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1.
Cas Lek Cesk ; 159(3-4): 131-135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33297688

RESUMO

Setting the right eating habits is one of the basic pillars of non-pharmacological treatment of obese patient. Nutritional interventions led by dietitians are a key part of obesity management. The principle of modern nutritional therapy is not the transmission of general information about nutrition, but individualized recommendations. The task of a dietitian is to provide information that is specific, requested, at the right time and in the right form, information that is understandable to the patient and can be included in his/her life. Dietitian creates a therapeutic relationship with the patient based on trust and accompanies them on his path to mastering the principle of a diet for weight loss. There is thus a shift from a rigid approach to dietary treatment of obese patients, where instead of prescribing a diet aiming at weight loss, the patient is given space for their own active involvement. Emphasis is placed on the long-term sustainability of the newly set regime. Therefore, not only the present comorbidities of obesity, but also other factors such as the patient's daily routine, level of physical activity and individual habits are considered in a well-performed nutritional intervention.


Assuntos
Nutricionistas , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Obesidade/terapia , Perda de Peso
2.
Nihon Koshu Eisei Zasshi ; 67(9): 573-581, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33041283

RESUMO

Objectives The present study examined factors that affect learning about dental caries and periodontal disease before or after graduation or completion of training for dietitians and registered dietitians.Methods A questionnaire survey was conducted with members of the Aomori Prefectural Dietetic Association between October and November 2019, and 276 participants were included in the analysis. A multiple logistic regression analysis was performed to assess the characteristics associated with learning about dental caries and periodontal disease; odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. The following independent variables were assessed: age (<30, 30-39, 40-49, 50-59, or ≥60 years), license (dietitian or registered dietitian), and occupational field (medical institution [nutrition management or food service], administrative agency, nursing care insurance facility, school-related work, training instructor in training facility for dietitians and registered dietitians, or other).Results The multiple logistic regression analysis showed that dietitians and registered dietitians who had learned about dental caries and periodontal disease during training tended to be below the age of 40 years and have a registered dietitian license (dental caries: OR=2.79, 95% CI=1.08-7.24; periodontal disease: OR=6.51, 95% CI=1.71-24.84). Furthermore, dietitians and registered dietitians who had learned about dental caries and periodontal disease after graduation or training completion tended to be over the age of 40, have studied at a training facility (dental caries: OR=3.21, 95% CI=1.65-6.27; periodontal disease: OR=3.06, 95% CI=1.32-7.12), and be employed in the field of school-related work (dental caries: OR=4.23, 95% CI=1.03-17.27; periodontal disease: OR=5.56, 95% CI=1.15-26.98).Conclusions To facilitate increased cooperation among practitioners in the fields of nutrition and dental health, necessary opportunities for learning about dental caries and periodontal disease alongside experts should be provided to those who do not have a registered dietitian license and have not studied at training facilities.


Assuntos
Cárie Dentária , Dietética/educação , Educação Continuada/métodos , Educação em Saúde Bucal , Aprendizagem , Nutricionistas/educação , Doenças Periodontais , Adulto , Currículo , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Artigo em Inglês | MEDLINE | ID: mdl-32751853

