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[PMID]:28455262
[Au] Autor:Alcazar L; Raber M; Lopez K; Markham C; Sharma S
[Ad] Endereço:University of Texas Health Science Center Houston, School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
[Ti] Título:Examining the impact of a school-based fruit and vegetable co-op in the Hispanic community through documentary photography.
[So] Source:Appetite;116:115-122, 2017 09 01.
[Is] ISSN:1095-8304
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Hispanic families are at elevated risk for certain diet related illnesses including obesity and diabetes. Brighter Bites is a 16-week school-based program that delivers produce and nutrition education to high-need areas. The purpose of this study was to explore the adoption of Brighter Bites healthy eating strategies in low-income Spanish-speaking families as well as barriers to the sustainability of improved dietary behaviors using Photovoice. Two researchers worked with a predominately Hispanic, low-income public school to conduct the project. Spanish speaking parents participating in Brighter Bites were recruited and five mothers completed the study. Participants developed research questions, took documentary photos, attended group analysis sessions, and organized a community event. Photos from participants were gathered at two time points: i) during the Brighter Bites produce distributions, and ii) when the distributions were no longer in session. Participants organized resulting photos into themes during discussion groups that proceeded each photo-taking period. Themes that emerged during the produce distribution period included: cost savings, increased variety and accessibility of fresh produce, and ability to practice healthy eating. Themes that emerged when the weekly produce distributions were no longer in session included: increased costs, lack of variety, the continued effect of Brighter Bites, and innovative ways to cook with produce. Overall, participants were enthusiastic about the benefits they experienced with the program, but noted hardships in accessing nutritious food without the produce distributions in session. Innovative approaches are needed to create sustainable pathways to healthful food access after community nutrition interventions are complete.
[Mh] Termos MeSH primário: Participação da Comunidade
Assistência Alimentar
Frutas
Dieta Saudável
Ciências da Nutrição/educação
Cooperação do Paciente
Verduras
[Mh] Termos MeSH secundário: Telefone Celular
Criança
Consenso
Estudos de Viabilidade
Feminino
Frutas/economia
Dieta Saudável/economia
Dieta Saudável/etnologia
Hispano-Americanos
Seres Humanos
Masculino
Mães
Cooperação do Paciente/etnologia
Educação de Pacientes como Assunto
Grupo Associado
Fotografia
Áreas de Pobreza
Pesquisa Qualitativa
Instituições Acadêmicas
Texas
Verduras/economia
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29206979
[Au] Autor:Huang J; Kim Y; Barnidge E
[Ad] Endereço:College for Public Health & Social Justice, Saint Louis University.
[Ti] Título:Seasonal Difference in National School Lunch Program Participation and Its Impacts on Household Food Security.
[So] Source:Health Soc Work;41(4):235-243, 2016 Nov 20.
[Is] ISSN:0360-7283
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The National School Lunch Program (NSLP) is one of the most important food assistance programs in the United States to ensure children's food security and healthy development. Previous studies have offered mixed results and challenges in estimating the effects of program participation. This study assesses NSLP's effect on household food security using data from the Survey of Income and Program Participation (SIPP). SIPP collects information on food security that covers four reference months, including both summer (June, July, August) and nonsummer months. The number of summer months in these four reference months varies by SIPP rotation group. These unique features allow this study to address the potential selection bias in the research of NSLP and food security by examining a seasonal difference in program participation. The analysis found that one more summer month in the reference period increases the difference in low food security rates by about 1.5 percentage points between recipients and nonrecipients eligible for free or reduced-price lunch. Findings have important social work and health policy implications for increasing food security among low-income households with children.
[Mh] Termos MeSH primário: Assistência Alimentar/estatística & dados numéricos
Serviços de Alimentação/estatística & dados numéricos
Abastecimento de Alimentos/estatística & dados numéricos
Almoço
Estações do Ano
[Mh] Termos MeSH secundário: Criança
Feminino
Seres Humanos
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/hsw/hlw043


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Texto completo SciELO Saúde Pública
[PMID]:28453068
[Au] Autor:Gamboa-Delgado EM; González de Cossío T; Colchero-Aragonés A
[Ad] Endereço:Universidad Industrial de Santander, Bucaramanga, Colombia, emgamboa@uis.edu.co.
