Browsing by Author "Schlenker, Eleanor D."

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    Are Nutrition and Food Security Concerns a Priority of Certified Nursing Assistants in Work and Family Environments?
    Holsinger, Amanda Joy Toscano (Virginia Tech, 2002-04-12)
    Certified Nursing Assistants (CNAs) are responsible for the care of America's aging population. CNAs are paid a miniscule amount of money and are often ineligible for medical benefits through their employers. CNAs bathe, change, feed, and help toilet the residents of long-term care facilities. The stressful work and personal lives of CNAs leads to many problems such as high turnover rates, absenteeism, health problems, and elder abuse. In the United States, food insecurity is a concern for many of the uninsured working poor. The purpose of this study was to assess the overall perceived concerns, barriers, and solutions of CNAs in both their work and family environments, identify where nutrition and food security fits into the priorities of CNAs, and identify educational strategies to improve their health and overall quality of life. Twenty-nine CNAs participated in six focus groups across the state of Virginia. Triangulation techniques were used to compare both qualitative (focus groups) and quantitative (participatory activities and questionnaires) research. Participatory activities showed that the top home concern of CNAs was money management. CNAs ranked keeping their family healthy fourth (9.6%), and they ranked preparing fast easy meals eighth (1.7%). The top work concern of CNAs was time management. Staying healthy at work ranked fourth (12.9%), while packing a nutritious lunch was sixth (3.4%). The preferred methods of education for the participants were watching videotapes, attending classes at a central location, and having a mentor to help them with their problems.
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    Changes in Skeletal Muscle Sarcoplasmic Reticulum Function in Adult and Aged Fisher 344 Brown x Norway Rats
    Rabon, Karma Melisa (Virginia Tech, 1997-06-16)
    The decline of physical ability that occurs with aging has been linked to reduced skeletal muscle function. It has been theorized that Ca2+ uptake and release by the sarcoplasmic reticulum (SR) is altered with aging. Data pertaining to the actual structural and functional changes of SR due to aging are limited; thus, this theory has not yet been fully proven. The purpose of this research was to determine if SR function is altered as a result of aging in the following muscles: soleus, plantaris, and diaphragm. The soleus is composed of slow twitch muscle fibers. The plantaris is composed of fast twitch muscle fibers, and the diaphragm is composed of both slow and fast twitch muscle fibers. Fisher 344 Brown x Norway Cross Rats were used as subjects for this project. A total of 12 animals were used: six in group 12 months and six in group 27 months. A Jasco CAF-110 Fluorometer and fura-2 were used to determine the rate of Ca2+ uptake and release by isolated SR vesicles. In the aged animals, mass of the soleus was reduced by 22%, while the plantaris was reduced by 23%, and the diaphragm by 15%. However, these differences were eliminated when masses were normalized by body mass. In all three muscles examined, the rates of Ca2+ uptake were not significantly different between the young and aged animals. Rates of Ca2+ release, however, were reduced by 30% in both the plantaris and diaphragm of the aged animals. These results suggest that SR function is altered in "fast" muscles of the rat. It is possible that changes in SR Ca release may contribute to diminished muscle function and also lead to the decline in physical ability of older adults.
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    College Women's Perceptions of Dairy Foods: A Qualitative Study
    Weiglein, Carolyn Anderson Jr. (Virginia Tech, 1998-07-24)
    Research has indicated that college-age women are not consuming the recommended daily servings of dairy foods, and therefore, have inadequate calcium intakes as well. Four focus groups were conducted with a total of 29 college women to explore their perceptions, opinions, thoughts, and feelings about dairy foods. Single, non-Hispanic white females, aged 19-22, enrolled in state-funded colleges and universities in Virginia were recruited for the study. Discussion questions addressed preferences for dairy foods, advantages and disadvantages of dairy foods, factors that influence dairy consumption, and ideas for product improvements. Focus group discussions were audio taped, transcribed by the researcher, then checked for accuracy by a Virginia Tech undergraduate student. Major themes and subthemes were identified, and results were reported in the following theme categories: 1) health and nutrition perceptions of dairy foods, 2) external influences on dairy food consumption, 3) characteristics of dairy products, and 4) ideas for product improvements. Women in this study perceived the high calcium content of dairy foods to be a health benefit. Women thought calcium was important for the prevention of osteoporosis; however, most women did not seem to perceive osteoporosis as an immediate health concern. A predominant theme throughout all focus groups was that college women thought many dairy foods were high in fat. Use of calcium supplements as well as other vitamin/mineral supplements to meet nutrient requirements was common among this sample of college women. Other factors that influenced women's dairy food choices included family influences (especially mothers), college lifestyle, and media sources. Specifically, mothers encouraged women to drink milk during childhood and to use supplements. Women's busy lifestyles at college influenced them to choose convenient dairy foods. Women's concern with body weight and image played a role in their lower fat dairy food choices. Sensory characteristics of dairy foods, particularly taste, were important to the college women's dairy food choices. Women wanted convenient and "easily accessible" dairy foods, and their ideas for product improvements included smaller package sizes, easier opening of packages, and improved availability of low fat dairy options in restaurants and dining halls. Nutrition educators should strive to emphasize the importance of adequate dairy food consumption to college women now to prevent osteoporosis in the future. Continued promotion of low fat dairy choices is important to help ensure that women receive adequate intake of calcium and other important nutrients.
