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| New
York Academic
Minerva Web
Journal |
| January
2003 Volume 3,
Number 01 |
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Paper
0301:
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The
Effectiveness Of A Fitness Program Following Stroke Study. Interim
Report
Sudhir
Vaidya MD, Cathleen Edinger PT, and John O’Connor BA
Burke
Rehabilitation
Center, Westchester,
NY.
Introduction:
After
the completion of rehabilitative interventions, following
stroke, there is an expressed need from patients and families
to continue with exercise. Since stroke patients may not be appropriate for
most community based elderly programs due to unique motor,
coordination, balance and perceptual problems, a Fit 4 Life
After Stroke program was designed to meet these needs.
There is evidence that aerobic activity can improve
physiological function in neurological diseases.
The objective of our study is to test the effectiveness
of a fitness program designed for the stroke patient.
Methods:
The effectiveness of this program is being determined through
the assessment of exercise capacity, function, and quality of
life. Inclusion
criteria involve participants who have suffered a stroke, have
a Mini Mental Status Examination (MMSE) score 24 or higher,
have a completed liability waiver form, and Exercise Readiness
Questionnaire (ERQ), filled and signed permission from their
physician, have an exercise partner, if needed, and have
available transportation to and from Burke.
Exclusion criteria includes a MMSE score below 24,
a recent history of cardiac events requiring treatment,
have Congestive Heart Failure (CHF) class 3 or 4 or Ejection
Fraction (EF) below 30 percent.
Each study participant is stratified in one of three levels,
based on level of function, and are randomized into the
control group who are deferred from exercise program for a
period of three months or the experimental group who start
participating in the exercise groups soon after completing
initial assessments.
The exercise program for each level meets three times
per week for one hour and includes flexibility and
strengthening exercises, balance activities and aerobic
activities at Reported Perceived Exertion (RPE) of 13.
Both groups are being assessed for Frugle Myer motor
scores, exercise capacity, function and quality of life
assessments, at baseline, three month and six month time
frames. Phone
call follow-ups will be conducted at nine and twelve months.
Interim
Results:
At present time, there are 19 study participants with 17
participants completing the baseline and three follow-up
sessions. Preliminary
data analysis indicates that group stratification based on
functional level appears effective.
Further analysis includes only participants from the
level 2 (medium function) and the level 3 (highest function)
groups due to small number of participants so far. The data
indicates trends of improvement in these areas primarily with
the highest functioning level group.
For better data comparison with this study, additional
participants will need to be recruited for all levels,
especially the lowest functioning level.
This Study is Supported by Burke Foundation
NYAMWJ
2003,
3:Abstract 0301
Presented to the
Second BWAFP
Research Forum
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| Paper
0302: |
Factors
Contributing To Nutritional Risk In The Elderly
Population.
Onyemachi
George Ajah, MD, and Enubuzor, Harriet, MD.
FPRP at Saint Vincent’s Catholic Medical Centers,
Brooklyn and Queens Region, Brooklyn, NY
Background
:
The etiology of increased nutritional risk in the elderly
population is multifactorial. These factors include
physical function, mood, cognition, alcohol use,
polypharmacy, living arrangement, poor finances, poor
dentition or difficulty swallowing, inadequate or
inappropriate food intake.
Objective:
The purpose of this study is to determine the prevalence
of nutritional risk factors among community- dwelling
elderly (60 years and older) participants in Jamaica Food
and Nutrition (FAN) program and to assess the effect of
the program on their knowledge, attitude and practice of
healthy nutrition. This study also evaluated the
effectiveness of the FAN food supplementation program.
Method
:
Questionnaires were
designed based on a literature review and the DETERMINE
nutritional health screening questionnaire developed by
the Nutrition Initiative, a project of American Academy of
Family Physicians, The American Dietician Association and
the National Council on the Aging. Translations were made
into Spanish and Russian.
Total sampling of interested elderly participants
that attended the program on the days and times the
investigator was in the facility was done. The
questionnaires were self-administered except for those who
for reasons such as poor vision and tremors, were assisted
with the completion. Those respondents were interviewed using the questionnaire as a
guide. A total of 150 questionnaires were distributed, 100
were completed during the month-long data collection
period, representing about 6% of the target population
(~1720). Surveys were analyzed in Excel. The FAN program
gives food supplementation to participants monthly.
Therefore limiting the study to 1 month eliminated the
chance of duplicates in the sample.
Results:
The study showed that:
About
3 in 4 (75%) of the participants were aged between 60 and
70 years.
Only 8% were 75 and older.
91% were unemployed; 9% were employed.
55% were on social security/pension; 19% on disability and
11% on public assistance.
The majority of the participants have income <$1288 per
month (75%) which is required income eligibility level for
one member family, 6% have income between $1288 and $1734.
Most of the respondents live in a amily size of 2 (45%)
followed by single person family (19%) and 3 person family
(17%).
45% of participants were overweight while 28% were obese;
only 19% had normal BMI.
73% of the elderly were at high nutritional risk; 18% at
moderate risk and 9% at low risk, based on a combination
of socioeconomic and nutritional risk factors. Eating few
vegetables, fruits and milk appears to be the most
predominant nutritional risk factor (63%).
At least 42% were unaware of the other equally important
services provided by FAN for example nutritional
counseling.
At
least 49% of participants admitted that FAN had
significant positive effect on their knowledge of healthy
nutrition. The greatest effect was in the area of learning
the kinds of nutrients available; better cooking methods
and eating the right food
for their medical conditions.
