Nutrition Consultation Research Articles

The Extraordinary in the Ordinary

As I meet with many of our colleagues in different parts of the country, I hear accounts about their clinical practice, their research, their teaching, and their learning. Although these colleagues often express their joy in the science and art of what we do and the hope that we can provide to those we care for, I sometimes hear comments about how elements of what they do seem ordinary. One such comment came after an account of a colleague's work with a patient with a rare protein receptor deficiency resulting in serious myopathy. The patient's muscle wasting was severe—estimated at 25 pounds of muscle in one month—and the patient's creatine kinase levels were consistently above 60,000 units per liter, far above what we know to be the norm of predictably under 200 units per liter. While working on the root cause of the pathology, the patient's neurologist was in a quandary about how to manage the myopathy. In consulting with the physical therapist, the neurologist said simply, “Will you see this patient? I am not sure what you can do, but you are our best option right now.” The physical therapist explained to me that the examination seemed routine, and there was nothing particularly unusual about the interventions of strengthening, aerobic conditioning, and functional activities that she chose to use with the patient. This physical therapist further described to me the need for her to take charge of a bigger picture of care and how that action led to a wheelchair evaluation and fitting, a nutrition consult, and the call for some additional nursing care. What was the result of this colleague's action? The patient is now out of the power chair, is walking, and is back to work at about 85% of pre-episode levels. This physical therapist told me …

Electronic Health Records: Driving Nutrition Interventions

The participants will learn when implementing an effective computerized physician order entry (CPOE), it is important to ensure that nutrition consults are triggered based on risk factors identified by both nursing and the physician.

Estado nutricional relativo ao zinco de crianças que frequentam creches do estado da Paraíba

OBJETIVO: Avaliar o estado nutricional relativo ao zinco de crianças assistidas em creches do Estado da Paraíba. MÉTODOS: O estado nutricional relativo ao zinco de 235 crianças pré-escolares foi avaliado através de sua concentração no soro, da ingestão dietética de zinco e da estatura para idade, como recomendado pelo International Zinc Consultative Group. As concentrações séricas de zinco foram determinadas por espectrofotometria de absorção atômica de chama, considerando deficiência de zinco valores <65µmol/L. O consumo alimentar foi registrado mediante o recordatório de 24 horas, considerando a alimentação da criança no dia anterior e o consumo de alimentos na creche, e foi analisada a inadequação dietética de zinco de acordo com as necessidades médias estimadas de zinco segundo etapa da vida e tipo de dieta estabelecido pelo International Zinc Consultative Group. Adotou-se o Padrão de Crescimento Infantil da Organização Mundial da Saúde para o índice estatura para idade, considerando-se com deficit de estatura as crianças que apresentaram esse índice dois escores-Z abaixo do valor mediano da população de referência. Empregou-se o teste t ou análise de variância na análise estatística, programa Statistical Package for the Social Sciences-16.0. RESULTADOS: As prevalências de deficiência de zinco no soro, inadequação dietética de zinco e deficit de estatura foram de 16,2%, 16,6% e 7,7%, respectivamente. A média de zinco no soro foi estatisticamente menor nas crianças de mães com baixo peso em comparação com as crianças de mães com peso normal. CONCLUSÃO: As crianças estudadas apresentaram risco moderado de deficiência de zinco, pois são indicadas prevalências significativas de baixos níveis séricos de zinco, de consumo inadequado de zinco e de desnutrição crônica.

Pelayanan antenatal care dalam pengelolaan anemia berhubungan dengan kepatuhan ibu hamil minum tablet besi

