Update on Nutrition Guidelines and Practices in Diabetes: Preface.

Carbohydrate Counting

Point/Counterpoint


 This review used a rapid best-fit framework analysis approach to synthesize 9 included studies exploring how people who engage with emergency department (ED) services experience and understand the impacts of ED overcrowding, access block, and boarding on quality of care, patient safety, and the well-being of health care professional learners and staff working in the ED. None of the included studies were conducted in Canada.
 The included studies detailed how people who engage with ED services understand the ED as a location that is appropriate for providing short-term treatment to people requiring critical or emergent care, but inappropriate for providing care to patients for extended lengths of time. Study participants described experiencing ED overcrowding, boarding, and access block as transforming the ED into an unsafe environment where the risk of avoidable patient harm increased due to the accelerated depletion of available equipment, space, and human resources. They observed that this unsafe environment led to patients experiencing delayed, missed, and inappropriate care, resulting in potential or actual physical harm, threats to their human rights and dignity, exposures to secondary suffering, reduced satisfaction, and worsening emotional and psychological states.
 Participants reported that ED overcrowding, access block, and boarding had, for the most part, negative impacts on health care professional learners and staff working in the ED. Some ED staff reported that these phenomena led them to experience increased exposure to violence and physical harm, emotional and moral distress, dimensions of burnout, and/or missed learning opportunities for health care professional learners. Some ED staff reported experiences of camaraderie and collaboration necessarily forged as a coping mechanism to manage adversity in the context of overcrowding. Amid the challenges experienced within their practice setting, some experienced staff also perceived overcrowding as providing opportunities to exercise and expand their existing knowledge and skills.
 Considering these findings, decision-makers seeking to address the adverse impacts of ED overcrowding, access block, and boarding on quality of care and patient safety may explore facilitating the integration of routine preventive care into ED processes; enhancing communication within the ED; optimizing available equipment and space; giving patients information before and during their stay to manage their expectations; and enhancing staff’s access to education and resources necessary to better address the needs of patients who frequently experience extended stays in the ED and require specialized care beyond that which ED staff typically have the training and experience to provide. They may prioritize interventions that alleviate, rather than add to, the workload of ED staff. Additionally, they may assess and explore working conditions in the ED with a lens of promoting the well-being and retention of ED staff. By drawing on the findings of this review, they may, for example, consider exploring how to incentivize senior staff to remain in their positions, enhance learning opportunities for health care professional learners, and promote interprofessional collaboration. They may also consider investigating and addressing systemic factors contributing to overcrowding, access block, and the recruiting and retaining of health care providers in their jurisdictions.
 Decision-makers may also further explore how proposed interventions might address or exacerbate ethical and equity issues raised by ED overcrowding, including: the fair and equitable allocation of scarce resources; harms and forgone benefits to patients, health care providers, and other hospital staff; and inequitable access to and experience of ED care by patients, including impacts on patients’ dignity, relationships with care providers, and trust in EDs or health care systems. They may consider providing targeted support to groups identified as disproportionately at risk of harm in overcrowded EDs, including but not limited to: those requiring extended lengths of stay, those with limited agency to self-advocate or gain appropriate attention and care, those who are unable to perform activities of daily living, or those experiencing mental health emergencies. They also may consider that the included studies provided limited or no insight into the perspectives of people belonging to equity-deserving groups with a history of harm and lack of agency in the ED, including but not limited to: Indigenous people, Black people, and other people of colour; people with disabilities; people experiencing houselessness; those experiencing language barriers without access to a professional interpreter; and members of the 2SLGBTQ+ community. More research is needed to understand how these and other equity-deserving groups experience overcrowding, access block, and boarding as impacting their quality of care and safety.