[Ti] Título:[Obesity risk in preschoolers beneficiaries of food aid programs].
[Ti] Título:Riesgo de sobrepeso en niños preescolares beneficiarios de programas de ayuda alimentaria..
[So] Source:Rev Salud Publica (Bogota);18(4):643-655, 2016 Aug.
[Is] ISSN:0124-0064
[Cp] País de publicação:Colombia
[La] Idioma:spa
[Ab] Resumo:Objective To review the evidence regarding the potential impact of food programs on the risk of obesity in beneficiary children. Methods The search was conducted in databases using terms in Spanish and English. Those items that included the variable of interest, cross sectional studies, cohort or community trials were selected. Results Food assistance programs could contribute to increased obesity rates in the target population due to the availability and easier access to food with high energy content, either through the delivery of provisions or cash. However, the impact of the programs on this outcome has been little studied and evaluations have been mostly in adults or school-age children. Conclusion This review contributes to knowledge about the possible effect that food programs have on the risk of obesity in beneficiary children. This review may also serve as a reference for the design, implementation and evaluation of food and nutrition programs in countries of low and middle income facing malnutrition.
[Mh] Termos MeSH primário: Ingestão de Energia
Assistência Alimentar
Obesidade Pediátrica/etiologia
[Mh] Termos MeSH secundário: Pré-Escolar
Estudos Transversais
Saúde Global
Seres Humanos
Estado Nutricional
Obesidade Pediátrica/epidemiologia
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:27771206
[Au] Autor:Whittle HJ; Palar K; Seligman HK; Napoles T; Frongillo EA; Weiser SD
[Ad] Endereço:Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States. Electronic address: henry.whittle.14@ucl.ac.uk.
[Ti] Título:How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area.
[So] Source:Soc Sci Med;170:228-236, 2016 12.
[Is] ISSN:1873-5347
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive. OBJECTIVE: We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods. METHODS: Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach. RESULTS: Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions. CONCLUSION: Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
[Mh] Termos MeSH primário: Abastecimento de Alimentos/normas
Infecções por HIV/economia
Avaliação de Resultados (Cuidados de Saúde)
[Mh] Termos MeSH secundário: Adulto
Idoso
Antirretrovirais/efeitos adversos
Antirretrovirais/economia
Antirretrovirais/uso terapêutico
Feminino
Assistência Alimentar/utilização
Infecções por HIV/epidemiologia
Infecções por HIV/psicologia
Seres Humanos
Masculino
Adesão à Medicação/psicologia
Adesão à Medicação/estatística & dados numéricos
Meia-Idade
Organizações sem Fins Lucrativos/estatística & dados numéricos
Pesquisa Qualitativa
São Francisco/epidemiologia
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29232072
[Au] Autor:Food and Nutrition Service, USDA.
[Ti] Título:Child Nutrition Programs: Flexibilities for Milk, Whole Grains, and Sodium Requirements. Interim final rule.
[So] Source:Fed Regist;82(229):56703-23, 2017 Nov 30.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This interim final rule extends through school year 2018-2019 three menu planning flexibilities currently available to many Child Nutrition Program operators, giving them near-term certainty about Program requirements and more local control to serve nutritious and appealing meals to millions of children nationwide. These flexibilities include: Providing operators the option to offer flavored, low-fat (1 percent fat) milk in the Child Nutrition Programs; extending the State agencies' option to allow individual school food authorities to include grains that are not whole grain-rich in the weekly menu offered under the National School Lunch Program (NSLP) and School Breakfast Program (SBP); and retaining Sodium Target 1 in the NSLP and SBP. This interim final rule addresses significant challenges faced by local operators regarding milk, whole grains and sodium requirements and their impact on food development and reformulation, menu planning, and school food service procurement and contract decisions. The comments from the public on the long-term availability of these three flexibilities will help inform the development of a final rule, which is expected to be published in fall 2018 and implemented in school year 2019-2020.