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    Determinants of Nonrecovery Following Hip Fracture in Older Adults: a Chronic Disease Trajectory Analysis
    Dawson, Donna Kay (Virginia Tech, 2000-05-05)
    Hip fracture in older adults may be the sentinel event leading to functional decline, long-term disability, and death. For the substantial number of older persons who fracture a hip each year, the chances of full functional recovery remains relatively low. The purpose of this study was to examine the differences between older persons with hip fracture who recover fully and those individuals who do not fully recover. A chronic disease trajectory framework guided the theoretical design of the research. Data were collected from the medical records of 102 persons aged 60 years and older who sustained a proximal hip fracture from 1993 to 1998 at a medical center in North Carolina. Data included personal characteristics, prefracture health status, hospital factors, rehabilitation features, and functional outcomes. The analysis consisted of a two-step hierarchical logistic regression model with the control variables of age, prefracture ambulation status, and prefracture cognitive status entered first and the variables of type of therapy program, frequency of therapy, number of therapy provider organizations, and location of therapy at 4 weeks entered second. Significance of the final model was observed, Chi-Square(7, n = 99)=43.55, p < .05. Significant individual predictors (p < .05) in the model were prefracture ambulation status (43.56 odds ratio) and cognitive status (6.44 odds ratio). Post-hoc analysis of the cases revealed a substantial lack of stability in ambulation status from three months post-fracture to the six-month and one-year follow-up. Findings support other research studies that indicate prefracture personal characteristics of older persons who fracture a hip are the most influential factors in predicting successful recovery. Linkage of the findings to the chronic disease trajectory model suggests that intervention efforts should focus on prevention, health promotion, and policies that extend the ability of health care providers to assist older persons with hip fracture in managing their conditions.
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    Diet compliance of home care clients with diabetes mellitus
    Beemer, Abigail M. (Virginia Tech, 1993-06-06)
    Home health services are increasing for elderly individuals diagnosed with chronic diseases which are often treated by diet modification. This study was undertaken to evaluate the diabetic homebound client's understanding of and compliance to his/her prescribed diet. An interviewer assisted modified food frequency and food habit questionnaire was completed by 20 male and 28 female home care clients, ranging in age from 51 to 91 years. Living in a metropolitan area, these respondents met the Medicare definition of homebound and were diagnosed with diabetes mellitus. Computer driven dietary analysis was completed from questionnaire responses to estimate the food and nutrient intake of the home care clients. Calculated food intake was compared to physician diet orders taken from the home care medical record and to respondents' verbalization of their diet orders. This comparison was based on the composite diet and the components of energy, sodium, and cholesterol or fat. These findings were evaluated according to sex, age, length of time respondent had been diagnosed as diabetic, and a vulnerability index based on living situation using Chi square methods.
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    Eat Well, Age Well: Fight Foodborne Illness
    Goodwin, Stephanie K. (Virginia Cooperative Extension, 2015-07-14)
    Provides 10 basic tips to keep your food safe and prevent foodborne illness for yourself, your friends, and your family.