Recent estimates point to the stark reality that one in three people will have diabetes by 2050.1 As the epidemic of diabetes continues to grow, educators aim to help those with diagnosed diabetes live healthier lives. To date, much evidence-based information exists on how to help our patients reduce their health risks and potentially add quality years to their lives. Both lay and professional publications often emphasize managing the ABCs—A1C, blood pressure, and cholesterol—for optimal diabetes management. The American Diabetes Association (ADA) recommends lowering A1C to < 7%, controlling blood pressure to < 130/80 mmHg, and controlling LDL cholesterol to < 100 mg/dl (< 70 mg/dl for those with diagnosed cardiovascular disease [CVD]) to reduce the risk of microvascular and cardiovascular complications.2 Although these recommendations have not shifted greatly over the years, diabetes management in the population continues to be less than optimal. Data from the National Health and Nutrition Examination Survey of 2001–2002 indicated that an estimated 53% of individuals with diabetes failed to attain target blood pressure levels, and 50.2% were not at goal for A1C.3 Given these statistics, it is not surprising that death from coronary heart disease (CHD) and the risk of having a stroke is two to four times greater in adults with diabetes than in those without diabetes.4 Nutrition therapy and regular physical activity are the cornerstones for managing A1C, blood pressure, and cholesterol, and treatment for each has its own set of nutrition guidelines. Although there is some overlap in the recommendations, nutrition guidelines can be complex and confusing to people with diabetes who are often working to manage their diabetes in combination with other health risks. For example, nutrition recommendations often require an individual have advanced skills, such as label reading or data interpretation (e.g., calculation of carbohydrate …

Nutritional knowledge, attitudes, and practice are important ways of assuring a healthy pregnancy start, which can be shaped during the pre-pregnancy period by the intervention of healthcare providers. In this cross-sectional study, the main objective was to explore contextual determinants of diet quality in women of fertile age, including socioeconomic factors and sources of information. Data on socioeconomic background, sources of nutritional advice, and determinants of food choices were collected through an anonymous web-based questionnaire completed by 465 women. Diet quality was assessed with the International Federation of Gynaecology and Obstetrics diet quality score (FIGO-DQS). Better food choices (OR = 1.73; 95% CI: 1.16-2.51), higher knowledge level (OR = 1.66; 95% CI: 1.119-2.466), and healthcare advice (OR = 1.70, 95% CI: 1.119-2.466) increased the chances of having a better diet. Both healthcare providers (β = 0.503, p = 0.018) and determinants of food choices (β = 0.520, p = 0.011) had a significant influence on the FIGO score, although the advice provided by the healthcare professionals did not yield a significant influence on the determinants of food choices (β = 0.310, p = 0.125); Conclusions: Knowledge had a mediator effect on the impact of healthcare guidance on nutrition practices, but it does not fully explain the adherence to healthy lifestyle choices.

Praise for Computational Systems BiologyApproaches in Cancer Research: "Complex concepts are written clearly and with informative illustrations and useful links. The book is enjoyable to read yet provides sufficient depth to serve as a valuable resource for both students and faculty." — Trey Ideker, Professor of Medicine, UC Xan Diego, School of Medicine "This volume is attractive because it addresses important and timely topics for research and teaching on computational methods in cancer research. It covers a broad variety of approaches, exposes recent innovations in computational methods, and provides acces to source code and to dedicated interactive web sites." — Yves Moreau, Department of Electrical Engineering, SysBioSys Centre for Computational Systems Biology, University of Leuven With the availability of massive amounts of data in biology, the need for advanced computational tools and techniques is becoming increasingly important and key in understanding biology in disease and healthy states. This book focuses on computational systems biology approaches, with a particular lens on tackling one of the most challenging diseases - cancer. The book provides an important reference and teaching material in the field of computational biology in general and cancer systems biology in particular. The book presents a list of modern approaches in systems biology with application to cancer research and beyond. It is structured in a didactic form such that the idea of each approach can easily be grasped from the short text and self-explanatory figures. The coverage of topics is diverse: from pathway resources, through methods for data analysis and single data analysis to drug response predictors, classifiers and image analysis using machine learning and artificial intelligence approaches. Features Up to date using a wide range of approaches Applicationexample in each chapter Online resources with useful applications'