Background: The prevalence of pregnant women with anemia is still one of nutrition problems in Indonesia. The main cause of this case is low iron supplementation compliance as the effect of lack of antenatal care (ANC) services and lack promotion of anemia prevention and iron tablet benefit.Objective: The study was aimed to know the relationship between ANC services in anemia management with iron supplementation compliance of pregnant women.Method: The study was observational with cross sectional design. Subjects were 202 pregnant women in the II–III trimester period in Asahan District. Sampling interpretation was randomly performed by choosing 3 sub-districts with K4 ≥ 85% and ≤ 85% coverage. Data collection was carried out by interview based on structured questionnaire and KIA literature study while validity of iron supplementation compliance using stool test. Data analyzed using chi-square and logistic regressions test.Results: The result showed that 41.1% of pregnant women were complied. Based on chi-square test, there were four significant variables related to pregnant women’s compliance namely ANC services (ratio prevalence 1.82; CI95%: 1.22-2.70), anemia assessment (ratio prevalence 1.79; CI95%: 1.22-2.64), nutrition consultation (ratio prevalence 1.41; CI95%: 1.12-1.76) and knowledge (ratio prevalence 1.42; CI95%: 1.12-1.79). Meanwhile logistic regressions test showed that the most influencing variable was ANC services (OR 3.125) after controlling knowledge variable.Conclusion: There were positive relationship between ANC services, anemia assessment, and nutrition consultation with iron supplementation compliance.

Management of nutrition--and endocrine metabolism-related complications of bariatric surgery

Bariatric surgery has increasingly been applied for patients with severe obesity. By dramatically reducing body weight and producing favorable effects on disorders in endocrine metabolism, bariatric surgery has shown to be able to lower the overall mortality. However, this intervention involves a profound change in digestive physiology and may cause nutrition and endocrinal metabolism-related severe complications, which mainly result from the deficiency or unbalance of macronutrients and micronutrients. Therefore, it is necessary to establish a fixed management procedure which includes routine perioperative nutritional consultation, regular monitoring, and early preventive nutritional support, so as to prevent metabolic complications and achieve better outcomes.

Provision of Nutrition Support to Athletes Competing at the Delhi 2010 Commonwealth Games

Provision of nutrition support by dieticians at elite level competition has been previously shown to assist athletes to make informed food choices prior to competition. Elite level competition in a country where food safety is dubious and access to suitable special dietary food is challenging creates additional pressure for athletes and officials. PURPOSE: To evaluate a nutrition support service available within the athlete's village dining hall at the Delhi 2010 Commonwealth Games. METHODS: Dietitians (n=4) kept detailed records of each occasion of service from the week prior to competition until the end of competition (23rd Sept - 14th Oct 2010). In addition, a questionnaire that included information on athlete's dietary preferences and rating of the nutrition services was distributed randomly to patrons in the dining hall over each meal period. Data was analysed using SPSS for Windows. Frequencies and means were computed. Chi-Square tests were undertaken to determine the association between categorical variables. RESULTS: A total of 443 enquiries (60% athletes, 40% officials) were received at the kiosk on issues relating to food service (eg. availability and safety of food) (31%), special diets (eg. gluten free) (23%), and competition (19%) or general/training nutrition (16%). Nutrition consultations (n =52) where conducted with athletes (65% male and 35% female; mean age: 27.4 + 8.5 years) with 40% from power, 31% from weight category, 25% from skill based, and 4% from team sports. The majority of athletes were seeking advice on weight related issues with 39% wanting to lose weight, 23% attempting to make weight and 14% looking to gain weight. The majority of food service enquires came from Australia (18%), New Zealand (11%) and India (8%), while dietetic consultations were mainly conducted with athletes from Africa (37%) and Asia (25%). Results from the dining hall questionnaire (n=351) indicated that 64% athletes followed at least one type of special diet. The majority (63%) reported following a dietary regime based on the nutrient content of the food (eg. high carbohydrate, low fat) while 13% avoided potential allergens (eg. nuts). CONCLUSIONS: The majority of athletes reported that a nutrition service was essential to their confidence in food provision in such a challenging and unique environment.