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    The effect of different sources of dietary fiber on the plasma total and lipoprotein cholesterol, liver cholesterol, fecal neutral steroid excretion and histology of major organ tissues in hamsters
    Jonnalagadda, Satya Srivathsa (Virginia Tech, 1992-05-05)
    The effect of diets with various dietary fiber sources on the plasma lipids, liver cholesterol, the histology of the gastrointestinal tract, heart, liver and kidney and the fecal neutral steroid excretion was investigated in hamsters. 155, 9-11 wk old, male Golden-syrian hamsters were fed a purified basal hypercholesterolemic diet (0.1% cholesterol, 10% fat, 4% dietary fiber) for 5 wk to elevate plasma lipid levels. Based on wk 4 plasma total cholesterol (TC) levels hamsters with elevated levels were randomly assigned, 16 animals/group, into six groups for another 4 wk: control, oat bran, guar gum, cellulose, xylan and sacrifice. After 4 wk of the fiber diets (10% dietary fiber), the plasma TC levels were significantly lowered in the oat bran, guar gum and xylan groups (16%, 12% and 15%, respectively) (p<.05). They were also significantly lower than the control and cellulose groups. Plasma HDL-C concentrations tended to be lower in all the treatment groups, but was significantly decreased only in the guar gum group (12%) (p<.05). The combined plasma VLDL-C + LDL-C was significantly lowered by the oat bran, cellulose and xylan diets (38%, 40% and 34%, respectively) (p<.05). The liver cholesterol concentration increased significantly from 1 mg cholesterol/g liver to 4.1 mg cholesterol/g liver (p<.05) after 4 wk of the control diet; this was further increased significantly only in the cellulose group (5.6 mg cholesterol/g liver), while the other treatment groups showed no significant changes or differences compared to the control diet group (wk 4). The total fecal neutral steroid excretion was significantly (p<.05) higher in the oat bran group compared to the other treatment groups. No major differences were observed in the tissue histology of the animals in the different treatment groups. In the present study, it appeared that oat bran, guar gum and xylan were effective hypocholesterolemic agents; however, their mechanism of action is still not clear.
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    The effect of flexibility and resistance exercise on selected balance tasks and gait transfer in elderly subjects
    Bowers, DeJuana Sue (Virginia Tech, 1997-01-11)
    This investigation evaluated the effects of exercise on balance and ability to transfer in an elderly population.Eighteen elderly subjects (aged 65-96) were volunteers in this study. Nine of the elderly subjects participated in a six week exercise program, while the other nine were placed into a control group. It was hypothesized that the exercise group would improve balance and gait transfer. The variables of interest were: timed one-leg stance, spontaneous sway, transfer from bed to a chair, and an ABC (Activities-specific Balance Confidence) Scale. The variable of timed one-leg stance (sec), with both eyes open and closed, increased significantly (P(0.05) with the exercise training. The pre and post testing measures for the timed one leg stance found that the X increased from 2.56 to 4.64, the SO was 6.06 and the SE was 1.43. However, the pre and post testing measures for the variables of spontaneous sway (sec), transfer (high, med, low) and the ABC scale showed little or no change This investigation evaluated the effects of exercise on balance and ability to transfer in an elderly population. Eighteen elderly subjects (aged 65-96) were volunteers in this study. Nine of the elderly subjects participated in a six week exercise program, while the other nine were placed into a control group. It was hypothesized that the exercise group would improve balance and gait transfer. The variables of interest were: timed one-leg stance, spontaneous sway, transfer from bed to a chair, and an ABC (Activities-specific Balance Confidence) Scale. The variable of timed one-leg stance (sec), with both eyes open and closed, increased significantly (P(0.05) with the exercise training. The pre and post testing measures for the timed one leg stance found that the X increased from 2.56 to 4.64, the SO was 6.06 and the SE was 1.43. However, the pre and post testing measures for the variables of spontaneous sway (sec), transfer (high, med, low) and the ABC scale showed little or no change This investigation evaluated the effects of exercise on balance and ability to transfer in an elderly population. Eighteen elderly subjects (aged 65-96) were volunteers in this study. Nine of the elderly subjects participated in a six week exercise program, while the other nine were placed into a control group. It was hypothesized that the exercise group would improve balance and gait transfer. The variables of interest were: timed one-leg stance, spontaneous sway, transfer from bed to a chair, and an ABC (Activities-specific Balance Confidence) Scale. The variable of timed one-leg stance (sec), with both eyes open and closed, increased significantly (P(0.05) with the exercise training. The pre and post testing measures for the timed one leg stance found that the X increased from 2.56 to 4.64, the SO was 6.06 and the SE was 1.43. However, the pre and post testing measures for the variables of spontaneous sway (sec), transfer (high, med, low) and the ABC scale showed little or no change (P>0.05) for both the control and exercise groups.