RESUMO

This study aimed to evaluate the perceptions of dietitians' wellbeing at work before and during the SARS-COV-2 pandemic in Brazil. This cross-sectional study was performed using a previously validated instrument to investigate the wellbeing of dietitians at work in Brazil. The questionnaire on the wellbeing of dietitians was composed of 25 items (with a 5-point scale), characteristics, and questions about the SARS-COV-2 period. The application was carried out with GoogleForms® tool from 26 May to 7 June 2020. The weblink to access the research was sent via email, messaging apps, and social networks. Volunteers were recruited nationwide with the help of the Brazilian Dietitians Councils, support groups, as well as media outreach to reach as many dietitians as possible. Volunteers received, along with the research link, the invitation to participate, as well as the consent form. A representative sample of 1359 dietitians from all the Brazilian regions answered the questionnaire-mostly female (92.5%), Catholic (52.9%), from 25 to 39 years old (58.4%), with a partner (63.8%), and with no children (58%). Most of the participants continue working during the pandemic period (83.8%), but they did not have SARS-COV-2 (96%), nor did their family members (80.7%). The wellbeing at work before SARS-COV-2 was 3.88 ± 0.71, statistically different (p < 0.05) from during the pandemic, with the wellbeing of 3.71 ± 0.78. Wellbeing at work was higher before the pandemic for all the analyzed variables. Analyzing variables separately before and during the pandemic, dietitians with partners, children and a Ph.D. presented higher scores for wellbeing at work. Professionals receiving more than five times the minimum wage have higher scores. During the pandemic, better wellbeing was observed for dietitians working remotely.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/psicologia , Nutricionistas/psicologia , Pandemias , Pneumonia Viral/psicologia , Local de Trabalho , Adulto , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Feminino , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Inquéritos e Questionários
6.
BMC Health Serv Res ; 20(1): 660, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677924

RESUMO

BACKGROUND: Strong associations between diet and maternal and child outcomes emphasise the importance of evidence-based care for women across preconception, antenatal and postnatal periods. A 2008 survey of Australian maternal health dietetic services documented critically low resourcing with considerable variation in staffing levels and models of care. This study repeated the survey to examine resourcing in Australian maternal health services. METHODS: A cross-sectional online survey was emailed to publicly-funded Australian maternal health dietetic services in May 2018. Quantitative and qualitative variables collected across preconception to postnatal services (including diabetes) included; births per year (BPY), number of beds, staffing (full time equivalents; FTE), referral processes, and models of care. Results were collated in > 5000; 3500 and 5000; and < 3500 BPY. RESULTS: Forty-three eligible surveys were received from seven states/territories. Dietetic staffing levels ranged from 0 to 4.0 FTE (> 5000 BPY), 0-2.8 FTE (3500-5000 BPY), and 0-2.0 FTE (< 3500 BPY). The offering of preconception, antenatal and postnatal services varied significantly between hospitals (format, staffing, referral processes, delivery models). Few sites reported service effectiveness monitoring and only one delivered gestational diabetes mellitus care according to nutrition practice guidelines. Low staffing levels and extensive service gaps, including lack of processes to deliver and evaluate services, were evident with major concerns expressed about the lack of capacity to provide evidence-based care. CONCLUSIONS: Ten years after the initial survey and recommendations there remains an identified role for dietitians to advocate for better staffing and for development, implementation, and evaluation of service models to influence maternal nutrition.


Assuntos
Serviços de Dietética/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna , Nutricionistas , Austrália , Estudos Transversais , Serviços de Dietética/provisão & distribução , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Serviços de Saúde Materna/organização & administração , Gravidez , Encaminhamento e Consulta
7.
Lancet Gastroenterol Hepatol ; 5(10): 890-899, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32679040

