Predictors of leisure time physical activity among people with spinal cord injury.

BACKGROUND: Most studies of physical activity predictors in people with disability have lacked a guiding theoretical framework. Identifying theory-based predictors is important for developing activity-enhancing strategies. PURPOSE: To use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to identify predictors of leisure time physical activity among people with spinal cord injury (SCI). METHODS: Six hundred ninety-five persons with SCI (M age=47; 76% male) completed measures of Body Functions and Structures, Activities and Participation, Personal Factors, and Environmental Factors at baseline and 6-months. Activity was measured at 6 and 18 months. Logistic and linear regression models were computed to prospectively examine predictors of activity status and activity minutes per day. RESULTS: Models explained 19%-25% of variance in leisure time physical activity. Activities and Participation and Personal Factors were the strongest, most consistent predictors. CONCLUSIONS: The ICF framework shows promise for identifying and conceptualizing predictors of leisure time physical activity in persons with disability.

The effect of parental feeding behaviours and participation of children in organized sports/activities on child body mass index.

PURPOSE: In this cross-sectional descriptive study, we explored the relationship of parental feeding practices and child physical activity levels with measured body mass index (BMI) in a sample of 97 Ontario preschoolers. METHODS: Child weight and height were measured; physical activity and sedentary behaviours were assessed by questionnaire. Preschoolers' parents used the Child Feeding Questionnaire to report their attitudes, concerns, and practices in relation to child feeding. Hierarchical multiple linear regression was used to determine relationships among variables. RESULTS: Up to 25% of the preschoolers were overweight and/or obese. The regression model accounted for 53% of the variance in child BMI. Child BMI was predicted to be higher when parents had concerns about and perceived their children to be overweight, and when they felt responsible for what their children ate. Children's BMIs were predicted to be lower for those whose parents pressured them to eat and also for those who engaged in organized sports or activities. CONCLUSIONS: This study suggests an association between BMI and parental perceptions, concerns, and practices related to child feeding and organized sports or activities. Public health initiatives related to healthy eating and/or obesity prevention should include a focus on parents of preschool-aged children with the home environment as a potential setting.

Folic acid food fortification prevents inadequate folate intake among preschoolers from Ontario.

OBJECTIVE: Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers. DESIGN: Cross-sectional data were used from the NutriSTEP validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes. SETTING: Canada. SUBJECTS: Two hundred and fifty-four preschoolers (aged 3-5 years). RESULTS: All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30% (n 76) used folic acid-containing supplements. Mean (SE) fortificant folic acid intake was 83 (2) microg/d, which contributed 30% and 50% to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1%; however, excluding fortificant folic acid, the prevalence was 32%, 54% and 47% for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2% (7% among supplement users). CONCLUSIONS: Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.

Creating case scenarios or vignettes using factorial study design methods.

AIM: This paper is a report of a study conducted to develop clinical case vignettes using an adaptation of an incomplete factorial study design methodology. BACKGROUND: In health care, vignettes or cases scenarios are core to problem-based learning, common in practice guideline development processes, and increasingly being used in patient or care-giver studies of chronic or life-threatening illnesses. A large number of behavioural, psycho-social and clinical factors can be relevant in such decision problems. Unbiased methods for choosing what factors to include are needed, when it is not possible to include all relevant combinations of factors in the vignettes. METHOD: The factors to be considered, number of levels or categories for each factor, and desired number of scenarios were decided in advance. An algorithm was used first to create the full factorial data set, and then a random subset of combinations was generated, according to predefined criteria, based on maximizing determinants. The subset of combinations was incorporated into written vignettes. The study was conducted in 2004-2005. FINDINGS: Application of the method yielded diverse and balanced scenarios that covered the full range of factors to be considered for a project to elicit health providers' processes in diet counselling for dyslipidemia. CONCLUSION: The approach is flexible, decreases possible researcher bias in the creation of vignettes, and can improve statistical power in survey research. This novel application of study design methodology merits consideration when vignettes are being developed to elicit opinions or decisions in studies of complex health issues.

Zinc-fortified foods do not improve intake of total dietary zinc for Ontario preschoolers.