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    The Effect of Xanthan Gum and Guar Gum on Enhancing the Quality and Preventing Lipid Rancidity in Yeast Bread Supplemented with Flaxseed
    Souther, Brandy Jolene (Virginia Tech, 2005-07-25)
    This study examined the effects of guar gum and xanthan gum on flax supplemented breads through objective and sensory testing. Breads containing flaxseed and gums were found to have a significantly (p<0.05) higher water activity than the control bread. Control bread was also found to have a higher (p<0.05) volume while flax breads containing guar gum had a significant (p<0.05) decrease in volume. Control bread and bread containing guar gum were significantly (p<0.05) harder in crumb texture. Breads with flax and xanthan gum displayed a significant (p<0.05) amount of springiness. While there was no significant (p>0.05) difference in peroxide values among bread samples, control bread had a lower (p<0.05) anisidine value indicating a decrease in hydroperoxide breakdown. While not significant (p>0.05), bread containing xanthan gum had a lower anisidine value than the other treatments. Sensory analysis found bread with both gums to be moister (p<0.05) and have a strong (p<0.05) yeasty aroma and fresher flavor. Control bread was found to have the least (p<0.05) yeasty aroma and taste significantly (p<0.05) less bitter but more stale.
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    The effects of boron supplementation on bone mineral density, blood and urinary calcium, magnesium, phosphorous and urinary boron in female athletes
    Darnton, Susan Meacham (Virginia Tech, 1991-09-20)
    The effects of boron supplementation on blood and urinary minerals were studied in 17 female college athletes and 11 sedentary college control subjects. The subjects were similar in age (19.8 ± 1.4 and 20.3 ± 1.1 years for athletes and sedentary groups, respectively) and weight (61.8 ± 9.1 and 59.6 ± 10.5 kgs for athletes and sedentary groups, respectively). The athletic subjects had lower percent body fat averages (20.6 ± 5.6 and 25.8 ± 6.5 %, respectively, (p < 0.05)) and higher aerobic capacities (2.9 ± 0.5 and 2.1 ± 0.4 L O₂*min₋₁, respectively, (p < 0.05) than sedentary controls. No differences in dietary intake were observed. Serum phosphorus levels were lower in boron supplemented subjects than in subjects receiving placebos (p < 0.05) and were lower during final analysis than during baseline analysis. A group-supplement interaction was noted with serum phosphorus also (p < 0.05). In the sedentary group, boron supplementation lowered serum phosphorus and placebo supplementation elevated serum phosphorus. In the athletic group, no changes in serum phosphorus were observed due to supplementation. Serum magnesium was greatest in the sedentary controls supplemented with boron and increased with time in all subjects (p < 0.05). Again, a group-supplement interaction was observed with serum magnesium; exercise in boron supplemented subjects lowered serum magnesium (p < 0.05). In all subjects, calcium excretion increased over time (p < 0.05) and in boron supplemented subjects boron excretion increased over time (p < 0.05). In conclusion, boron supplementation affected serum phosphorus and magnesium and the excretion of boron in the urine. The significance of these findings in relation to overall mineral status, bone mineral density, and exercise in college female athletes needs further investigation. It is possible that increasing the intake of foods high in boron may be found to be beneficial in the treatment and/or prevention of metabolic bone disorders such as those related to excessive exercise.
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    The effects of exercise and dietary iron on iron status in 19 month old adult female rats
    Chitale, Charusheela M. (Virginia Tech, 1995-05-03)
    This study investigated the effects of exercise and dietary iron on iron status in 19-month-old female rats. Fifty-seven female Sprague-Dawley rats were randomly assigned to one of five experimental groups: baseline (BL); iron sufficient-exercise (HE); iron sufficient-sedentary (HS); moderate iron deficient- exercise (LE) and moderate iron deficient-sedentary (LS). The six-week exercise protocol involved swimming 5 days/week beginning at 10 minutes/day and ending at I hour/day by the fifth and sixth week. The results indicated a significant effect of exercise on food intake and on body weight, with higher levels of intake and body weight in the LS group compared to the exercised groups. Soleus muscle weight was significantly lower than BL in the HS, LE and LS groups. Gastrocnemius muscle weight was significantly higher in the HS than in the LE group. Cardiac weights were comparable in the1LE, LS and HE groups but significantly higher than the HS group. Cardiac citrate synthase activities were not significantly different among the groups. No significant effects of diet, activity or an interaction effect were noted on hemoglobin, serum iron and total iron binding capacity. Hematocrit concentrations demonstrated a significant effect of activity, with elevated levels in the exercised groups compared with baseline. Serum iron levels were significantly lower in the LE group than the iron sufficient groups. The TIBC levels were significantly lower in the LE group than in the baseline. Liver iron concentrations showed a significant effect of diet, with higher concentrations in the iron sufficient groups compared to the LE group. Iron concentrations in the spleen and soleus muscle were unchanged however spleen iron concentrations were significantly higher in BL than in the experimental groups. Exercise had a significant effect on the gastrocnemius muscle with lower iron concentrations in the sedentary groups than in the exercised groups. These results suggest a trend towards redistribution of iron stores as a result of exercise as evidenced by alterations in iron concentrations in some tissues and a trend towards elevated hemoglobin and hematocrit levels. Thus, dietary iron deficiency and exercise adversely affected various components of iron metabolism in the aged female rat although it was not manifested as iron deficiency.