RESUMO

BACKGROUND: Functional gastrointestinal disorders are common and costly to the health-care system. Most specialist care is provided by a gastroenterologist, but only a minority of patients have improvement in symptoms. Although they have proven to be effective, psychological, behavioural, and dietary therapies are not provided routinely. We aimed to compare the outcome of gastroenterologist-only standard care with multidisciplinary care. METHODS: In an open-label, single-centre, pragmatic trial, consecutive new referrals of eligible patients aged 18-80 years with Rome IV criteria-defined functional gastrointestinal disorders were randomly assigned (1:2) to receive gastroenterologist-only standard care or multidisciplinary clinic care. The multidisciplinary clinic included gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioural (biofeedback) physiotherapists. Randomisation was stratified by Rome IV disorder and whether referred from gastroenterology or colorectal clinic. Outcomes were assessed at clinic discharge or 9 months after the initial visit. The primary outcome was a score of 4 (slightly better) or 5 (much better) on a 5-point Likert scale assessing global symptom improvement. Modified intention-to-treat analysis included all patients who attended at least one clinic visit and who had answered the primary outcome question. This study is registered with ClinicalTrials.gov, NCT03078634. FINDINGS: Between March 16, 2017, and May 10, 2018, 1632 patients referred to the hospital gastrointestinal clinics were screened, of whom 442 were eligible for a screening telephone call and 188 were randomly assigned to receive either standard care (n=65) or multidisciplinary care (n=123). 144 patients formed the modified intention-to-treat analysis (n=46 in the standard-care group and n=98 in the multidisciplinary-care group), 90 (63%) of whom were women. 61 (62%) of 98 patients in the multidisciplinary-care group patients saw allied clinicians. 26 (57%) patients in the standard-care group and 82 (84%) patients in the multidisciplinary-care group had global symptom improvement (risk ratio 1·50 [95% CI 1·13-1·93]; p=0·00045). 29 (63%) patients in the standard-care group and 81 (83%) patients in the multidisciplinary-care group had adequate relief of symptoms in the past 7 days (p=0·010). Patients in the multidisciplinary-care group were more likely to experience a 50% or higher reduction in all Gastrointestinal Symptom Severity Index symptom clusters than were patients in the standard-care group. Of the patients with irritable bowel syndrome, a 50-point or higher reduction in IBS-SSS occurred in 10 (38%) of 26 patients in the standard care group compared with 39 (66%) of 59 patients in the multidisciplinary-care group (p=0·017). Of the patients with functional dyspepsia, a 50% reduction in the Nepean Dyspepsia Index was noted in three (11%) of 11 patients in the standard-care group and in 13 (46%) of 28 in the multidisciplinary-care group (p=0·47). After treatment, the median HADS scores were higher in the standard-care group than in the multidisciplinary-care group (13 [8-20] vs 10 [6-16]; p=0·096) and the median EQ-5D-5L quality of life visual analogue scale was lower in the standard-care group compared with the multidisciplinary-care group (70 [IQR 50-80] vs 75 [65-85]; p=0·0087). The eight SF-36 scales did not differ between the groups at discharge. After treatment, median Somatic Symptom Scale-8 score was higher in the standard-care group than in the multidisciplinary-care group (10 [IQR 7-7] vs 9 [5-13]; p=0·082). Cost per successful outcome was higher in the standard-care group than the multidisciplinary-care group. INTERPRETATION: Integrated multidisciplinary clinical care appears to be superior to gastroenterologist-only care in relation to symptoms, specific functional disorders, psychological state, quality of life, and cost of care for the treatment of functional gastrointestinal disorders. Consideration should be given to providing multidisciplinary care for patients with a functional gastrointestinal disorder. FUNDING: None.


Assuntos
Assistência à Saúde/economia , Gastroenterologistas/normas , Gastroenteropatias/terapia , Síndrome do Intestino Irritável/terapia , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Austrália/epidemiologia , Biorretroalimentação Psicológica/métodos , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/psicologia , Humanos , Hipnose/métodos , Análise de Intenção de Tratamento/métodos , Comunicação Interdisciplinar , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Nutricionistas/normas , Psiquiatria/normas , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Int J Med Inform ; 139: 104158, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32388157