Overweight and Obese Patients Do not Seem to Adequately Recognize their Own Risk for Colorectal Cancer

Being overweight is a risk factor for colorectal cancer; patients' adequate perception of their risk may lead to better involvement in management. The purpose of this study was to measure perception of risk for colorectal cancer in overweight and obese patients. A consecutive sample of overweight adult patients (n = 195) attending to nutritional counseling was submitted to clinical questionnaire addressing personal and family data, awareness about colorectal cancer risk factors, health status, and estimates of their own risk. Only 32% identified obesity among CCR risk factors. For 57% of participants, their own current BMI status did not confer any increased risk for CRC. Also, for half (46%) of the patients, their BMI status will not lead to an increased risk during lifetime. For 36%, an increased risk was accurately estimated as two or more. Accurate estimates tend to be made by older patients (p = 0.033), those with GI complaints (p = 0.040), or with familial history (p = 0.016). Even among patients attending to a nutritional consultation, only a third of patients seem to adequately consider their own overweight as a potential risk for colorectal cancer during lifetime. health education programs concerning obesity must include colorectal cancer as a potential outcome for overweight patients.

Dietary Intake and Nutritional Deficiencies in Patients With Diabetic or Idiopathic Gastroparesis

Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis. Patients with gastroparesis on oral intake (N = 305) were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to the Block Food Frequency Questionnaire, and gastric emptying scintigraphy results were analyzed. Caloric intake averaged 1168 ± 801 kcal/day, amounting to 58% ± 39% of daily total energy requirements (TER). A total of 194 patients (64%) reported caloric-deficient diets, defined as <60% of estimated TER. Only 5 patients (2%) followed a diet suggested for patients with gastroparesis. Deficiencies were present in several vitamins and minerals; patients with idiopathic disorders were more likely to have diets with estimated deficiencies in vitamins A, B(6), C, K, iron, potassium, and zinc than diabetic patients. Only one-third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients who reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastroparesis; consultation was more likely among patients with longer duration of symptoms and more hospitalizations and patients with diabetes. Multivariable logistic regression analysis indicated that nutritional consultation increased the chances that daily TER were met (odds ratio, 1.51; P = .08). Many patients with gastroparesis have diets deficient in calories, vitamins, and minerals. Nutritional consultation is obtained infrequently but is suggested for dietary therapy and to address nutritional deficiencies.

Abstract 209: Zinc is essential for the efficacy of p53 reactivating drugs

Abstract According to the International Zinc Nutrition Consultative Group, 20% of the world's population lack sufficient Zinc in their diet. Zinc is required by &amp;gt;200 different proteins including the most extensively studied Zinc-finger protein p53 that is considered guardian of genome. Its crucial role in p53 core domain folding has been proven, as disruption of this interaction greatly reduces or abrogates p53 DNA binding and transactivation of target genes. Therefore, alterations in Zinc homeostasis may impair p53 activity and also reduce the efficacy of wt-p53 re-activating drugs. Recently, we have shown that Zinc is necessary for proper wt-p53 re-activation and cancer cell apoptosis by small molecule inhibitors of HDM2 such as MI-219 (Oncogene 2010). As a logical extension to our these results, in this clinically translatable study we show that Zinc is crucial for the activity of mutant p53 reactivated by PRIMA and provide evidence for using combination therapies with PRIMA that include supplemental Zinc for the treatment of mut-p53 tumors. ZnCl2 (64 µM) enhanced PRIMA (0-100 µM) anti-tumor activity (induced growth inhibition and apoptosis and suppressed colony formation) in multiple pancreatic, colon and breast cancer cell lines. Chelation of Zinc by chelex 100 resin not only blocked the activity of PRIMA, but also suppressed reactivation of the mut-p53 and its downstream effector molecules 14-33σ, Bax and p21 as detected by western blot analysis. N,N,N'N′-tetrakis(−)[2-pyridylmethyl]-ethylenediamine (TPEN), a specific Zinc chelator, but not 1,2-bis-(o-aminophenoxy)-ethane-N,N,N′,N′-tetraacetic acid (Bapta-AM), a calcium chelator or desferroxamine, a iron chelator blocked PRIMA-induced apoptosis. Zinc chelation by TPEN suppressed p53 nuclear localization that is important for its transcriptional activity. Zinc did not affect PRIMA activity in p53 null cells, suggesting that this was indeed a p53 dependent phenomenon. Addition of Zinc suppressed the known p53 feedback MDM2 activation, which could be restored by TPEN. Before wt- or mut-p53 re-activating drugs such as MI-219 and PRIMA make their way into the clinic for cancer patients who usually have mild to moderate Zinc deficiency, we believe that the results of our findings will help in the design of novel combination strategies with Zinc for better survival outcome. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 209. doi:10.1158/1538-7445.AM2011-209

Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care

It is the position of the American Dietetic Association that child-care programs should achieve recommended benchmarks for meeting children's nutrition needs in a safe, sanitary, and supportive environment that promotes optimal growth and development. Use of child care has become increasingly common and is now the norm for the majority of families in the United States. Therefore, it is essential that registered dietitians; dietetic technicians, registered; and other food and nutrition practitioners work in partnership with child-care providers and families of children in child care to meet children's nutrition needs and provide them with models of healthful eating and active lifestyles. This Position Paper provides guidance for food and nutrition practitioners, health professionals, and child-care providers regarding recommendations for nutritional quality of foods and beverages served; menus, meal patterns, and portion sizes; food preparation and service; physical and social environment; nutrition training; nutrition consultation; physical activity and active play; and working with families. This Position Paper targets children aged 2 to 5 years attending child-care programs and highlights opportunities for food and nutrition practitioners to promote healthful eating in child care through both intervention and policy-based initiatives.

Cancer Surgeons’ Distress and Well-being, II: Modifiable Factors and the Potential for Organizational Interventions

We showed in a companion paper that the prevalence of burnout among surgical oncologists at a comprehensive cancer center was 42% and psychiatric morbidity 27%, and high quality of life (QOL) was absent for 54% of surgeons. Here we examine modifiable workplace factors and other stressors associated with burnout, psychiatric morbidity, and low QOL, together with interest in interventions to reduce distress and improve wellness. Study-specific questions important for morale, QOL, and stressors associated with burnout were included in an anonymous Internet-based survey distributed to the surgical faculty at Memorial Sloan-Kettering Cancer Center. Among the 72 surgeons who responded (response rate of 73%), surgeons identified high stress from medical lawsuits, pressure to succeed in research, financial worries, negative attitudes to gender, and ability to cope with patients' suffering and death. Workplace features requiring greatest change were the reimbursement system, administrative support, and schedule. Work-life balance and relationship issues with spouse or partner caused high stress. Strongest correlations with distress were a desire to change communication with patients and the tension between the time devoted to work versus time available to be with family. Surgeons' preferences for interventions favored a fitness program, nutrition consultation, and increased socialization with colleagues, with less interest in interventions conventionally used to address psychological distress. Several opportunities to intervene at the organizational level permit efforts to reduce burnout and improve QOL.

The Facilitated Early Enteral and Dietary Management Effectiveness Trial in Hospitalized Patients With Malnutrition

The prevalence of malnutrition in the hospitalized setting is 30% to 55%. Previous studies reported an association of malnutrition with an increased hospital length of stay (LOS), morbidity, and mortality of patients. This study evaluated the role of early nutrition intervention on LOS, diagnosis coding of malnutrition cases, calculating case mix index, and reducing delays in implementing nutrition support to patients. Demographic data, anthropometric measurements, LOS, and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation. Based on these results, a nutrition intervention study was conducted in 1 ward; the other ward served as a control. Patients were classified as normally nourished or malnourished. Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS, controlling for other potential confounding factors on the cohort and a subset with severe malnutrition. Of the 400 patients assessed, 53% had malnutrition. Multiple general linear regressions showed that nutrition intervention reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group. Case mix index and female gender were positively associated with LOS in the malnourished group. Nutrition intervention reduced the delays in implementing nutrition support to patients by 47%. Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients. Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits.

Nutritional recommendations for patients with non-alcoholic fatty liver diseases

Fatty liver is the most common liver disease worldwide. Patients with fatty liver disease die primarily from cardiovascular disease and not from chronic liver diseases. Hyperglycemia and hyperinsulinemia induce lipogenesis, thereby increasing the hepatic pool of fatty acids. This pool is also increased by increased delivery of fatty acids through the diet or lipolysis in adipose tissue. Nutritional consultations and lifestyle modification are important in the treatment of non-alcoholic fatty liver disease (NAFLD). Among the dietary constituents, combination of vitamin D, vitamin E, and omega-3 fatty acids shows promise for the treatment of NAFLD.

Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care

The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.

Fructose Intolerance/Malabsorption and Recurrent Abdominal Pain in Children

Purpose: The purpose of this study was to ascertain if pediatric patients with chronic abdominal pain had concurrent fructose intolerance as determined by breath hydrogen test (BHT) using a standardized dose, and whether symptoms would improve with low-fructose diet. Methods: BHT-fructose test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating and/or diarrhea. Patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. A microlyzer self-correcting model SC QuinTron machine was used to measure hydrogen (H2) and methane (CH4) at time points 30 min, 60 min, and 90 min. Test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were started on a low-fructose diet as prescribed by a staff registered dietician. Results: Total of 245 patients. One hundred and fifty females (62.1%) were part of the study. Ages ranging from 2 to 18 years with a mean age of 11. Breath hydrogen test for fructose was performed in all patients and it was positive for fructose intolerance in 132/245 patients (53.9%). A total of 113/245 (46.1%) patients had negative BHT for fructose intolerance. The entire 132 patients with a positive BHT for fructose had a nutrition consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, Eighty-eight of the 132 patients (67.7%) reported resolution of symptoms on a low-fructose diet. Furthermore 54/113 patients (47.8%) with negative BHT for fructose reported resolution of symptoms without a low-fructose diet. Conclusion: Fructose intolerance/malabsorption is common in children with recurrent/functional abdominal pain and a low-fructose diet is an effective treatment.

DBT Telephone Skills Coaching With Eating Disordered Clients: Who Calls, for What Reasons, and for How Long?

The goal of this paper is to report on the typology, frequency, and duration of intersession calls placed by outpatient eating disorder clients to their therapists. Participants were 17 women, offered DBT after-hours telephone coaching adapted for individuals with eating disorders. Results indicated that clients used telephone coaching primarily to reduce eating disorder–related urges, followed by nutrition consultation. The average number of calls received by the DBT therapist per day was .89 ( SD = 2.38) with a range of 0 to 4 calls per day. The mean duration in minutes for a coaching call was 5.92 ( SD = 4.66) with a range of 1 to 30 minutes. Illustrative vignettes using the DBT telephone coaching protocol for eating disorders are provided. Implications for implementing DBT telephone coaching in settings with eating disorder patients are discussed.

Importance of lifestyle modification in cervical cancer survivors.

e15521 Background: With the introduction of multimodality therapy for cervical cancer many women will be long-term survivors in need of comprehensive postsurveillance care. Lifestyle modifications are critical components of such care. Our goal was to evaluate patterns of obesity and smoking in a cohort of cervical cancer survivors. Methods: We reviewed the records of patients treated for invasive cervical cancer at our institution from 2000-2003 who were NED ≥ 3 years. Demographic and clinical information was collected, including smoking history and anthropometric measurements. BMI was categorized according to WHO criteria. Logistic regression, Wilcoxon-signed rank test, and chi-square analyses were performed. Results: Of the101 women with complete follow-up data at 3 years, median age at diagnosis was 44.4 yrs (mean 45.2; range, 23.9-75.7). 68% were White; 16% were Hispanic; 14% were Black. At diagnosis, 38% had a normal BMI, 22% were overweight, and 41% were obese compared with 35%, 20%, and 46% at 3 years, respectively. Of the 21 women whose BMI categorization changed, only 15 had weight gain, and 6 lost weight. By paired analysis, increase in BMI was significant over the 3-year interval (n = 65) (p < 0.01). There was a trend for more psychiatric consults in obese women (p = 0.1), and only 7 had nutrition consults. 50 patients were nonsmokers; 25 formerly smoked, and 26 actively smoked at diagnosis. Smoking cessation was discussed with 15 patients and 1 patient accepted referral. Compared with nonsmokers, ever smokers were more likely to experience treatment complications (OR 2.6; 95%CI [1.2, 5.8]) and have consults by the pain service (p = 0.01). Current smokers also appeared to be at greater risk for radiation cystitis (OR 3.2, p = 0.1). Median time to GU consult for ever smokers was less than never smokers (11 vs. 51 mos). Conclusions: Obesity and smoking may significantly complicate care in cervical cancer patients during the survivorship phase of the cancer continuum. It is crucial for oncologists and primary care physicians to reinforce healthy lifestyle changes in these women. In 2008, our institution began offering comprehensive services in the GYN Survivorship Clinic, a major aim of which is to provide patients with lifestyle management strategies. No significant financial relationships to disclose.