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    The Effects of Resistant Starch Intake in African-American Americans at Increased Risk for Type 2 Diabetes
    Penn-Marshall, Michelle (Virginia Tech, 2006-05-05)
    Background: African-Americans are a vulnerable population group with disproportionately elevated rates of type 2 Diabetes Mellitus (DM). Resistant starch is a promising food ingredient that has the potential to reduce the risk factors involved in the development of type 2 DM. To date, there is a dearth of published research studies on the effect of resistant starch on African-Americans who are at increased risk for type 2 DM. Objective: The major objective of this study was to determine if daily consumption of approximately twelve grams of high-maize™ 260 resistant starch (RS) added to bread improved glucose homeostasis by monitoring changes in fasting plasma glucose, fructosamine, hemoglobin A1c, insulin, glucagon-like peptide-1, C-reactive protein, homeostasis model assessment insulin resistant (HOMA- IR) and beta-cell function (HOMA-Beta), serum acetate, propionate, and butyrate levels. Design: A fourteen-week, randomized, double-blind, within-subject crossover design feeding study was carried out in African-American males (n=8) and females (n=7) at increased risk for type 2 DM who resided in Southwest Virginia. All participants consumed bread containing added RS or control bread (no added RS) for six-weeks. RS and control bread feedings were separated by a two-week washout period. Results: Fasting Plasma Glucose (FPG) levels were significantly lower (P = 0.0179) after six-week control bread feedings compared to baseline. FPG levels were also significantly lower (P < 0.0001) after two-week washout period than at baseline. FPG levels were significantly higher (P < 0.0001) after six-week resistant starch bread feeding than at washout. FPG levels due to consumption of resistant starch versus control bread approached significance (P = 0.0574). Fructosamine levels were significantly lower (P = 0.0054) after control bread and resistant starch bread (P < 0.0012) consumption compared to baseline. No significant differences were found in fructosamine levels due to resistant bread intake versus control (P = 0.9692). Mean baseline HbA1c levels were 6.9% (n=15). This value was slightly lowered to 6.79% (n=14) at the end of the fourteen-week study, although statistical significance was not found. Mean ± standard errors for HbA1c values were 6.9% ± 0.18% and 6.9% ± 0.14% at baseline for the sequence groups, resistant starch first (n=7) and control treatment first (n=8) groups, respectively. Mean± standard error HbA1c values were 6.7%± 0.27% and 6.9% ± 0.27% at the conclusion of fourteen-week study for sequence groups, resistant starch first group (n=7) and control treatment first group, respectively. Baseline mean and standard errors C-reactive Protein (CRP) levels for male and female combined results were 0.62 ± 0.16 mg/dL (n=15). Mean CRP levels were 0.53 ± 0.12 mg/dL for resistant starch bread and 0.64 ± 0.21 mg/dL for control bread feeding periods. No significant differences were found for treatment, gender, or sequence effects for C-reactive protein levels during the fourteen-week study (P > 0.05). Mean HOMA-IR levels following six-week resistant starch and control bread consumption decreased to normal values (> 2.5), although no significant differences were found for treatment (P = 0.5923). Conclusions: Eighty-seven grams of Hi- maize™ 260 Resistant Starch added to baked loaves of bread consumed by a free-living African-American population at increased risk for type 2 diabetes did not consistently show significance in all clinical indicators and biochemical markers assessed. On the basis of the evidence in this study we do not have evidence that this amount of resistant starch in this population's diet will prevent the onset of diabetes. However, results are suggestive that higher levels of resistant starch in a more controlled experiment could reduce clinical risk factors for type 2 diabetes.