RESUMO

INTRODUCTION: Self-monitoring technologies produce patient-generated data that could be leveraged to personalize nutritional goal setting to improve population health; however, most computational approaches are limited when applied to individual-level personalization with sparse and irregular self-monitoring data. We applied informatics methods from expert suggestion systems to a challenging clinical problem: generating personalized nutrition goals from patient-generated diet and blood glucose data. MATERIALS AND METHODS: We applied qualitative process coding and decision tree modeling to understand how registered dietitians translate patient-generated data into recommendations for dietary self-management of diabetes (i.e., knowledge model). We encoded this process in a set of functions that take diet and blood glucose data as an input and output diet recommendations (i.e., inference engine). Dietitians assessed face validity. Using four patient datasets, we compared our inference engine's output to clinical narratives and gold standards developed by expert clinicians. RESULTS: To dietitians, the knowledge model represented how recommendations from patient data are made. Inference engine recommendations were 63 % consistent with the gold standard (range = 42 %-75 %) and 74 % consistent with narrative clinical observations (range = 63 %-83 %). DISCUSSION: Qualitative modeling and automating how dietitians reason over patient data resulted in a knowledge model representing clinical knowledge. However, our knowledge model was less consistent with gold standard than narrative clinical recommendations, raising questions about how best to evaluate approaches that integrate patient-generated data with expert knowledge. CONCLUSION: New informatics approaches that integrate data-driven methods with expert decision making for personalized goal setting, such as the knowledge base and inference engine presented here, demonstrate the potential to extend the reach of patient-generated data by synthesizing it with clinical knowledge. However, important questions remain about the strengths and weaknesses of computer algorithms developed to discern signal from patient-generated data compared to human experts.


Assuntos
Glicemia/análise , Diabetes Mellitus/dietoterapia , Dieta , Estado Nutricional , Nutricionistas/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Autogestão , Algoritmos , Sistemas Especialistas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Projetos Piloto
13.
Ann Intern Med ; 172(9): ITC65-ITC80, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32365374

RESUMO

Eosinophilic esophagitis (EoE) is a relatively new disease that has reached an incidence similar to that of Crohn disease and ulcerative colitis. With this increased presence, greater recognition is essential. This applies both to children with nonspecific but potentially debilitating symptoms and to adults who have spent years behaviorally compensating for narrow esophageal strictures. The pathogenesis of EoE is rapidly being unraveled and is based on initiation of a type II allergic response to specific food antigens, leading to dense esophageal eosinophilia, chronic inflammation, and esophageal fibrosis. With greater familiarity and understanding of EoE, treatments are evolving, including identification and avoidance of food antigens; broad applications of topical steroids; and, eventually, pathway-specific biologic therapy.


Assuntos
Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Alergistas , Biópsia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Diagnóstico Diferencial , Dietoterapia/métodos , Dilatação , Esofagite Eosinofílica/complicações , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Predisposição Genética para Doença , Glucocorticoides/uso terapêutico , Humanos , Hipersensibilidade/complicações , Imunoglobulina G/sangue , Nutricionistas , Guias de Prática Clínica como Assunto , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida
14.
Artigo em Inglês | MEDLINE | ID: mdl-32429386

RESUMO

Altogether, 1588 dietitians were dispatched from the Japan Dietetic Association (JDA) to a disaster area for the first time on a nationwide scale following the 2011 Great East Japan Earthquake. Various studies have been conducted based on the activity reports, but the support that the disaster area requested was not documented. The purpose of this study is to identify the support that was needed in the disaster area. Therefore, we investigated the necessary support desired by dietitians who lived in the disaster areas. Questionnaires were sent to 1911 dietitians who were members of the JDA and lived in 3 affected prefectures in August 2012. In total, 435 dietitians (22.8%) completed the questionnaire. Among the questions on the questionnaire, we analyzed answers to the open-ended question: "Please write freely about the support that you wanted at the time of the disaster" (n = 332). Using qualitative descriptive analysis, we extracted data from the answers and categorized and labeled them into similar groups. These groups were divided into four categories: (1) "goods," (2) "establishing a system in advance of a large-scale disaster," (3) "information," and (4) "human resources." To provide "goods," "information," and "human resources" to the disaster area smoothly, it is important to plan a "system" in advance of large-scale disasters.