PurposeNumeracy skills hinder a consumer’s ability to meet nutrition and calorie consumption guidelines. This study extends the literature on nutritional labelling by investigating how a calorie counter, which displays the total amount of calories consumers add to a shopping basket, aids them in making food choices. This study aims to ascertain whether the calorie counter affects food choices and also how individual and situational factors moderate this effect.Design/methodology/approachTo test the developed hypotheses, the authors designed an online shopping experiment and administered it to a national panel of British consumers. This included a sub-sample from the general population who did not report any food-related health conditions (n = 480) and a separate sub-sample from the same population who had reported a food-related health condition or lived with someone who had one (n = 250).FindingsThe results of this study show that the calorie counter leads to a large and statistically significant reduction in calories purchased when compared to the no nutritional information condition and a small (but statistically insignificant) reduction in the number of calories chosen by consumers when compared to the nutritional information only condition. The main effect is moderated by individual factors such as whether or not the person has a health condition and shopping situations which involve time pressure.Research limitations/implicationsAlthough the main effect of the calorie counter was not statistically significant when compared to the nutrition information only condition, the effect was in the correct direction and was statistically significant for consumers who had a food-related health condition. The conceptualisation and findings of this study are not only largely consistent with Moorman’s (1990) nutrition information utilisation process but also suggest that situational factors should be considered when understanding nutrition information processing.Practical implicationsThe findings from this study provide the first evidence to suggest that aggregating calorie information through a calorie counter can be a useful way to overcome consumer numeracy biases, particularly for those with existing health conditions and who are most motivated to use nutritional information. Based on the descriptive statistics, the main effect was comparable to the UK’s sugar tax in its impact and the authors estimate this would lead to a reduction in calories consumed of about 5,000 per year, even for consumers who did not report a health condition. Further testing is required with different formats, but these results are encouraging and are worthy of further research.Originality/valueTo the best of the authors’ knowledge, this is the first study to investigate how consumers react to aggregated nutritional information for a basket of products, mimicking a real shopping situation. Such information has the potential to become more relevant and useful to consumers in the context of their overall diets. As technology advances rapidly, there is a need to explore alternative ways of presenting nutritional information, so it connects more easily with consumers. These results point very much to a more targeted and personally relevant approach to information provision, in contrast to existing mass communications approaches.

Background : The prevalence of nutritional problem in school aged children was high, beside Indonesia has Nutritional Balance Guidelines. Socialization of this guidelines in nutrition education and nutrition practice to be applied is very important to do in school aged children.Objective: Analyze nutrition education effect on nutritional knowledge, nutritional practice and nutritional status in Elementary school children.Methods: This study used pra experimental with one group pretest-posttest design. This study was conducted in March – April 2017 in SDN Paringin 2 South Kalimantan. Subjects consisted of 61 students that choosen purposively. The research divided into 4 phases. First phase was pretest, second phase were intervention and first post test of nutritional knowledge, third phase was observation of nutrtitional practice, and the last phase was post test.Result: Nutrition education increased the category of nutritional knowledge from poor to fair. Nutrition education did not increase nutritional practice significantly yet. Nutritional status showed changes in every category and most of the subjects were normal. The difference test showed that nutrition education has a significant difference on pre test and first post test of nutrition knowledge (p=0.000; p&lt;0.05), energy intake (p=0.002; p&lt;0.05), protein intake (p=0.001; p&lt;0.05), and fat intake (p=0.007; p&lt;0.05). The correlation test showed that there were no significant correlation between sujects’ characteristic with nutritional status and food consumption (p&gt;0.05), nutritional knowledge with nutritional status and nutritional practice(p&gt;0.05), except second post test of nutritional knowledge with fourth nutritional practice observation (p=0.001; p&lt;0.05). Conclusions: There was an increased of nutritional knowledege from poor categorize to fair categorize after the intervention. There were increased and decreased on nutritional practice after intervention. There was no significant different of nutritional status before and after intervention.