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    Female Baby Boomers' Perceptions of Dairy Foods and How Their Perceptions Influence Dairy Food Choices
    Hagy, Leslie Faye II (Virginia Tech, 1998-08-17)
    Osteoporosis is a debilitating disease that afflicts an estimated 25 million Americans, especially women. Suboptimal intakes of calcium, phosphorus, and vitamin D contribute to development of osteoporosis. Results from the Third National Health and Nutrition Examination Survey (NHANES III) indicate that adult women do not meet the Recommended Dietary Allowance (RDA) for calcium. Results from other national studies indicate that adult women consume less than the recommended number of servings of dairy foods per day. Focus groups were conducted in rural and urban areas of Virginia to gain insight into middle aged women's perceptions of dairy foods. Four focus groups were conducted with a total of 39 women. The majority of the women were between the ages of 35 to 50 years; all were non-Hispanic white women. All had a minimum of a high school education, and the majority had some education beyond high school. Discussion questions addressed preferences for dairy foods, advantages and disadvantages of dairy foods, factors that influence dairy food choices, and possibilities for product improvements. Focus group discussions were audio taped and transcribed by the moderator. The moderator identified major and minor themes; women's responses were organized thematically. Results were reported in the following broad theme categories: perceptions of health and nutrition that influenced dairy food choices and factors that influenced dairy food choices. The predominant negative perception of dairy foods was that dairy foods were high in fat. Women also negatively associated dairy foods with lactose intolerance and kidney stones. The predominant positive perception of dairy foods was that dairy foods were a good source of calcium. Women also believed dairy foods were a good source of vitamins, although they were unsure of specific vitamins found in dairy foods. Participants were aware of osteoporosis, but many were not knowledgeable about risk factors or prevention related to osteoporosis. Many women used calcium supplements or vitamin-mineral supplements to help meet dietary calcium requirements. Results indicate a need for education on the role of dairy foods in osteoporosis prevention. Women's preferences for dairy foods influenced dairy food choices. Product characteristics, such as sensory attributes, convenience, cost, availability, and packaging, were mentioned as factors that greatly influenced dairy food choices. The majority of women stated that other household members influenced dairy food choices. Women also mentioned that physicians and media sources, such as magazine advertisements and television commercials, influenced their dairy food choices. Nutrition education for this population should continue to promote the view that "all foods can fit" into a healthy eating pattern. Nutrition education should be geared toward the fast paced lifestyle these women lead. Product development should focus on convenience items.
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    Folate status and milk folate concentration in lactating women
    Amanna, Karen Ruggio (Virginia Tech, 1996-12-01)
    Lactating women have an increased requirement for folate which contributes to their risk for suboptimal folate status. Although milk folate secretion appears to be maintained independent of folate intake and maternal folate status, studies with animal species have demonstrated a relationship between iron deficiency and impaired milk folate secretion. Objectives of this study were to monitor the folate status of lactating women and to examine the relationship among folate intake, dietary iron, folate status, iron status and milk folate. Seven-day dietary records, milk samples, and blood samples were collected monthly for four months from five lactating women. Dietary iron and folate was analyzed. Milk folate, serum ferritin, serum folate, and red blood cell (rbc) folate concentrations were measured. Mean folate and iron intakes were 495 ± l05μg/d and 24 ± 4 mg/d, respectively. All women had normal rbc folate and serum ferritin values during the study. Milk folate increased (p=.06) from 35± 10 μg/L in month one to 69 ± 30 μg/L in month three. Dietary and rbc folate were not significantly correlated with milk folate. There was a significant positive correlation between milk folate and serum folate (r = .48, p= .04) and between milk folate and iron intake (r=.63, p=.003). Results indicate that the folate intake in this population of lactating women was sufficient to maintain adequate folate stores. Results also suggest a relationship between iron intake and milk folate. Research is needed to determine dietary requirements during lactation and to investigate the relationship between dietary iron and milk folate.
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    Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia
    Rafie, Carlin; Hosig, Kathryn W.; Wenzel, Sophie; Borowski, Shelby; Jiles, Kristina; Schlenker, Eleanor D. (2021-08-02)
    Introduction: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes selfmanagement programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. Methods: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. Results: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. Conclusion: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia’s CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.