[Mh] Termos MeSH primário: Fenômenos Fisiológicos da Nutrição Infantil
Assistência Alimentar/legislação & jurisprudência
Programas Governamentais/legislação & jurisprudência
Instituições Acadêmicas
[Mh] Termos MeSH secundário: Adolescente
Animais
Criança
Pré-Escolar
Dieta Saudável
Seres Humanos
Leite
Sódio na Dieta
Grãos Integrais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sodium, Dietary)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:29173349
[Au] Autor:Holben DH; Marshall MB
[Ti] Título:Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.
[So] Source:J Acad Nutr Diet;117(12):1991-2002, 2017 Dec.
[Is] ISSN:2212-2672
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.
[Mh] Termos MeSH primário: Dietética
Abastecimento de Alimentos/economia
Promoção da Saúde/economia
[Mh] Termos MeSH secundário: Academias e Institutos
Custos e Análise de Custo
Dieta/economia
Características da Família
Assistência Alimentar/economia
Educação em Saúde/economia
Seres Humanos
Desnutrição/economia
Desnutrição/prevenção & controle
Micronutrientes/administração & dosagem
Micronutrientes/deficiência
Micronutrientes/economia
Avaliação Nutricional
Política Nutricional/economia
Nutricionistas
Fatores Socioeconômicos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Micronutrients)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28973507
[Au] Autor:Berkowitz SA; Seligman HK; Rigdon J; Meigs JB; Basu S
[Ad] Endereço:Division of General Internal Medicine, Massachusetts General Hospital, Boston.
[Ti] Título:Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults.
[So] Source:JAMA Intern Med;177(11):1642-1649, 2017 Nov 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. Objective: To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. Design, Setting, and Participants: This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS). Exposures: Self-reported SNAP participation in 2011. Main Outcomes and Measures: Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions. Results: A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, -$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (-$1409; 95% CI, -$2694 to -$125). Sensitivity analyses were consistent with these results, also indicating that SNAP participation was associated with significantly lower estimated expenditures. Conclusions and Relevance: SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.
[Mh] Termos MeSH primário: Assistência Alimentar/economia
Gastos em Saúde
Renda/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Feminino
Abastecimento de Alimentos
Inquéritos Epidemiológicos
Seres Humanos
Masculino
Pobreza
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.4841


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[PMID]:28855422
[Au] Autor:Choi SK; Fram MS; Frongillo EA
[Ad] Endereço:Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC; and.
[Ti] Título:Very Low Food Security in US Households Is Predicted by Complex Patterns of Health, Economics, and Service Participation.
[So] Source:J Nutr;147(10):1992-2000, 2017 Oct.
[Is] ISSN:1541-6100
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Very low food security (VLFS) happens at the intersection of nuanced and complex patterns of risk characteristics across multiple domains. Little is known about the idiosyncratic situations that lead households to experience VLFS. We used classification and regression tree (CART) analysis, which can handle complex combinations of predictors, to identify patterns of characteristics that distinguish VLFS households in the United States from other households. Data came from 3 surveys, the 2011-2014 National Health Interview Survey (NHIS), the 2005-2012 NHANES, and the 2002-2012 Current Population Survey (CPS), with sample participants aged ≥18 y and households with income <300% of the federal poverty line. Survey participants were stratified into households with children, adult-only households, and older-adult households (NHIS, CPS) or individuals aged 18-64 y and individuals aged ≥65 y (NHANES). Household food security was measured with the use of the 10-item US Adult Food Security Scale. Variables from multiple domains, including sociodemographic characteristics, health, health care, and participation in social welfare and food assistance programs, were considered as predictors. The 3 data sources were analyzed separately with the use of CART analysis. Household experiences of VLFS were associated with different predictors for different types of households and often occurred at the intersection of multiple characteristics spanning unmet medical needs, poor health, disability, limitation, depressive symptoms, low income, and food assistance program participation. These predictors built complex trees with various combinations in different types of households. This study showed that multiple characteristics across multiple domains distinguished VLFS households. Flexible and nonlinear methods focusing on a wide range of risk characteristics should be used to identify VLFS households and to inform policies and programs that can address VLFS households' various needs.
