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New York Web Journal of Health Care
Supplement

Papers accepted for presentation at the Second Annual BWAFP Research Forum 2003, Hosted by the DFM at AECOM.

Paper 3004: Dietary Habits In Low-Income Children: A study conducted among students at PS 40 in Jamaica, Queens.

Jeffries, C., and Enubuzor, H.
DFP at Saint Vincent Catholic Medical Centers of New York.

Background: Studies have shown that the diet of American children ages 2 – 18 needs improvement. According to a 1995 study by the USDA Center for Nutrition Policy and Promotion, hunger existed in 4.2 million American households (11.2 million people) due to low income. 19.5% of these households (which consist of 85% children), experienced severe hunger. This translates to nearly 700,000 seriously hungry children. Low household income and low educational levels directly correlate to poor nutrition.
The target population for this study was PS 40, located within zip code 11433. This particular area has 23% of the population living below the poverty line compared with an average of 10.9% for all of Queens. In both Queens as a whole and within zip code 11433, 30% of those living below the poverty line are children up to 17 years old. In addition, the educational attainment level within this area is considerably lower than that of Queens as a whole.
Objective: Determine the existence of nutritional deficiencies and excesses in the dietary habits of 9-10 year old children living in a low-income area. Based on the results, identify solutions and/or means of improvement.
Methods: A dietary survey of fourth and fifth grade schoolchildren was conducted, including a telephone survey with their parents. The survey included questions aimed at determining the frequency of eating the major food groups, snacks and types of beverages consumed, and whether they occur inside or outside the home.
Results: 74 out of 100 surveys were completed and returned for evaluation. Twelve percent of respondents ate less than 3 meals per day, while 47% ate snacks 3 or more times per day. Regarding types of food eaten, 93% ate vegetables only three times per week or less, 69% ate rice, grains or cereals only three times per week or less and 58% ate fruits 4 or more times a week. Regarding beverages, 85% drank soda and sports drinks regularly compared to only 54% who drank milk regularly. Furthermore, 65% watched 4 or more hours of television daily and 92% snack while watching TV. On top of all this, 45% of all meals were eaten outside the household.
Conclusion: Food quality rather than quantity was the major problem in this population. Children ate too many snacks, too few vegetables, and infrequent sources of complex carbohydrates. Since nearly half of children’s meals are eaten outside the house, ensuring proper nutrition in school meals and educating children in proper eating habits would produce the greatest nutritional gains.

Paper 3005: Follow Up And Knowledge About Diabetes And Eye Problems In Elderly Patients.

I. Klyatis, MD, and H.Enubuzor, MD.
Dept. Of Family Practice, Saint Vincent’s Catholic Medical Center, NY.

Introduction: Vision loss among the elderly is a major health care problem. Approximately one person in three has some form of vision reducing eye disease by the age of 65. The most common causes of vision loss among the elderly are age-related macular degeneration, glaucoma, cataracts and diabetic retinopathy. Age-related macular degeneration is characterized by the loss of central vision. Primary open-angle glaucoma results in optic nerve damage and vision field loss. Because this condition may initially be assymptomatic, regular screening examinations are recommended for elderly patients. Cataracts are a common cause of vision impairment among the elderly, but surgery is often effective in restoring vision. Diabetic retinopathy may be observed in the elderly at the time of diagnosis or during the first few years of diabetes. Patients should undergo eye examinations with dilation when diabetes is diagnosed and annually thereafter.
Impaired vision is highly prevalent in the elderly ambulatory population, a condition that is preventable by tight surveillance of predisposing factors and regular simple measurement of visual acuity. The primary care setting is most suitable for these activities.
Recency of eye examination is related to health locus of control, private insurance, Medicare, insulin-dependent diabetes, and presence of eye disease. No significant relationships between recency of eye examinations and self-reported health status, social support, vision impairment, and non-insulin- dependent diabetes were detected. The lack of association between non-insulin-dependent diabetes and the recency of eye examinations suggest that the amount of preventive care in place may not be adequate.
Because diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old and diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year we did our survey in Jamaica Service Program for Older Adults (JSPOA). This community senior center is a not-for-profit organization of professional staff and volunteers whose priorities are determined by the community it serves and for the benefit of senior adults in Queens. Their purpose is to coordinate and deliver a broad range of client-centered services that enable this growing and diverse population to live as healthy, active and productive citizens.
JSPOA serves 5,000 senior adults yearly and reaches 15,000 indirectly. The agency works cooperatively with over 100 agencies to advocate for programs and services for the elderly.
Method: A voluntary, confidential survey consisting of 15 questions was administered in JSPOA in a low-income, medically underserved neighborhood of Queens, NY. The participants consisted of men and women older than 65 years old, mainly Hispanics and blacks.
Results: sixty-two survey forms were completed and analyzed. The results of this study revealed that 58 patients (93.5%) were wearing glasses, including 7 who were legally blind. 23 patients (37%) had their last eye exam 6 months prior to the date of the survey, 20 (32%) in one year, 17 (27%) in over two years. 2 respondents (3%) never had an eye exam for prescription glasses. 50 patients (80.6%) are being referred to ophthalmologists. 18 patients (29%) had diabetes, 2 of them used insulin, 11- used pills, 5- used diet alone.15 diabetic patients (83%) were referred to an ophthalmologist. 33 patients (53%) had high blood pressure. 14 of them used diuretics, 14- used diuretics plus other medications, 5- were on diet alone. 25 patients (40%) got a brochure on diabetes and high blood pressure from the doctor. Only 21 patients (33.8%) thought that diabetes affects the vision in general, 27 (43.5%) thought that diabetes doesn’t affect the vision, and 14 (22.5%) were not sure about this. Only18 patients (29%) thought that high blood pressure affects vision in general. Surprisingly, despite very limited knowledge about connections between diabetes, high blood pressure and eye problems, only 11 patients (17.7%) wanted more information about these topics.

Knowledge of Diabetes as Vision Risk Factors
Risk factors		% Responding (n=62)
Eye Exam >2 years ago		27% (17)
Diabetic		29% (18)
Diabetics Referred to ophthalmologist		83% (15)
Incorrect knowledge of Diabetes/vision		66% (41)

Discussion: The level of knowledge of the effects of diabetes on vision among minority seniors is low. Almost half of those screened in this population 27 (43.5%) were not aware that diabetes affects their vision. An additional 14 (22.5%) were not sure about this relationship. Only 21 patients (33.8%) knew that diabetes affects vision. There is an unmet need for all diabetic patients to be referred to an ophthalmologist. In this population the rate was only 83%. Current guidelines recommend that all diabetic patients be seen by an ophthalmologist. Patients should undergo eye examinations with dilation when diabetes is diagnosed, and annually thereafter.