (P=0.002) and prosthetic corrections (P=0.004). Diabetes duration or metabolic control of the disease was not related to periodontal status. However, patients with longer duration of diabetes had more manifest caries lesions (P=0.05) as had those on insulin treatment when compared with patients on oral/diet or combined treatment (P=0.0001). The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health. Close collaboration between the patient, the primary health care and oral health professionals could be a way of improving the diabetic patient's general and oral health.

Influences on food choice perceived to be important by nationally-representative samples of adults in the European Union.

OBJECTIVE: The purpose of this baseline survey was to obtain comparable data on perceived influences on food choice from EU member countries as the starting point for EU healthy eating promotion campaigns and programmes. DESIGN: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: 14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: The five most important factors influencing consumers food choice were 'quality or freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'family preferences' (29%). Subjects in different categories (age, sex, education and employment status) selected different factors as having major influence on their food choice. Demographic factors seemed to have greater effects on perceived influences than culture (country): 'quality/freshness', 'price', 'trying to eat healthy', 'family preferences' seemed to be most important in women, 'taste' and 'habit' in males. Females and older and more educated subjects were more likely than other subjects to select 'trying to eat healthy' as having a major influence. 'Price' seemed most important in unemployed and retired subjects.

Cultural perspectives of meals expressed by patients in geriatric care.

The aim of this study was to investigate cultural values and ideas concerning table manners and food habits expressed by patients in geriatric care. The research approach was ethnographic. The findings exposed conflicts related to three themes. The first, "Mind your manners", demonstrated problems in managing food and objects, keeping clean, and conduct at table. The second, "Appetite for food", was connected to tradition and taste, healthy food and the need not to waste food. The third, "Be contented and do not complain", illustrated the elderly patients' socialized manners in talking about meals and food.

Ritualized practices among caregivers at meals in geriatric care.

The aim of this study was to examine the procedures of the caregivers in their daily work with meals in geriatric care, emphasizing ritualized practices, praxis and norms. An ethnographic approach was used. Registered nurses, enrolled nurses and nurse's assistants observed in the study responded to a questionnaire and, finally, were interviewed. The findings indicated that the meals mainly took the form of ritualized practices, and praxis depended on the ability and needs of the patients as well as on the working conditions. The guiding norms identified were 'to provide a home-like situation with fellowship for training purposes', 'to ensure each patient gets what he/she needs/wants by means of a fair method of serving', and 'to keep things in order and to be responsible'. These norms were transferred from the traditional family in the society, giving the caregivers the role of the parent when training patients. The enrolled nurses, responsible for the meal performance, strove to keep the eating milieu in order, and the meal as a whole was performed as a ritual. Its static form made it difficult to individualize the meal in accordance with the different needs of the patients.

The meal situation in geriatric care--intentions and experiences.

Meals in geriatric institutions are often served in a dining room. The elderly patients--endowed with their socialized table manners and diet habits--who enter this milieu are affected by diseases and handicaps, reducing their ability to eat. In the present study individual patients' meals in geriatric care institutions were studied with respect both to nursing staffs' intentions and assessments of patients, as well as to those patients' experiences and the amount of influence they expected to have. The research approach was ethnographic. Eighteen newly admitted, mentally orientated patients and their primary enrolled nurses were allocated. The results indicated that the idea of both the nurses and the elderly patients was to reach a meal situation that was as natural and independent as possible. Compared with the elderly patients, the nursing staff had broader standards for acceptable table manners, and carried out collective dining of all 18. The elderly patients strove to behave in accordance with their standards and suffered because of their own limited eating competence and the experience of other patients' problems. The elderly patients avoided expressing their needs, and some enrolled nurses thought they were prying if they asked questions about such issues. These different, culturally dependent, perceptions resulted in care that was not congruent with the needs of the elderly patients.

An unusual case of lingual mandibular depression.

The literature concerning lingual mandibular depressions is briefly presented, and a case of an anterior depression containing salivary gland tissue is described. Since this is a rare condition, the presentation of an additional case is of interest.

CT of the edentulous maxilla intended for osseo-integrated implants.

CT has been used as a diagnostic tool in presurgical planning for osseo-integrated implants in the edentulous maxilla. No other technique provides more information. The examination-procedures are easy.

Optimal processing of Ektaspeed dental film.

Three rapid and two standard developing solutions have been tested. A jaw specimen and an aluminium step wedge were exposed on Kodak Ektaspeed film with a 60 kVp dental x-ray machine. The films were developed during varying times at 21 degrees C under controlled conditions. The image quality was tested with a densitometer as well as visually. The characteristic density curves were constructed and the relative speed, average density, fog and contrast were calculated for each test film. The time at which the contrast specified by the film manufacturer was reached, and beyond which the speed and contrast increased only marginally was regarded as the optimal developing time. With longer developing times no increase in image quality could be perceived visual by three trained observers. The optimal developing time at room temperature 21 degrees C, for the different solutions were found to be Kodak Dental 1:1 1.5 minutes Elfwing Rapid 1:3 1.0 minutes Scanfors Dental 1:2 1.5 minutes Kodak Dental 1:3 3.0 minutes Gevaert G 150 1:5 3.0 minutes The characteristic curves were identical for all developing solutions at the times recommended above and the total fog was below 0.20. However, the image quality was maintained and only an insignificant increase of fog was found even when those times were doubled.