Test 3 Flashcards
Define infant mortality rate, what does it mean to our health care system?
Infant Mortality Rate (IMR) –number of liveborn infants
who die within first year of life per 1000 births
• Used as indicator of health status and quality of life of populations
• More than twice as high in American blacks as in whites
Where is the United States based on their IMR?
U.S. IMR is higher than many other industrialized countries
What two major indicators predict an infant’s future health status?
Birth weight and length of gestation
Ways of reducing LBW
Poverty • Minority status • Lack of access to health care • Inability to pay for health care • Poor nutrition • Low education level • Unsanitary living conditions • Drug use, smoking, alcohol
National goals for the health of both mom & baby (where are we doing well and where are we
not doing so well?
Objectives focusing on mortality
• Objectives addressing risk factors
• Objectives on incidence of developmental disabilities and
folate intake
Small decline in infant mortality rates for Hispanics, whites,
blacks
• Incidence of neural tube defects has decreased
• Increase in breastfeeding by women in all racial and ethnic
groups
• Continued decline in smoking during pregnancy
No progress or reverse direction:
• Maternal death for African-American women
• Iron deficiency
• Low birth weight
• Proportion of women receiving prenatal care
Recommended weight gains during pregnancy
underweight - 28-40
normal -25-35
overweight 15-25
obese 11-20
Risk of adolescent pregnancy
• Pregnant adolescents are nutritionally at risk and require
intervention
• Risks include hypertension, iron-deficiency anemia,
premature birth, stillbirth, LBW infants, prolonged labor`
Nutrition assessment in pregnancy (three categories)
Preconception Care dietary measures Clinical measures • Anthropometric measures • Laboratory values
Growth of the infant and ways of measuring and interpreting growth
Relative to body weight, infants need more than twice as
much of many nutrients
Breastfeeding recommendations & promotion (also know the barriers)
Helps protect against infection
• Protects against allergy development
• Favors normal tooth and jaw alignment
• Breastfed babies are less likely to be obese
• Convenience and lower cost
Barriers:
• Lack of knowledge or experience among mothers and
family members
• Lack of instruction from health care professionals
• Non-supportive hospital practices
• Lack of work place accommodation
Information provided by hospitals and health care
professionals – Baby Friendly Hospitals
• WIC campaign - Peer counseling among low-income
women
• Best Start project – focus groups
Infant feeding do’s and don’ts
Whole cow’s milk not recommended during first year of life
• Breast milk or iron-fortified formula during first six months
• Begin adding solid foods at six months
Top nutrition related problems in infants
Iron Deficiency
• From continuing breast feeding after six months without
iron supplementation
• Use of cow’s milk earlier than recommended can lead to
deficiency
• Food Allergies
• Less prevalent in breastfed infants
• Introduce foods singly to detect any allergies
Programs for moms and infants
Title V Maternal and Child Health Program
• Medicaid and EPSDT
• Health Center Program
• Healthy Start Program
Ways to improving the health of mothers and infants
Insure quality nutrition counseling is available and accessible
• Use MCH money
• Ask voluntary health organizations to help
• Worksite health promotion programs
• Adolescent pregnancy counseling in the classroom and individually
Insure quality nutrition counseling is available and accessible
• Use MCH money
• Ask voluntary health organizations to help
• Worksite health promotion programs
• Adolescent pregnancy counseling in the classroom and individually
How are children & adolescents doing on the Healthy people 2010 objectives?
Weight status of children reflects a trend for the worse Prevalence of overweight among children and adolescents of all ethnic groups has increased substantially Prevalence of growth retardation among low-income children decreased Percentage of elementary and secondary schools offering low-fat choices for breakfast and lunch increased substantially Proportion of students in grades 9-12 participating in daily physical education has increased slightly Incidence and prevalence of diabetes have increased
What are children and adolescents eating, how do their diets rate? How do they change with
age
Dietary quality of most children aged 2-17 is less
than optimal
Children in poor families are more likely to have
diet rated as poor or needs improvement
Quality continues to decline into adolescence
with decreased vegetables, and increased solid
fats and soft drinks
Children aged 6-11 have lower-quality diet than
younger children
Reduced fruit, milk and sodium HEI scores – more
fast food and salty snacks
Dietary quality of most children aged 2-17 is less
than optimal
Children in poor families are more likely to have
diet rated as poor or needs improvement
Quality continues to decline into adolescence
with decreased vegetables, and increased solid
fats and soft drinks
Children aged 6-11 have lower-quality diet than
younger children
Reduced fruit, milk and sodium HEI scores – more
fast food and salty snacks
What influences this age group’s eating habits?