Nutritionist’s Variation in Counseling Style and the Effect on Weight Change of Patients Attending a Community Based Lifestyle Modification Program

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support.

Estratégias de atuação do nutricionista em consultoria alimentar e nutricional da família

O objetivo deste trabalho é apresentar princípios e estratégias de atuação do nutricionista em consultoria alimentar e nutricional da família. O especialista nesta área, denominado personal dieter, tem por objetivo principal a educação nutricional da família. A atuação do personal dieter é baseada em três princípios fundamentais: envolvimento de todos os membros da família, promoção da alimentação saudável e aperfeiçoamento das técnicas dietéticas usadas no preparo dos alimentos. Para isso, o nutricionista realiza visitas domiciliares para conhecer a realidade da família e propõe mudanças dos hábitos alimentares por etapas. O protocolo de intervenção adaptado a cada realidade inclui, entre outras atividades, elaboração de cardápio e de lista de compra de alimentos, prescrição de dieta individualizada e treinamento de cozinheira. O conhecimento detalhado dos comportamentos, hábitos e práticas relacionados à alimentação da família favorece uma intervenção personalizada. Isto é essencial para a adoção de hábitos alimentares saudáveis e garante maior eficácia do profissional nutricionista no cuidado à nutrição e à saúde da família.

The Young Women's Program: A health and wellness model to empower adolescents with physical disabilities

Background This article introduces a comprehensive health and wellness program that serves young women, ages 14 to 21, with physical disabilities. The program is a component of the Initiative for Women with Disabilities (IWD), a hospital-based center serving women with physical disabilities/conditions that offers accessible gynecology, primary care, physical therapy, nutrition consultations, exercise and fitness classes, and wellness and social work services. Recent literature has shown that young women with physical disabilities often face physical and emotional barriers to their own health and wellness. This group of adolescents often has difficulty developing a healthy image of their bodies, especially compared with their able-bodied peers. Unhealthy attitudes regarding the body image and sexuality of those with physical differences are often perpetuated by the media, peers, and parents. People with disabilities have become increasingly able to live fulfilling lives in recent decades. This is due largely to studies that have confirmed that once barriers are addressed and minimized, young women with physical disabilities lead active and productive lives and have much to contribute to society. Methods The goal of the Young Women's Program (YWP), established in 2006, is to help young women adopt healthy lifestyles by exposing them to a carefully planned curriculum. The program provides a variety of classes and workshops, expert instruction, and access to resources and a network of peers and mentors. The ultimate goal is for the participants to apply the concepts learned in the group sessions to identify and evaluate their personal goals and develop health and wellness plans for achieving these goals. Results Data were obtained from several sources: a self-administered program evaluation, program recruitment and retention statistics, and an assessment of whether individual health and wellness goals were achieved. All of these measures indicate a favorable response to the program structure and content. Participants are able to integrate and apply the learned concepts to alter aspects of their daily lifestyles and improve their self-confidence, self-worth, and self-competence. Conclusions The results to date suggest that the YWP addresses the transitional challenges cited in the literature that young women with physical disabilities face from adolescence to adulthood. The structure of the program, which combines individual and group sessions, and the focused content appear to have a positive impact on the participants' lives by exposing them to experiences that promote self-determination and self-competence. By providing opportunities for socialization with peers and mentors and exposure to community resources, and by helping participants to develop self-care skills and to set goals for a healthy lifestyle, the program facilitates leading an independent life. The efficacy of the YWP will be determined by annual follow-up studies as participants enter adulthood.