The
greatest behavioral changes effected by FAN were adopting
low cholesterol diet (56%); increased consumption of
vegetables, fruits and milk products (55%); eating food
appropriate for the medical condition (50%);
boiling/steaming food instead of frying (47%) and regular
medical follow up (38%). Over 50% are willing to
participate in health and nutrition classes. The theme of
highest interest was cholesterol (37%) followed by
depression (30%) and disease prevention (28%).
Conclusion:
The prevalence of nutritional risk factors in the elderly
population in this low income Jamaica, New York community
is high. Since the majority of the participants are
willing to partake in nutritional education classes, the
opportunity should be utilized to target the reduction of
the identified modifiable nutritional risk factors.
Finally, the FAN program is achieving its goal of food
supplementation to the needy elderly.
NYAMWJ
2003,
3:Abstract 0302
Presented to the
Second BWAFP
Research Forum
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| Paper 0303:
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Obesity Among Preschool Age WIC Clients
Charles S., MD, Enubuzor H., MD,
Schlussel Y ., PhD.
Department of Family Practice and Community Medicine St. Vincent Catholic
Medical Center, NY
Objective:
To determine what factors are associated with obesity in preschool age
WIC clients.
Design: Randomized Cross Sectional Survey
Setting : Special Supplemental Nutrition Program for Women, Infants,
And Children (WIC), in low income area of Queens, NY.
Participants: One hundred clients of WIC ages 3-5
Measurements: Maternal
demographics variables, maternal self reported height and weight, children’s
measured height and weight. Mothers
were asked whether they considered themselves or their children overweight. A
chart review was also conducted to determine the percentage of children who
were obese by definition.
Introduction:
Approximately 25% of the nation’s children are obese, of which 20%
stay obese into adulthood. There
are now twice as many overweight children in the United States as there were
20 years ago, and this trend is not explained by changes in the prevalence of
genes associated with obesity. Although children can inherit a genetic
susceptibility to obesity, not all children born to obese parents become
obese. Thus, there is a strong "nurture" component to childhood
obesity that begins at birth and remains poorly understood. If this component
were better identified, it could be targeted in obesity-prevention efforts
early in life.
Also noted is that although obese infants, less than 3y/o, are
heavier than normal weight infants, they are not more likely to be obese
adults unless obesity persists by ages 3-5. Overweight school age children are
more at risk of becoming obese adults, and an
overweight school age child with an obese parent(s) has a 70% chance of
being an obese adult. Obesity is
defined as weight for height 120% more than the median (using height for
weight chart/ gender specific). Some
of the reasons sited for obesity in children are eating and cooking practices,
physical activity, whether or not children were breastfed, and genetics.
Mother’s level of education has also been identified as a related factor.
The objective of this study was to investigate whether the risk factors
speculated upon in numerous studies apply to an inner city minority population
of children at high risk for obesity. Because
obesity that persists into adulthood is associated with a host of adverse
medical conditions, (hypertension, cardiovascular disease,
hypercholesterolemia, and depression), it would be beneficial for family
practitioners to be aware of characteristics that are associated with
childhood obesity, and advocate
dietary interventions to mothers of obese pre-school age children in order to
prevent adult obesity.
Methods: A chart review
was conducted to determine the percentage of children who were obese by
definition, whether or not they were breastfed, and the duration of
breastfeeding. A questionnaire
was also administered to the parents to determine eating/ cooking practices,
level of physical activity, and parent’s weight, and whether parent perceived that child was overweight or obese.
Results: The chart
review revealed that of the children served (42.8% males; 57.1% female) at the
WIC center, 41.7% were obese by
definition.(31% male and 69% female). It
also showed that 34% of the kids
were breastfed, of which 54% were obese.
The duration of breastfeeding ranges from 1month to 1 year (mean
=6.52;SD =4.88). The entire
sample of children were reported as being very active, and did not watch much
TV, and eating/ cooking practices were observed to be culturally linked.
Obesity among the parents (mostly mothers) i.e. a BMI > 30kg/m2, was
observed to be more common among the low education mothers and their children
tended to be also overweight. Also noted was that many mothers did not
perceive their child as being obese.
Conclusion: The
results of the chart review and survey helped to determine if the risk factors
stated above held true. Methods of cooking/ eating was be the number one risk
factor in this age group, secondary to culture.
The children in this age group were reported to be very active; 100% of
parents stated the above, so inactivity was not a factor in this age group.
Therefore, the main intervention would be to teach proper eating
habits, and healthy ways of cooking, and also make the clients of the WIC
program aware of the community resources available whereby they could maintain
adequate physical activity. Interventions therefore should begin early in life
starting in preschool or even earlier. The American Academy of Pediatrics
recommends proper eating habits from infancy; not using food as a reward; and
not using food to pacify children. Parents
are the ones who instill and are influential in shaping early eating and
physical activity patterns. Parents are also the ones who control what food is
made available to children. Therefore, parental involvement is crucial for
successful obesity interventions/prevention.
This includes making the parents aware as to recognizing that adult
overweight/obesity and its sequelae is preventable, if addressed early.
NYAMWJ 2003,
3:Abstract 0303
Presented to the Second BWAFP Research Forum
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Paper 0304:
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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,
Brooklyn, NY
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.
NYAMWJ 2003,
3:Abstract 0304
Presented to the Second BWAFP Research Forum
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Paper 0305:
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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.
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Knowledge
of Diabetes as Vision Risk Factors
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Risk
factors
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%
Responding (n=62)
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Eye
Exam >2 years ago
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27%
(17)
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Diabetic
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29%
(18)
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Diabetics
Referred to ophthalmologist
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83%
(15)
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Incorrect
knowledge of Diabetes/vision
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66%
(41)
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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.
NYAMWJ
2003,
3:Abstract 0305
Presented to the Second BWAFP Research Forum
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