Fewer families eat meals together Dining out – schools, fast foods, convenience stores, vending machines, worksites Adolescents – convenience and peer pressure are main influence on choices Media influence on food choices and body image
Childhood obesity, what is happening? How do we define/diagnosis it?
Percentage of overweight children has nearly doubled Percentage of overweight adolescents has nearly tripled Obesity – BMI at or above 95th percentile on CDC growth chart Overweight – BMI at or above 85th percentile on CDC growth chart
Other nutrition-related problems of children and adolescents.
associated with hyperinsulinemia, hypertriglyceridemia, reduced HDL cholesterol increased risk of cardiovascular disease, type 2 diabetes, sleep apnea, gallbladder disease, psychosocial dysfunction, orthopedic problems Undernutrition Iron deficiency and iron-deficiency anemia Blood lead level Dental caries High blood cholesterol Eating disorders
What are the nutritional risks of children with special needs? What can we do to help
Are at increased nutritional risk because of feeding problems, metabolic problems, drug-nutrient interactions, decreased mobility, altered growth patterns Need interdisciplinary approach to feeding strategies Legislation and community-based programs have helped
Know the food assistant programs for this age group. Which are run by the USDA & DHHS
School Breakfast Program
• After School Snack Program
• Special Milk Program for Children
• Summer Foodservice Program
What things can discourage nutrition program participation at school? What are some of the
trends of today’s children/adolescents?
Sugar-sweetened beverages Low-nutrient, energy-dense foods Absence of fruits and vegetables Snack bars School stores Vending machines A la carte foods Shortened lunch times
How can we make the schools and healthful environment?
Limitations on competitive foods, vending Nutrition and health education Limit fried and high-fat foods in cafeterias Wellness policy in school districts
Know some of the nutrition education programs and private sector programs offered for this
age group.
Fresh Fruit and Vegetable Program • Expanded Food And Nutrition Education Program • Team Nutrition • Coordinated School Health Program • EAT SMART. PLAY HARD. • Farm to School Programs • Fruits & Veggies – More Matters • Best Bones Forever • Fuel Up to Play 60 • Kids Caf
What are the demographic treads of this age group? What do we see happening? How does it
affect health care?
Americans are living longer than ever before • Good nutrition can retard and ease the aging process in many significant ways • Proportion of elderly is increasing dramatically • Health care demands will increase
Focus areas of healthy people 2010. Which goals are not being met?
National Goals for Health Promotion
• Healthy People 2020 focus areas for older
adults –
• Reduce prevalence and number of people
suffering from chronic diseases
• Increase number receiving pneumonia and
influenza vaccinations and colorectal
screening
• Increase daily physical activity and
cardiovascular health
• HP 2010 final report – there was little or no
progress in most objectives
Top leading causes of death in this age group.
d
Fruit, vegetable and grain consumption trends
d
Baby boomers. What are some of their characteristics?
Born between 1946 and 1964 • Almost one-third of U.S. population • General characteristics: • Have the power to change the marketplace • Make decisions based on personal beliefs • Are constantly pressed for time • Look for value and quality in their investments • Will not age gracefully • Like nostalgia
Nutrition education programs for this population.
Found in both public and private sectors
• Nutritional goals:
• To help consumers select diets providing
enough energy to maintain healthful weight
• Meet recommended intakes for all nutrients
• Low in solid and trans fat, added sugars,
sodium, cholesterol, and alcohol
• Adequate in whole grains and fiber
Public programs for this population.
Expanded Food and Nutrition Program (EFNP) • FDA and USDA public education campaign on food labels and food safety • Family Nutrition Program • National Cholesterol Education Program • DASH - High Blood Pressure Education Program • Fruits and Veggies: More Matters • The WOMAN Challenge
What are the primary nutrition-related problems with this age group?