OBJECTIVE: To examine if zinc food fortification makes a significant contribution to dietary zinc intake and to describe zinc-fortified food usage, amongst Canadian preschoolers. METHODS: Cross-sectional data were used from the NutriSTEP validation project for which preschoolers (3-5 years) from across Ontario were recruited using convenience sampling. Three-day food records were used to estimate mean daily zinc intake and children were stratified by age group for analysis. Comparisons were then made to the Dietary Reference Intakes, whilst accounting for zinc from zinc-fortified foods and supplements and also whilst excluding zinc from zinc-fortified foods, to determine the prevalence of inadequate (< Estimated Average Requirement (EAR)) and excessive (> Tolerable Upper Intake Level (TUL)) zinc intakes. The contributions (%) made to total zinc intake by zinc-fortified foods, unfortified foods and zinc-containing supplements were determined as were contributions made to zinc intake by zinc-fortified foods, categorized by fortified-food type. RESULTS: Fewer than a third (30%, n = 76) of participants ate zinc-fortified foods and only 3% (n = 7) used a zinc-containing supplement. Including the contribution from zinc-fortified foods, 25% (n = 32) of 3-year-olds (n = 128) had mean zinc intake (range 7.0-7.6 mg/day) marginally above the TUL (7 mg/day). Zinc-fortified foods contributed only 2.3 +/- 5.8% (mean% +/- SD) to total zinc intake. The mean intake of the 25% of 3-year-olds above the TUL is attributed to their higher mean energy and protein intakes (p < 0.001) as compared to 3-year-olds not consuming zinc at levels above the TUL. Even excluding zinc-fortified foods, the prevalence of inadequate zinc intakes (

Prevention of weight loss in dementia with comprehensive nutritional treatment.

OBJECTIVES: To determine whether body weight can be maintained or improved in dementia residents of special care units (SCUs) using a comprehensive intervention strategy. DESIGN: Quasi-experimental with an interventional site and a noninterventional site. SETTING: Four SCUs in two long-term care facilities in Ontario. PARTICIPANTS: The intervention site included 33 residents; the comparison site included 49 residents. MEASUREMENTS: Weight change over time was the primary outcome. Three time periods were compared: 9-month baseline period, 9-month intervention period (enhanced dietitian monitoring and menu changes at intervention site), and 12-month postintervention period (only menu changes at intervention site). Comparisons were made within and between sites. Full nutritional assessments were completed for the intervention group. Medical charts and basic anthropometric, behavioral, and cognitive measures were completed in both groups to determine baseline site differences. Weight change over time was analyzed with a repeated measures analysis, controlling for various covariates. Bivariate analyses were completed for other outcomes of death, number of infections, falls, and hospital days. RESULTS: The intervention period that included the dietitian time and menu changes significantly promoted weight gain, compared with the standard treatment at the comparison facility. Other covariates of pacing, type of dementia, sex, age, number of comorbid conditions, and medications were also significant predictors of weight change. Weight gain or maintenance regardless of site was associated with survival. CONCLUSION: Body weight can be maintained in residents of SCUs regardless of pacing and other clinical characteristics. The comprehensive intervention of clinical dietitian time and an enhanced menu designed to be individualized for ambulatory people with dementia promoted significant gains in body weight. A minimum 5% weight gain is associated with survival in these residents of SCUs.

Nutritional risk predicts quality of life in elderly community-living Canadians.

BACKGROUND: Although nutrition parameters have been linked to quality of life (QOL), few studies have determined if nutritional risk predicts changes in QOL over time in older adults. METHODS: 367 frail older adults were recruited from 23 service agencies in the community. Baseline interview included nutritional risk as measured by SCREEN (Seniors in the Community: Risk Evaluation for Eating and Nutrition), as well as a wide variety of covariates. Participants were contacted every 3 months for 18 months to determine QOL as measured by three questions from the Behavioral Risk Factor Surveillance System (BRFSS), a general whole-life satisfaction question, and a general change in QOL question. "Good physical health days" from the BRFSS was the focus of bivariate and multivariate analyses, adjusting for influential covariates. RESULTS: Seniors with high nutritional risk had fewer good physical health days and whole-life satisfaction at each follow-up point compared with those at low risk. In general, participants reported decreases in general QOL from baseline, with those in the moderate nutritional risk category most likely to report this change. Nutritional risk predicted change in good physical health days over time. Other important covariates include: gender, number of health conditions, perceived health, and age. CONCLUSIONS: Nutritional risk is an independent predictor of change in health-related QOL. The results also indicate a relationship between nutrition and the more holistic view of QOL. Evaluation studies of interventions for older adults need to include QOL measures as potential outcomes to further demonstrate the benefits of good nutrition.