Journal of the Canadian Dietetic Association最新文献

People suffering from the acquired immunodeficiency syndrome (AIDS) often experience involuntary weight loss and malnutrition. Altered body composition, recurrent opportunistic infection and a decline in immune function are associated with the progression of the human immunodeficiency virus (HIV) infection to AIDS. The factors that might affect nutritional status in AIDS are numerous and include a reduced food intake, increased metabolism, malabsorption and the acute phase response to infection. It is not clear what difference nutritional intervention can make to the progression of the disease. However, there is a consensus that it has an important role to play during the course of the disease. A report was compiled to assess the requirement for a dietitian in an HIV Clinic (the Southern Alberta Clinic) and the role of the dietitian in that position. Nutritional and anthropometric data were collected from medical records. In addition, Clinic physicians were sent a questionnaire. It was found that clients, when seen by the dietitian, had lost weight and had more gastrointestinal symptoms and a lower CD4+ lymphocyte count than the average Clinic patient at their initial Clinic visit. The report recommended that all Clinic staff use body mass index as a screening tool for referral to the dietitian and that good nutrition be promoted by the Clinic as an important part of the care of the HIV infected person. The assessment recommended a 0.4 full-time equivalent position within the Southern Alberta Clinic.

Rapid change and marked diversity are expected to characterize the 21st century. If dietitians are to serve as change facilitators in this environment they will have to demonstrate greater flexibility and creativity, practise critical analysis and problem solving and employ creative thinking. Although provision of quality nutrition care will remain the unique contribution of dietitians, practitioners in the future will require a greater understanding of the impact of social, economic and political systems on food availability and food consumption and, in turn, health and well-being. Critical to the future practice of dietetics will be a greater understanding of research methodology, computer technology, quality improvement processes and risk management, principles governing learning and behaviour, personnel management and organizational behaviour, family and group dynamics, interpersonal communication and their application to dietetic practice. The Canadian Dietetic Association recently adopted a framework for the development of baccalaureate programs in dietetics designed to enable the dietetic practitioner to continue to make a unique contribution in the 21st century. The framework allows individual institutions the freedom and flexibility to plan programs that are compatible with their philosophy and organizational structure. In addition, it is predicted on the principle that a career in dietetics entails a lifetime commitment to education, of which the baccalaureate program is only the beginning.

The dietitian plays a leadership role in improving the quality of life of nursing home residents. A better understanding of this role can strengthen practice in this area. This paper attempts to define the role of the dietitian in the nutritional care of the elderly in long-term care facilities. The impact of poor appetites, extended stays and nutrient requirements on menu planning and recipe development are discussed. Resident empowerment, improvement of the dining environment, evaluation of eating skills, and eating rehabilitation are proposed as new roles for the dietitian in the promotion of food consumption. The characteristics of nutritional assessment and therapeutic diets as they relate to long-term geriatric care are discussed.

This study investigated the self-perceived competence of public health nutritionists employed in provincial and municipal/regional departments of health in Canada. One hundred and fifty-three (78%) of all eligible Canadian public health nutritionists responded to a mailed questionnaire. Nutritionists were asked to rate their level of competence on 10 competency scales and to indicate sources of their knowledge and skill development. Respondents gave the highest ratings to their interpersonal and communication skills and the lowest ratings to their research and information management abilities. T-tests showed that nutritionists who had completed a postgraduate degree felt significantly more competent in their managerial and administrative (p less than .05), organizational (p less than .01), program planning/evaluation (p less than .001), research (p less than .001), and supervisory/leadership/facilitating skills (p less than .05) than those with only a bachelor's degree. One-way ANOVA revealed significant effects of geographical location for eight competency scales. The results of this study identify continuing education needs and have implications for the graduate education of public health nutritionists.

This paper presents observations on the main difficulties and areas of concern in doing practice-based research for dietitians in one teaching hospital and suggests strategies that may support practice-based research in clinical nutrition.

A priority in nutrition care is early identification of patients at risk of developing nutrition disorders. Simple identification measures such as nutrition screening on admission must be demonstrated to be as effective as the more lengthy traditional nutrition assessment. This study compares a nutrition screen to a clinical assessment in a geriatric setting. Seventy-two consecutive admissions to a geriatric assessment unit were both screened and individually assessed by different staff dietitians. Results of the assessment and the screen corresponded in classifying those at nutrition risk 92% of the time and those not at nutrition risk 77% of the time. The screen was found to be highly sensitive (88%) and specific (83%). A geriatric nutrition screen that has a high degree of agreement with a lengthier assessment may be a useful tool for the clinical practitioner in early identification of patients at nutritional risk.