Functional capacity declines in almost every organ system • Changes in absorption of nutrients • Chronic diseases • Physiological, psychological, environmental, socioeconomic factors
Changes/effects that occur due to the aging process
d
How aging affects nutritional status
Several major recommendations are related to
the value of nutrition services
• Strategies to improve care and broaden access
to nutrition services for older adults are
supported
• Recommend that nutrition services and nutrition
counseling and education be included
throughout health care services
Evaluating nutritional status- specifically malnutrition and daily activities
Malnutrition
• Poverty
• Living alone
• Medications interfering with nutrient
absorption
• Daily Activities
• Increasing difficulty with daily activities
• Activities of daily living (ADLs) – self-care
functions
• Instrumental activities of daily living (IADLs)
– require higher level of functioning
Screening initiative & tools
Developed by the Academy of Nutrition and Dietetics, American Academy of Family Physicians, and National Council on Aging • Primary products of this cooperative effort were screening tools designed to be used by the older person and health professionals
Components of the nutrition assessment and what is part of each component
Anthropometric measures • Clinical assessment • Biochemical assessment • Dietary assessment • Functional assessment • Medication assessment • Social assessment
Programs for this population
General assistance programs
• Nutrition programs of USDA
• Nutrition programs of DHHS
• The Older Americans Act Nutrition Program
• Private-sector nutrition assistance programs
• Nutrition education and health promotion
programs for older adults
How can we promote successful aging?
Prepare for old age early in life
• Learn to reach out to others to forestall
loneliness
• Develop skills or activities that can continue in
later years
• Develop the habit of adjusting to change
• Arrive at maturity with as healthy a mind and
body as possible
Food insecurity and undernutrition/malnutrition
problem of poverty
• Food is available but not accessible to the
poor who don’t have land or money
• 16% of the developing world’s population
suffer from chronic undernutrition
• Found in countries that can neither produce
enough food nor earn enough to import it
• Nearly 25% of the world’s population suffers
some form of malnutrition
Things that can lead to being underweight for children and how it affects their health status
d
PEM (Kwashiorkor vs. Marasmus)
Protein-energy malnutrition (PEM) – most widespread form of malnutrition in the world • Consists of: • Kwashiorkor – inadequate protein intake • Marasmus – inadequate food intake (starvation)
Countries that are most undernourished (hot spots for hunger)
d
Who are must vulnerable for malnutrition
Inadequate weight gain during pregnancy
• Low birthweight
• Children are stunted
• Higher infant and under-5 mortality rate
The economic burden of malnutrition
Direct health-related expenses
• Lost productivity and income
• Stunted physical and mental development
– reduced lifetime earnings
Causes of world hunger (colonialism)
Colonialism – removal of raw materials for industrial use International trade and debt – high import costs and low export profits • Multinational corporations – hire local people at low wages to grow export crops Overpopulation • High birth rates in low-income countries • Population growth threatens world’ s capacity to produce adequate food • Distribution of resources
International trade & debt and multinational corporations and how they affect food insecurity
d
Other factors of food insecurity (overpopulation, distribution of resources, agricultural
technology, sustainable development)
Overpopulation • High birth rates in low-income countries • Population growth threatens world’ s capacity to produce adequate food • Distribution of resources • Distributed unequally between rich and poor within nations and between nations • Poor nations must gain access to land, capital, water, technology, knowledge Agricultural technology • Labor-intensive methods • Biotechnology, GM foods • Sustainable development • Accelerated soil erosion • Need crop rotation • Need to manage agricultural resources
Action for children- GOBI
Growth monitoring • Oral rehydration therapy • Promotion of breastfeeding • Timely and appropriate complementary feeding • Immunizations
Focus on Women, why
Women with their children represent the
majority of those living in poverty
• Development projects frequently overlook
women’s needs
• Women play a vital role in the well-being of
their nation’s people
Strategies for programs for women
Basic strategies for women’ s programs: • Removing barriers to financial credit • Access to time-saving technologies • Appropriate training for self-reliance • Teaching management and marketing skills • Making health and day care services available • Forming women’s support groups • Information and technology for planned pregnancies
International nutrition programs
Emphasis in developing countries: • Breastfeeding promotion programs, appropriate weaning foods • Nutrition education programs • Food fortification and/or nutrient supplements • Special feeding programs for vulnerable groups • Grass roots progress in improving agriculture, water, education, health services
Global challenges
Daily struggle for survival in developing countries Pandemic of HIV/AIDS Trend toward urbanization • Rapid population growth Destruction of global environment • Challenges of global aging
Personal action, what we can do.