The 1944 Education Act marked the foundation of the modern School Catering Service. A statutory duty is imposed on Local Education Authorities (LEAs) to provide a 'mid-day dinner...suitable in all respects as the main meal of the day'. LEAs are free to provide meals consistent with broad nutritional guidelines of the Department of Education and Science but financial pressures have a large bearing on this. The traditional 2-course meal is still the norm, although there is a multi-choice menu for the majority of secondary schoolchildren. But a wide choice of food is incompatible with closely prescribed nutritional standards and pupils need to be aware of the implications for their health in the choice of food. The adoption of dietary recommendations for prevention of coronary heart disease would not generate serious practical difficulties for the professional caterer. The technical problems arising from minor adaptations in catering practice would be minimal in comparison to those of cost, education and hence modification of consumer demand. The move away from nutritional standards is likely to accelerate if, owing to financial constraints, the Government withdraws nutritional guidelines or removes the obligation on LEAs to provide a catering service. The danger is that financial considerations will override those of nutrition and a unique opportunity for health education by guidance and example in the schools may be lost.

The world of diabetes is changing rapidly. Health care professionals, educators, and people with diabetes are advocating for more and better management options. Educators and providers must grow with the technology and tools available to better serve participants and patients. The 2017 National Standards for Diabetes Self-Management Education and Support (DSMES) (1), issued jointly this summer by the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE), help educators and providers do just that, by outlining requirements of DSMES service providers and offering best practices for those in the field. The DSMES standards are updated periodically—currently, every 5 years—by a Standards Revision Task Force convened by ADA and AADE to review and incorporate the latest research. Following are some of the major updates and highlights from the 2017 DSMES standards, including key takeaways and tools for providers of DSMES services. Previous DSMES standards referred separately to “diabetes self-management education” and “diabetes self-management support.” In the 2017 standards, the two have been combined and are now referred to jointly as “diabetes self-management education and support.” Education is not sustainable for people with diabetes if they do not have the support to continue to make choices and changes to manage their condition. Likewise, support from a diabetes care team needs to include a teaching element, so people with diabetes are up to date about tools and actions they can use for their management. Also, both education and support need to be ongoing, because diabetes is a lifelong condition; there is no “one …

African Americans' Faith and Religion Historically, religion and spirituality have been major influences in the social, cultural, and political lives of African Americans. Spirituality is deeply embedded into their rich cultural heritage, and it is intertwined into all aspects of their lives, including beliefs about health and illness. For African Americans, health and illness are a dynamic entity, governed by body, mind, and soul. Therefore, it is imperative that any adult learning initiatives include the importance of cultural dynamics. Religion provides individuals with a shared world view that they come to experience as persuasive and meaningful. Given its historical and ongoing role within the African American community, the church offers an ideal setting for health promotion and prevention activities as well as religious educational opportunities. Such health activities are warranted because: (a) African Americans have lower life expectancies, (b) they are less likely to have health insurance, and (c) they make fewer primary care office visits when compared to their white counterparts (Harris, 2001). The African American church can be viewed as a positive influence in the African American community. It provides spiritual guidance and direction as well as helps meet the day-to-day needs of congregants through a broad range and use of social services and commitment to the community. Diabetes, Incidence, and Prevalence Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that converts sugar, starches, and other foods into energy needed for daily life. There are many theories that attempt to elucidate the cause of diabetes, including genetics, and environmental factors, such as obesity, lack of exercise, and poor nutritional habits. Regardless of the cause, diabetes is reaching epidemic proportions, both nationally and internationally' It is the sixth leading cause of death for Americans in the United States. It is estimated that 57 million Americans have pre-diabetes, a condition that leads to overt diabetes if not properly managed (American Diabetes Association, 2008). More than 2.2 million African Americans have diabetes; 1.5 million have been diagnosed and 730,000 have not yet been diagnosed. African Americans are disproportionately affected with diabetes, and it has been estimated that there are four times as many African Americans diagnosed with diabetes today as there were in 1968. Approximately 90% to 95% of all diagnosed cases of diabetes are considered type 2 diabetes (formerly called adult-onset diabetes). This condition occurs when the body does not make enough insulin or cannot effectively use the insulin it makes. This form of diabetes usually develops in adults over the age of 40, but is becoming more prevalent in younger age groups, including children and adolescents. Common symptoms of type 2 diabetes are: (a) feeling tired or ill, (b) unusual thirst, (c) frequent urination, especially at night, (d) unexplained weight loss, (e) blurred vision, (f) frequent infections, and (g) slow-healing wounds. In very rare cases, there may be no symptoms at all. In adults, there are several other risk factors associated with the development of type 2 diabetes. Having a family history of type 2 diabetes puts one at greater risk for the disease. Increased body weight also raises the risk. With age, the body becomes more resistant to the actions of insulin; therefore, as one ages, the incidence of type 2 diabetes is likely to increase. Lifestyle factors, such as lower rates of physical activity and poor dietary and nutritional practices, also increase the risk of developing type 2 diabetes. Type 2 Diabetes in African Americans Despite the overall health of the United States population having improved over the past two decades, diabetes has reached epidemic proportions among African Americans and contributes significantly to higher morbidity and mortality rates in this population. …