Assuntos
Planejamento em Desastres , Terremotos , Nutricionistas , Desastres , Feminino , Humanos , Japão , Masculino , Inquéritos e Questionários
15.
Rev Gaucha Enferm ; 41(spe): e20190121, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32294685

RESUMO

OBJECTIVE: To know the spiritual care practices of health workers in the context of an inpatient unit for the treatment of addictive disorders, aiming to incorporate an expanded care practice. METHOD: Qualitative study considering the Convergent Care Research theoretical framework. The data collection occurred using semi-structured interviews, with three rounds of conversations and informal chats with 14 health professionals, from July to November 2017. The analysis followed the steps of apprehension, synthesis, theorization and transference. RESULTS: Four categories emerged: respect for user ethical values; addressing the beliefs and values of professionals; the health professional-user relationship; and collective spiritual care. The main actions highlighted were individual (relaxation and prayer) and collective (meditation, spirituality and the 12 steps). CONCLUSION: The rounds of conversations carried out in this research allowed workers to talk about spiritual care in addiction, to better understand its relevance to meet the needs of the patient.


Assuntos
Pessoal de Saúde , Assistência Religiosa , Espiritualidade , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Feminino , Pessoal de Saúde/ética , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Humanos , Masculino , Meditação , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/psicologia , Nutricionistas/psicologia , Assistência Religiosa/ética , Relações Profissional-Paciente , Psicologia , Pesquisa Qualitativa , Religião , Respeito , Transtornos Relacionados ao Uso de Substâncias/psicologia
17.
Patient Educ Couns ; 103(8): 1645-1649, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199691

RESUMO

OBJECTIVE: Effective communication is fundamental to helping patients change behaviour. Few studies have operationalised how to quantify and improve the patient centeredness of communication during the dietitian outpatient consultation. We sought to evaluate the impact of a renal diet question prompt sheet (QPS) on patient centeredness (PC) in dietitian outpatient clinics and describe the impact of a renal diet QPS on the volume and pattern of communication between dietitians (n = 4) and patients/carers (n = 24, n = 11). METHODS: The Roter Interaction Analysis System was used to compute a PC index, the volume communication (number of questions and utterances) and categorise dietitian communication. RESULTS: The QPS was associated with significant improvements in the PC of communication (p = 0.004 and p = 0.001), without increasing the volume of communication. The QPS was also associated with an increase in the total number of questions asked (p < 0.0001) especially from patients (p = 0.0009); and an increase in the volume of communication devoted to education and counselling (p < 0.0001). CONCLUSIONS: This study describes a promising intervention to increase the patient centeredness of dietetic consultations in an outpatient setting. PRACTICE IMPLICATIONS: Whilst simple in design, the use of a QPS had a large effect on how patients and carers interact with the dietitian in the outpatient setting.


Assuntos
Aconselhamento/métodos , Nutricionistas/psicologia , Participação do Paciente , Assistência Centrada no Paciente , Relações Médico-Paciente , Encaminhamento e Consulta/normas , Instituições de Assistência Ambulatorial , Comunicação , Dieta , Feminino , Humanos , Masculino
19.
Nutrients ; 12(2)2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32012749

RESUMO

BACKGROUND: Nutrigenetics indicates that individual genetic variability results in altered health outcomes necessitating personalized nutrition adaptation. Registered dietitians are recognized as the clinical nutrition experts, but their knowledge and attitudes regarding nutrigenetics has not been delineated. METHODS: This cross sectional online survey was conducted in a convenience sample of 169 national nutrition conference attendees. The survey queried demographics, knowledge, and attitudes towards nutrigenetics and information on training in nutrigenetics. RESULTS: The majority of participants were registered dietitians and female, 45% of whom held advanced degrees. Personalized nutrition was perceived by 93.5% of participants as highly important or important; however, 94% of respondents indicated they are not sufficiently knowledgeable in personalized nutrition and only 9.5% had received training in nutrigenetics. The mean nutrigenetics knowledge score was 6.89 ± 1.67 (out of a possible 12). A multivariate regression model of knowledge score identified education as the only independent predictor of this outcome. CONCLUSION: Personalized nutrition is a rapidly developing field that incorporates genetic data into clinical practice. Dietitians recognize the importance of advanced studies to acquire knowledge in nutrigenetics. Only by acquiring the necessary knowledge can dietitians accurately translate this nutrigenetics into clinical practice.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Nutrigenômica , Nutricionistas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
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