Work with others who have similar
interests
• Follow current hunger-related legislation
• Write and telephone local and national
political representatives
• Encourage and give monetary support to
your church, synagogue, mosque to
support outreach feeding efforts
Resources - use only what we need
• Choose a diet at level of necessity
• Personal lifestyles do matter
• Ending hunger is a moral imperative for
everyone
Designing interventions
Need to understand behavior of target population • Must have tools or strategies to influence behavior • Is targeted at a nutrition-related problem
Behavior change models or approaches
Behavior change theories and models: • Provide evidence-based methods or strategies • Target changes in attitudes and beliefs • Target behavior change • Improved understanding of why and how intervention strategies work – better client outcomes
Define nutrition education, social marketing, & nutritional counseling
Nutrition education – formal process to impart knowledge to a group or individual • Social marketing – approach to promote healthy behaviors using marketing techniques • Nutrition counseling – collaborative activity between counselor and client
Stages of change
Precontemplation – individual unaware of or
not interested in making a change
• Contemplation – individual is thinking about
making a change within the near future
• Preparation – individual actively decides to
change and plans a change very soon
• Action – individual is trying to make the
desired change and has been working at it for
less than 6 months
• Maintenance – individual sustains change for
six months or longer
Motivational interviewing
Builds upon client-centered counseling
• RULE Principles:
• Resist urge to confront client about need to
change
• Understand – proceed in nonjudgmental way
• Listen – express empathy
• Empower – support self-efficacy
Health belief model
Three components for adopting a new health behavior: • the perception of a threat to health • expectation of certain outcomes related to a behavior – benefits • self-efficacy – the belief that one can make a behavior change to produce outcomes
Theory of planned behavior
An individual’
s intention to change behavior
is determined by both personal attitudes
toward the new behavior and perception of
social pressure to change the behavior
• A person is more likely to adopt a new health
behavior if he/she believes that the new
behavior will lead to mostly positive outcomes
and that other people important to him/her
think that the behavior should be adopted
Weight control program-surveyed participants beased on intentions
• Paired participants with those successful
in the past
• Combined Health Belief and Theory of
Planned Behavior
• Osteoporosis intervention – increased
calcium intake in participants
Social cognitive theory
An individual’s confidence and ability to
perform a behavior and his perception of
outcome will influence his effort
• Focuses on target behaviors rather than
knowledge and attitudes
Used telephone-based intervention to
increase consumption of fruits and
vegetables, whole grains, and beans
• Used concepts of environment, behavioral
capabilities, expectations, self-efficacy,
reinforcement
Cognitive-behavioral theory
Based on assumption that all behavior is
learned
• Behavior is directly related to internal and
external factors
• Patients are taught to use behavioral
strategies
Diabetes Prevention Program – intensive
lifestyle modification program based upon
cognitive behavioral theory
• Lifestyle intervention was significantly more
effective than drug therapy in reducing
incidence of diabetes
Diffusion of Innovation Mode
The process by which an innovation spreads
within a population
• Four stages:
• Knowledge – individual has acquired
information and is aware of innovation
• Persuasion – individual forms attitude in favor
of or against innovation
• Decision – individual performs activities leading
to either adopting or rejecting innovation
• Confirmation – individual looks for
reinforcement for decision and may change if
exposed to counter-reinforcing messages
Innovators – adopt innovation readily,
perceive themselves as popular, are
financially privileged
• Early adopters – opinion leaders, well
respected by peers
• Early majority – cautious
• Late majority – skeptical, adopt
innovation only through peer pressure
• Laggards – last to adopt idea
