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Competencies for effective public health nutrition practice: a developing consensus.

OBJECTIVES: To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice. DESIGN: A modified Delphi study involving three rounds of questionnaires. SUBJECTS: A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia. RESULTS: Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. CONCLUSIONS: There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.

Australia↗

Characteristics of the nutrition provider in corporate and hospital wellness programs.

This two-phase research project was conducted to examine the content of corporate- and hospital-sponsored wellness programs and to determine the characteristics of the nutrition provider. In the first phase of the study, a questionnaire was sent to 150 wellness program directors located throughout the United States to determine the nature of their total wellness program. In the second phase, questionnaires were sent to the nutrition provider to elicit specific information on the characteristics and requirements for that position. Results indicated that corporate- and hospital-sponsored wellness programs offered a variety of activities. Those incorporating a nutrition component offered a range of events from nutrition assessment to individual counseling and disease awareness programs. The position of nutrition provider was most often held by a 26- to 46-year old woman with a master's degree and experience and educational background in an allied health field other than dietetics or nutrition. Registered dietitians were more likely to be responsible for the nutrition component of a hospital program than of a corporate program. Our results suggest that opportunities exist for registered dietitians in the field of health promotion and wellness.

Adult↗

Position of the American Dietetic Association: the role of nutrition in health promotion and disease prevention programs.

A healthful diet and wise food choices are critical components of promoting health and reducing the risk of chronic disease. A substantial amount of health care resources could be saved by expanding health promotion and disease prevention programs that target dietary change among Americans. To effectively reduce health care costs, the emphasis and delivery of health care must promote health as well as deliver treatment and rehabilitative services to the sick. Prevention measures, such as nutrition interventions that also encourage physical activity, can help prevent or halt progression of full-blown chronic disease and thus decrease chronic disease disability. Health promotion and disease prevention need to be integral parts of all health care, community, public health, and worksite programs across the life cycle. Correspondingly, such programs must be culturally competent and address the specific needs of vulnerable or underserved populations. Dietetics professionals in all areas of practice should play an integral role in health promotion and disease prevention programs. Achieving this goal will require expansion of training programs and active learning by dietetics professionals that includes theory and practice in using team approaches, developing coalitions, and managing complex systems. Dietetics professionals also need to amplify their understanding of politics, administration, health care financing, and reimbursement. Attention must also be expanded to include social and behavioral sciences and to address program evaluation, outcomes, and cost-benefit and cost-effectiveness in nutrition-focused health promotion and disease prevention programs. Continued training in program development, research, and evaluation will help build the body of evidence that supports ongoing inclusion of prevention in a rapidly changing health care environment.

Chronic Disease↗

Community health and nutrition screening for Special Olympics athletes.

Since 1961, Special Olympics has provided sports training and athletic competition for people with mental retardation. A recent addition to these Olympics has been the Healthy Athletes Program, designed to help the athletes improve their health and fitness, leading to enhanced sports experiences and well being. Original health services included dental and eye screening. In 2002, Special Olympics Delaware piloted a Wellness Park to add nutrition, blood pressure, and flexibility screening. Faculty from a university's health college trained discipline-specific students to conduct the screenings. Thirty nutrition and dietetics students measured height, weight, waist circumference, and calculated body mass index (BMI) for the athletes. Figures and risk-assessments were recorded on a "health report card." Two hundred ten athletes attended the nutrition screening. Ages ranged from 8 to 63 years; 81 percent males and 19 percent females. According to BMI standards, 32 percent of the athletes were overweight; 17 percent were obese. Twenty-five percent of adult males and 73 percent of adult females had a high risk waist circumference. Athletes at high risk for obesity-related diseases were referred to their primary physician for follow up. Nutrition education handouts included a simplified Food Guide Pyramid, tips for healthy eating in restaurants, 5 A Day information, and healthful hydration guides. Approximately 1,250 athletes participate in Special Olympics Delaware each year, providing a great opportunity to do some much needed health screening and improve access to health care for this often neglected population.

Adolescent↗

Post-baccalaureate activities of community nutrition graduates.