According to IDF (International Diabetes Federation) data in the 10th edition of the IDF Atlas, it is stated that in Indonesia, the estimated population of adult diabetes aged between 20-79 years is 19,465,100 people, so it is known that the prevalence of diabetes between the ages of 20-79 years is 10 .6% (IDF, 2021). Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia due to defects in insulin production and action or both (American Diabetes Association, 2013). Nutritional therapy or diet therapy for DM is part of the treatment of a disease or clinical condition that must be taken into account so that its administration does not exceed the ability of the body's organs to carry out metabolic functions. Enteral nutrition is a therapy that provides nutrients in the form of liquid food either orally or using a special tube (feeding tube). Enteral formulas consist of commercial formulas and hospital formulas. The aim of this research is to develop a formula and organoleptic test of the "BITASOY" enteral formula based on purple sweet potato flour (Ipomoea batatas L), black sticky rice flour (Oryza Sativa. var. glutinosa) and tempe flour (Rhizopus oryzae) as a choice of home formula food. pain for DM patients. The research results showed that based on the organoleptic test, F2 was the formula most preferred by the panelists. Key words: Enteral Formula, Diabetes Mellitus, Purple Sweet Potato Flour, Tempe Flour, Anthocyanins, Flavonoids

Understanding health care professionals' attitudes towards working in teams and interprofessional collaborative competencies: A mixed methods analysis

Background: Stress at workplace among health professionals predisposes to an inefficient organization, absenteeism from work, job dissatisfaction, and various physical, psychological as well as behavioral health problems. Despite this, little has been done into this health issue. So, this study assessed occupational stress and its determinants among health care professionals. Methods: Hospital-based cross-sectional study was implemented among 398 participants from May 1 to June 1, 2017, at Amanuel hospital, Addis Ababa, Ethiopia. A pretested and self-administered questionnaire was used to collect data. Nursing stress scale was used to assess occupational stress. Data was entered to Epi-info-version-7 and analyzed with SPSS-20. Descriptive statistics were also utilized. Binary logistic regressions with odds ratios and 95% confidence interval were used. P-value < 0.05 in final model was significant. Results: Among 398 participants included in the study, 393 provided complete information which gives a response rate of 98.7%. This study showed that 46.8% (95%CI: 41.7, 51.7) of health professional were having occupational stress. Multivariable binary logistic regression analysis showed that working in emergency department (AOR=3.48; 95% CI: 2.12, 12.08), forensic psychiatry unit (AOR=3.48; 95% CI: 1.25, 35.06) and job dissatisfaction (AOR=2.606; 95% CI: 1.563, 4.345) were risk factors for occupational stress. Conclusion: Occupational stress among health professionals was high. Work-related variables (working in the emergency department and dissatisfaction with the job) were its risk factors. Attention has to be given for such an important public health issue.

BackgroundThe introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them.ObjectiveOur primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings.MethodsIn a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth’s FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings.ResultsAnalyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as “no fun at all,” “working in a fake world,” “stressful,” and “annoying.” There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants.ConclusionsNurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT.