Little has been published on cultural competency curriculum and dietetics considering the impact of food-related beliefs and behaviours on health. A 14-item online survey was administered in January 2016 to 145 participants (125 members of Dietitians of Canada Aboriginal Nutrition Network and 20 dietitians with an interest in Aboriginal nutrition). Questions included multiple choice and ranking responses and were pretested by 4 preceptors with the Northern Ontario Dietetic Internship Program (NODIP). Quantitative data analysis included frequencies, pivot tables, and averaging/grouping of ranking scores. A total of 42 individuals (29%) completed the survey. The majority rated the 5 health and cultural competencies and 6 food and nutrition competencies as "important" (90%-98% and 86%-100%, respectively). Overall, the competency related to identifying health status was ranked highest (78%), whereas developing culturally appropriate recipes was ranked lowest (83%). Most participants (95%) believed that all dietitians and graduating dietetic interns should be minimally competent in Aboriginal health and culture. The initial 11 draft competencies for dietetic interns were condensed to 6 minimum and 2 advanced competencies. Results will inform dietitians working with Aboriginal peoples and refinement of NODIP intern and preceptor tools, with the potential to integrate across Canadian dietetic internship programs.
Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on attitudes to include information on gender and diet in the strategy for prevention of coronary heart disease, cancer, osteoporosis, and overweight/underweight. Risk factors for disease in general were ranked as follows: smoking, alcohol, stress, diet, physical exercise, heredity and hygiene. The patients' lack of motivation, insufficient time for each patient, and inadequate knowledge about nutrition were stated as barriers to dietary counselling. The GPs stated that the gender of the patient was important only to the counselling on osteoporosis. Lack of time and insufficient knowledge were perceived as barriers for including gender specific issues in prevention. It is concluded that GPs consider dietary counselling important but lack time and knowledge. The results point at a need for better pre- and postgraduate training in nutrition, and for a better reimbursement system for time spent on prevention.
AIM: European cardiologists agree that cardiac rehabilitation (CR) should be offered as an integrated part of cardiac care, and CR guidelines have been published. The authors aimed to ascertain the potential for expanding CR coverage at hospitals in Denmark. METHOD: A cross-sectional questionnaire study was conducted among all hospitals receiving acute cardiac patients (n = 67). The response rate was 79%, with no differences according to catchment area, number of beds, or geographical location. The hospitals were classified as having full CR if all core components (physical training, psychosocial support, dietary counselling, smoking cessation, and pharmaceutical risk factor management) were available during each of three phases: (I) in hospital; (II) outpatient; and (II) community-based services. RESULTS: Many hospitals offered one or more of the CR components during phases I and II: physical training (77%; 77%), psychosocial support (89%; 79%), dietary counselling (85%; 89%), smoking cessation (94%; 68%), and clinical control by a physician (100%; 93%). The content varied greatly. Full phase I CR was offered at 57% (95% confidence interval (95% CI): 44-70%) of the hospitals and 47% (95% CI: 34-60%) offered full phase II CR. Phase III CR was very rare (2% (95% CI: 0-6%). The numbers of patients receiving CR was not registered. CONCLUSION: Marked progress was made in the 1990s in implementing CR; nevertheless, the services are far from fully expanded. Denmark has great potential for improving CR services, as do most other European countries. CR activities need to be registered at Danish hospitals.
To construct and validate a self-contained index for the evaluation of a health-promoting diet in adults.
Participants (n = 103) were healthy volunteer adults aged 20 to 64 years. A food consumption questionnaire containing 55 questions was formulated and evaluated against seven-day food records. Key questions best reflecting the health-promoting diet, defined in nutrition recommendations, were identified by correlation and ROC analyses in comparison to calculated food and nutrient intakes from the food records. A shorter questionnaire was scored to compile an Index of Diet Quality (IDQ).
Based on ROC analyses 18 questions were sufficient to describe the health-promoting diet and comprised the index. IDQ had a sensitivity of 67% and a specificity of 71%. The IDQ score reflected dietary intake, shown as statistically significant correlations between higher IDQ scores and higher intakes of protein (r = 0.35), fibre (r = 0.42), calcium (r = 0.39), iron (r = 0.31), vitamin C (r = 0.31) and a higher ratio of unsaturated to saturated fatty acids (r = 0.23) and a lower intake of saturated fatty acids (r = -0.22) and saccharose (r = -0.25).
IDQ reflects dietary intake of key foods and nutrients associated with health and depicts adherence to dietary recommendations. It is applicable in nutritional studies where diet in its entirety is of interest and also in large-scale studies, being fast in execution with analysis free of complex calculations.
Integrating scientific changes, citizens' needs and economic constraints has become a challenge. New types of cost-effective services, technologies and products must be found. Manufacturers, hospital administrators and health professionals must be capable of effectively documenting the benefits, risks and costs of their services to society and the quality of care to patients. Choices must be made to decide upon appropriate actions in allocating and using resources. The concepts of cost-benefit analysis and cost-effectiveness analysis should be understood. Identifying and valuing costs and benefits, measuring effectiveness, and assessing quality of life are complex and difficult issues. They are discussed in reference to Canadian studies on the cost-effectiveness of nutrition support. The need for further research to improve cost-effectiveness of nutrition support is stressed.