A comparison was made of the employment status of graduates of three types of programs in community nutrition. Graduates of community nutrition programs were less likely to be employed in dietetics or nutrition-related positions; were less likely to be registered dietitians or to have fulfilled requirements for professional registration; and were less likely to recommend the profession than were graduates of coordinated undergraduate programs or of programs in general dietetics or foods and nutrition. Implications for student counseling and professional accreditation are discussed.

Community Health Services↗

[Dietetic assessment of patients with gastroenterologic diseases at the out-patient service of the Institute National of Sciences Medicine and Nutrition Salvador Zubiran].

UNLABELLED: Assessment of dietetic management is necessary for detection/correction of faults and best care of patients. AIM: Our aim was to evaluate dietetic management and nutritional status of gastroenterologic patients. METHODS: Anthropometric, clinical-nutritional, biochemical, and dietetic parameters were assessed in 110 patients (150 with liver cirrhosis [LC], 30 with inflammatory bowel disease [IBD], and 30 with chronic and skin. In CP, prescribed energy, g and % carbohydrates and lipids were less than ideal and proteins were greater; in cirrhotics, less proteins and a great % of carbohydrates were prescribed; in IBD fewer lipids and more proteins than ideal were prescribed. Cirrhotics usually consumed less fat (g) and more proteins than prescribed, and patients with CP and IBD a greater amount of carbohydrates than prescribed. Cirrhotics consumed more % carbohydrates and < % lipids than ideal; CP patients lipid intake was less and protein intake above ideal and in IBD, carbohydrate intake was greater and lipid intake lower than ideal. CONCLUSIONS: Anthropometric and biochemical parameters were not useful for assessment of these patients. Prescribed diet was too restricted regarding proteins in LC and was inadequate in energy/nutrients in patients with CP. Fewer lipids and more proteins were prescribed in IBD. The inadequacy of prescripted diet, lack of information regarding the person who prescribed it, and lack of constant supervision may cause non-adherence to diet and thus may affect nutritional status.

Adult↗

Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding.

It is the position of the American Dietetic Association that the development of clinical and ethical criteria for the nutrition and hydration of persons through the life span should be established by members of the health care team. Registered dietitians should work collaboratively to make nutrition, hydration, and feeding recommendations in individual cases. Registered dietitians have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When patients choose to forgo artificial nutrition and hydration, or when patients lack decision-making capacity, and others must decide whether or not to provide artificial nutrition and hydration, the registered dietitian has an active and responsible professional role in the ethical deliberation around that decision. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The registered dietitian's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration.

Advance Directives↗

[Food habits among HIV patients].

The authors analyze the eating habits of a group of 108 patients suffering from HIV. The authors elaborate a chart about the composition and distribution of foods which contains all the required food groups necessary for a complete diet. This food chart lists the variable of this study as well as the frequency of their consummation. Once this chart was drawn up, it was approved by the Nutrition and Dietetic Unit at the Virgen de Valma University Hospital. Among the results obtained, there is a relationship between the necessity these patients have regarding eating a complete diet and diverse nutrients that are easy to chew as well as an abundance of liquids. The article "Nutrition for Patients suffering from HIV" written by the same authors published in the Revista ROL de Enfermera 2002; 25(12):816-820, is recommended in order to have a more complete understanding of this topic, nutrition for patients suffering from HIV.

Feeding Behavior↗

Rights-based food and nutrition perspective: 21st century challenge for dietetics.

Progress in addressing the problems of hunger and malnutrition has been slow and uneven across regions and countries of the world. A rights-based perspective, not merely a utilitarian argument, must serve as the rationale for humans to be properly nourished. Rights impose corresponding binding obligations on others and the concept of rights holders and duty bearers goes beyond the human development paradigm. The right to adequate food is realized when every man, woman and child, alone or in community with others, has physical and economic access at all times to adequate food or means for its procurement. As duty bearers, governments are obligated to assure the realization of that right and accountable if the right is violated. The use of the human rights approach to adequate food necessarily implies a re-examination and fundamental changes in the way we think about hunger and malnutrition and their causes; the manner of shaping and reshaping policies; the context and processes of planning, monitoring and evaluating programmes; and the substance and method of research and education in food and nutrition. Dietitians and dietetic associations can be instrumental in making the human right to adequate food a reality.

Developing Countries↗