[Mh] Termos MeSH primário: Assistência à Saúde
Dieta
Características da Família
Abastecimento de Alimentos
Nível de Saúde
Renda
Pobreza
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Dieta/normas
Feminino
Assistência Alimentar
Abastecimento de Alimentos/economia
Seres Humanos
Masculino
Meia-Idade
Estado Nutricional
Análise de Regressão
Inquéritos e Questionários
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.3945/jn.117.253179


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[PMID]:28816807
[Au] Autor:Luthy KE; Anderson A; Macintosh J; Beckstrand RL; Eden LM; Amy R; Macintosh CI
[Ad] Endereço:Karlen E. Luthy is an Associate Professor, Brigham Young University, Provo, UT. The author can be reached via e-mail at beth_luthy@byu.edu Alicia Anderson is a Graduate Student, Brigham Young University, Provo, UT. Janelle Macintosh is an Assistant Professor, Brigham Young University, Provo, UT. Renea L. Beckstrand is a Professor, Brigham Young University, Provo, UT. Lacey M. Eden is an Assistant Teaching Professor, Brigham Young University, Provo, UT. Ryan Amy is an Operations Manager, Brigham Young University, Provo, UT. Christopher I. Macintosh is a Clinical Modeling Engineer, Intermountain Healthcare, West Valley, UT.
[Ti] Título:A Whooping Cough Education Module for WIC Clients in Utah.
[So] Source:MCN Am J Matern Child Nurs;42(5):283-288, 2017 Sep/Oct.
[Is] ISSN:1539-0683
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. PROBLEM: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included development of a whooping cough education module and evaluation of learning. METHODS: Learning was evaluated using a pre- and posttest design. Client feedback was solicited via open-ended questions. Quantitative analysis was performed on visual analog-type questions with paired t-tests and a Cohen's d. Content analysis was conducted on open-ended items. INTERVENTIONS: The module was designed by a team of vaccination experts and included general definitions, signs and symptoms during the three stages of disease, recommendations to prevent whooping cough, and vaccination recommendations. Learning of users of the module was then evaluated. RESULTS: After using the module, clients indicated they were significantly more likely to vaccinate themselves and their child against whooping cough, and to recommend the vaccination to their family members. The greatest concern of participants about whooping cough was how it affected infants. Participants reported they learned new information on disease seriousness, recognition of symptoms, and treatment options but still requested additional information on the whooping cough disease and vaccine. CONCLUSIONS: A whooping cough education module is an effective strategy to improve whooping cough knowledge and promote the whooping cough vaccine.
[Mh] Termos MeSH primário: Pais/educação
Coqueluche/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Movimento contra Vacinação/psicologia
Feminino
Assistência Alimentar
Seres Humanos
Programas de Imunização/métodos
Programas de Imunização/normas
Inquéritos e Questionários
Utah
Coqueluche/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1097/NMC.0000000000000358


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Registro de Ensaios Clínicos
Texto completo
[PMID]:28632867
[Au] Autor:Phelan S; Hagobian T; Brannen A; Hatley KE; Schaffner A; Muñoz-Christian K; Tate DF
[Ad] Endereço:Kinesiology Department, California Polytechnic State University, San Luis Obispo.
[Ti] Título:Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial.
[So] Source:JAMA;317(23):2381-2391, 2017 06 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. Objective: To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. Design, Setting, and Participants: A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. Interventions: Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. Main Outcomes and Measures: The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. Results: Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group). Conclusions and Relevance: Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program. Trial Registration: clinicaltrials.gov Identifier: NCT01408147.
[Mh] Termos MeSH primário: Internet
Educação de Pacientes como Assunto/métodos
Período Pós-Parto
Pobreza
Perda de Peso
[Mh] Termos MeSH secundário: Adulto
Retroalimentação
Feminino
Assistência Alimentar
Hispano-Americanos/estatística & dados numéricos
Seres Humanos
Avaliação de Resultados (Cuidados de Saúde)
Cooperação do Paciente/estatística & dados numéricos
Educação de Pacientes como Assunto/economia
Período Pós-Parto/etnologia
Pobreza/etnologia
Avaliação de Programas e Projetos de Saúde
Tamanho da Amostra
Grupos de Autoajuda/organização & administração
Método Simples-Cego
Mensagem de Texto
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170621
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7119



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