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    Living well. Fall 2009 : a newsletter of Family and Consumer Services
    Burkett, Sarah; Elkins, Kim; Schlenker, Eleanor D.; Abel, Jennifer (Virginia Cooperative Extension, 2009-10-20)
    This issue focuses on healthy homes. It includes articles on radon, making the home safe for those with allergies and asthma, and mold in the home.
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    Living well. Summer 2008 : a newsletter of Family and Consumer Sciences
    Hayhoe, Celia Ray; Poff, Karen; Schlenker, Eleanor D. (Virginia Cooperative Extension, 2008-08-27)
    This issue focuses on families and caregiving. It includes an articles on preventing foreclosure on your home, planning fun family activities, protecting the physical and financial health of family caregivers, and preventing accidents and injury to children.
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    Living well. Winter 2010 : a newsletter of Family and Consumer Sciences
    Schlenker, Eleanor D.; Tyler-Mackey, Crystal; Poff, Karen (Virginia Cooperative Extension, 2010-03-11)
    This issue includes articles on the 2010 United States Census, benefits of being involved in community activities, and safe disposal of household chemicals.
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    The nutrition and hydration of older adult cancer patients in hospice
    Ferrandino, Donna S. (Virginia Tech, 1995-08-05)
    The use of artificial means of nutrition and hydration for terminally ill patients is a controversial topic, involving medical, legal, social, and ethical issues. Often, the patient who is dying in the hospital and ceases to eat and drink receives tube feeding. In contrast, hospice patients are usually not given tube feeding, and emphasis is placed on palliative treatment. The purpose of the first project was to describe the dietary intake of twelve older adult cancer patients in home hospice care. The mean daily intakes of energy for males ranged from 657 to 2142 kcal per day, or from 28 to 93% of the recommended intake (RI). For females, the mean daily intakes of energy ranged from 358 to 1852 kcal per day or from 18 to 97% of the RI. Intakes for protein, carbohydrate, fat, and select vitamins and minerals were also highly variable. It was found that some patients survived for extended periods of time with very low intakes of food and fluids. Also, three patients who died during the study showed gradually declining intakes of food and fluids until death. In the second project, a structured interview was administered to 14 hospice patients and 18 family members to determine their knowledge, perceptions, attitudes, and wishes concerning tube feeding for seriously and terminally ill patients. Responses to the questions indicated that in general patients were less opposed to the use of aggressive means of nutrition support than were family members. Also, three of the patients, and only one family member indicated that they would want to receive tube feeding if they became unable to eat and drink by themselves. Both patients and family members mentioned circumstances related to patient autonomy and prognosis as reasons why it would be permissible to withhold tube feeding from a patient. The third project presents five case studies of hospice patients who died without receiving artificial nutrition or hydration. The patients' medical records were examined, and their nurses or family members were interviewed about their symptoms and conditions during the dying process. Results indicated that most of the patients experienced no anxiety or restlessness, no nausea or vomiting, and no additional pulmonary problems as death approached. In four patients, pain was either absent or under control. Although four patients stopped eating three to seven days before death, they did not appear to exhibit hunger or thirst during this time. All five patients were reported to have died peacefully. These case studies appear to support the position that terminal starvation and dehydration do not cause pain or discomfort to patients who die without tube feeding. In fact, such patients may experience relief from troublesome symptoms.
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    Opinions of registered dietitians on the withholding and withdrawing of food and fluid in the terminally ill
    Dietrich, Karen (Virginia Tech, 1999-05-05)
    This study was conducted to investigate the opinions of dietitians regarding the withholding and withdrawing of nutritional support in terminally ill patients. In addition, the role of the dietitian in feeding the terminally ill individual was researched. A mailed questionnaire was sent to 414 registered dietitians employed by the Marriott Corporation with at least one year of clinical experience. Of the 414 deliverable questionnaires, 284 [69%] were returned, and the results were tabulated. Data analysis included frequency distribution. Results indicated that the majority of the dietitians were female younger than 40 years of age with at least a Bachelor of Science degree and were married. Dietitians with experience with advance directives and living wills were more likely to agree that the terminally ill individual and not the physician nor family member had the right to make the decisions regarding his or her medical treatment. There were no statistical differences when broken down according to the different variables. Because most dietitians have not had any formal training in ethics, education for dietitians needs to focus on ethics skills to help dietitians to effectively deal with the challenges facing dietitians pertaining to feeding the terminally ill individual.