This study determined the type of organizational culture (bureaucratic, innovative, or supportive), and determined the relationships among organizational commitment, and behavioural outcomes (turnover, absenteeism, and productivity) in hospital foodservice departments. The sample included 423 foodservice employees from nine hospitals in eastern Canada and nine hospitals in East Tennessee. Two research instruments were used for data collection. The historical data instrument, completed by the department director, obtained data to calculate productivity, turnover, and absenteeism rates. The four-part employee instrument included the 24-item Organizational Culture Index, the 15-item Organizational Commitment Questionnaire, five questions to determine perceptions of job satisfaction, and demographic items. Multiple linear regression analysis tested relationships among variables. The predominant culture was bureaucratic (14.9 +/- 4.3 of a possible 24). Means were lower for innovative (13.2 +/- 4.3) and supportive (12.7 +/- 5.0) cultures. Supportive and innovative cultures had positive relationships with both job satisfaction and organizational commitment. Organizational culture was not related to turnover, absenteeism, or productivity. Mean productivity was 3.8 +/- 3.2 meals per labour hour, ranging from 0.8 to 15.1. Employees rated satisfaction with co-workers highest, and satisfaction with pay lowest. These findings will help hospital foodservice managers understand the relationship of culture to organizational and employee outcomes; changing culture may improve desired outcomes.

This study evaluates the results of weight control/obesity counselling in the outpatient nutrition clinic of a children's hospital. Using a retrospective design, 96 randomly selected patients referred to the clinic were followed for up to four years using their hospital charts or through information obtained from the referring physician on current weights and heights. At initial assessment, 87 of 96 (91%) children were classified as obese or severely obese at greater than 120% of their Ideal Body Weight (IBW); eight other children would be classified as overweight and one child was within normal weight for height. Forty-nine referrals (51%) did not return for a follow-up visit after the initial assessment; weights were available on 18 (37%). On follow-up of 65 patients; 8% of patients achieved an IBW; a further 34% lost weight; 46% gained weight; and 12% maintained their weight. There was no difference in weight gain or loss by amount of participation in the program or by age or gender. We conclude that the weight control/obesity counselling program in our hospital is ineffective. A multidisciplinary program, based on a nutrition education theory and which includes an evaluation framework and addresses reasons for attrition and family needs, should be developed.

This study was designed to investigate the career status of recent University of British Columbia (UBC) dietetics graduates and their satisfaction with undergraduate education and current job. All graduates from the UBC Dietetics Program between 1978-1987, inclusive (n = 238), were mailed questionnaires. Information was sought regarding success in obtaining a dietetic internship, current employment status, job satisfaction, and satisfaction with undergraduate education. Questionnaires were returned by 67% (n = 130) of those who received them. Approximately 83% were eventually successful in obtaining an internship. Most respondents (68.5%) were employed as dietitian/nutritionists, and 69% of those who were employed worked full-time. Those who interned had significantly higher salaries than those who did not. A measure of overall job satisfaction revealed that 89.6% were satisfied to very satisfied with their present job, and scores on the Brayfield-Rothe Index of Job Satisfaction revealed no differences between those who did and did not intern. With regard to undergraduate education, respondents were most satisfied with library resources, class size and quality of teaching, and least satisfied with internship opportunities. Those who had interned were significantly more satisfied with their undergraduate education than were those who had not. We conclude that success in obtaining a dietetic internship affects salary and satisfaction with undergraduate education, but does not affect job satisfaction.

The purpose of this study was to obtain a comprehensive demographic profile of public health nutritionists employed in provincial and municipal/regional departments of health in Canada in 1988. One hundred and fifty three (78%) of all eligible Canadian public health nutritionists responded to a mailed questionnaire. Almost all (98%) respondents were female, with a mean age of 35.8 +/- 7.2 years. Most nutritionists (83%) worked full time, and had been employed in public health for a mean of six years and nine months. Seventy percent of respondents had worked in another profession(s) or other area(s) of nutrition prior to entering public health. Although 65% were members of the management team or represented by a nutritionist on the management team, 25% of nutritionists were not regarded as members of senior management in their health agency. While the majority of nutritionists in Ontario (84%) had completed a graduate degree, this was the case for the minority of respondents from British Columbia (35%), the Prairies (32%), Quebec (33%), and Atlantic Canada (27%).