Nutrition and IT

1. Nutrition and IT Nutritional Information, education and communication – IT offers a new approach. Internet and WWW: the main problem is the amount of information and the lack of quality control E-learning is more than technology E-mail Surveys Web Conference Distance Education (Black Board): http://ecu.blackboard.com Problem Based Learning (PBL) and Electronic Information Nutrition Surveys and Assessment: Software available Dietary Assessment

2. Search Engines Medline PubMed (NIH) Yahoo Google Altavista Northern Light News Readers Sciece Director Science Citation Index 2

3. Nutrition and IT… Epi Info: For processing of collected data, produced by cdc at atlanta and is free  www.cdc.gov Useful for anthropometry Epiinfo 2000, window base, based on MS Access. Profile is another program: Excell base program, where we could analyze different data. UNICEF Reports WHO Charts: Country Profile FAO: Food Security, Food data sheet www.WHO.int World development Indicators: Microeconomics and Health. Health problem have a strong influence on Economic development NIM: Nutrition in Medicine www.med.unc.edu/nutr/nim 3

4. Nutrition and IT… PDF formate for printing IT Modules: Distance Training Modules Interactive Training Virtual Training Studio Not text book oriented, but case oriented, build on specific case or local situation Nutrition Foundation Community Learning Program 4

5. Nutrition and IT… Global Forum: Food Safety Regulators; www.foodsafetyforum.org Codex Alimentarius Commission (CAC) All final decision made by CAC General subject: Task Force Commodity Executive Committee www.codexalimentarius.net Joint FAO/WHO Expert Groups Joint FAO/WHO Expert Committee on Food Additives (JECFA) Joint FAO/WHO Expert Consultations on Risk Analysis 5

6. Nutrition and IT… Computer based education in Medicine One way to deliver this information is to use computer-assisted instructor (CAI). Provide a consistent base of nutrition information, a series of interactive, multimedia educational programs (Nutrition in Medicine) that teach the basic principles of nutritional science and apply those principles in case-oriented approach have been available. These modules offer the advantages of accessibility, self-paced study, interactivity, immediate feedback, and tracking of student performance. Successful implementation of CAI requires easy program access, faculty training, adequate technical support, and faculty commitment to the programs as a valuable resource. CAI fails when the program is just placed in the library and students are told to use it when they can find the time. For information see www.med.unc.edu/nutr/nim 6

7. Comparison of the advantages and disadvantages of computer-assisted instruction compared with traditional methods Advantages of CAI method Provides consistency of information across presenters and institutions Optimizes faculty time Portable to many sites Flexibility of course implementation Encourage active learning Immediate feedback via interactive features Self-paced learning Electronic grading eases instructor burden Immediate instructor access to user data Allows instructors to focus on advanced topics Permits faculty to spend more time working with students on synthesis and application of the learned concepts. 7

8. Comparison of the advantages and disadvantages of computer-assisted instruction compared with traditional methods …. Disadvantages of CAI method Fixed content Impersonal Unable to ask questions Potential cost issues Potential technical problems Varying time to completion Advantages of tradition method Can tailor presentation to a particular audience and to respond with great flexibility to the individual needs of students. Limitations of tradition method Requirement of significant faculty time Limited portability High degree of variation between instructors and between institutes. 8

9. IT and Nutritional support for patients with chronic illnesses Computer Technology and the Nutrition Support Professional Web-Based Targeted Nutrition Counseling and Social Support for Patients at Increased Cardiovascular Risk in General Practice The Internet may prove useful in providing nutrition counseling and social support for patients with chronic diseases.  A professionally moderated internet discussion group is actively visited by a broad base of patients and families, and appears to be a useful strategy for engaging patients with chronic disease for emotional support and information exchange. Studies reveals that access to an integrated system of internet health resources helps patients more than simply providing a list of URLs to accredited sites. 9

10. IT and Nutritional support for patients with chronic illnesses… Healthcare providers should direct people facing serious illness or injury to a single high-quality website that is comprehensive and regularly updated by objective unbiased experts. Patients need to be trained to use the websites they are referred to. The sites need to be more inclusive and contain not only information but support services and tools to help patients think through their situation. There are a limited number of computer programs for assessing the nutritional status of patients; charting medical records; teaching patients about diet and disease; growth monitoring and for computer-assisted education and continuing education for health and medical professionals. 10

11. IT and Nutritional support Patient education Programs to provide dietary information and education to patients are available for individuals with diabetes, hypertension, heart disease, and complex medication regimens. These programs teach patients about causes of the disease, symptoms, complications, dietary management and menu planning. The levels of personalization and interactivity vary greatly. 11

12. IT and Nutritional support Computer-assisted instruction for health professionals The nutrition programs available generally include content such as the relationship of diet to a disease, components of nutritional assessment, diet history methods, and patient case studies. These programs vary from computer-text-on-screen to computer-based multimedia applications. Users have found text-on-screen applications valuable for the immediate feedback provided by drills and quizzes. 12

13. IT and Nutritional support Nutrient analysis Based on food intake recalls/records During the 1980s and 1990s, software to analyze food intake proliferated. A list of foods and beverages, along with the serving sizes, for one or more days is keyed into the computer program. The program calculates the nutrient intake of individuals or groups of individuals and compares it to a nutrient standard. A personal nutrient profile is created, usually with a printout. Most applications require keyboard entry, but researchers interested in expanding the consumer reach of these programs have successfully demonstrated that consumers of a wide range of socio-economic and educational levels can use a touch-screen computer system for diet analysis. 13

14. IT and Nutritional Analyses Programs that analyze nutrient intake were welcomed by researchers and hospital dieticians. They found computerized nutrient analysis significantly reduced both the time and effort of calculating intakes using calculators and food composition books. The programs have now been used extensively for classroom assignments, and have been offered as a nutrition education service in shopping malls and health fairs, in science exhibits, and by public health and co-operative extension service professionals, fitness trainers, food scientists and food service professionals. The programs are used in doctors' clinics as part of medical assessments or nutrition counselling sessions. 14

15. IT and Nutritional Analyses… The effectiveness of these programs for computing nutrient intake for research and education purposes, identifying nutrient excesses and deficiencies, and teaching food composition to varied audiences is well documented. The speed of calculation has allowed nutrient analysis to be used more frequently in education and counselling settings. Nutrient analysis based on food frequency questionnaires (FFQs) 15

16. IT and Nutrition Database The nutrient database is the most important feature. The database must be accurate, verified, and large enough to meet the intended task. Most programs use the USDA nutrient database as the standard. Some programs augment the USDA database with information from commercial sources and allow the addition of more foods or ingredients. Nutrient adequacy is usually defined by the U.S. Recommended Dietary Allowances. Some programs use other standards, including the Recommended Dietary Intake for Canadians, the U.S. Food and Drug Administration (FDA), labelling standards (Recommended Daily Intake or RDI and Daily Values or DV), Food Guide Pyramid servings, and other food grouping systems. 16

17. IT and Nutrition Database ….. A few software vendors customize programs with international standards and foods. Computerized databases for food consumption information are available from FAO as well as other international organizations. Electronic databases are computerized collections of information, usually covering a specific subject, that are arranged to facilitate efficient retrieval and use. 17

18. IT and Nutritional support Food and nutrition on-line services The Food and Nutrition Information Centre (FNIC) of the USDA, National Agricultural Library, Beltsville MD (fnic@nalusda.gov) has been a leader in cataloguing sources of food and nutrition information available electronically. Computer on-line services offer fast, low-cost access to much of the world's accumulated nutrition information. On-line can deliver up-to-the-minute information. It is much like having access to a library without leaving the office, complete with a personal librarian to conduct a search. It is possible to instantly retrieve information like abstracts, read material on screen, and download material as hard copy. 18

19. Food and nutrition on-line services Subscriptions to on-line databases are good for people who want current and general information. Some on-line services have Personal Clipping Services, that alert the user automatically to new items of interest. 19

20. Use of Internet Technology to Support Nutrition andDiabetes Self-Management Care Medical nutrition therapy (MNT) includes determining individuals’ specific nutritional needs based on their medical status and disseminating this information to them in a manner that enables understanding and adherence to the goals they set with their health care providers. For some patients, the Internet can be a valuable resource to provide ongoing information and support outside of the health care organization. A variety of websites are available that can enhance and reinforce nutrition information, provide behavioral and motivational support, and track events. The use of websites can be a thoughtful, planned component of the health care intervention. 20

21. Diabetes MNT: Categories of Nutrition Websites There are three basic categories of nutrition/health websites that can be used to support diabetes MNT. These include those providing content information, behavioral and motivational support, and a means of tracking data. Content information sites Many patients access the Internet to gather facts to better understand what diabetes is, how it is treated, and what they can or should eat. With this information, patients may come armed to their first medical or education visit with the information they have gathered and appear ready to prescribe their own treatment. Other patients need help understanding the information they have collected or may feel overwhelmed with the amount of information available or what they have discovered. Providing patients with a few key, high-quality websites can facilitate “content management,”. 21

22. Categories of Nutrition Websites… Behavioral and motivational support sites As patients explore the content of various websites, they may feel motivated to take steps to follow therapy recommendations. The content information may list behaviors that could be followed to achieve desired outcomes. The presentation of these behaviors may stimulate a positive behavior change in a way that could not be achieved in a health office or clinic visit. Additionally, there are websites that specifically focus on the support aspect of diabetes self management and guide patients in making and maintaining choices that promote positive outcomes. These sites may provide daily or weekly newsletters or short reminders that can be personally motivating. Some websites offer online support groups specifically targeting behavioral goals, including weight loss, fitness, and improving clinical indicators, such as blood glucose and blood pressure. 22

23. Categories of Nutrition Websites… Data tracking sites Diabetes decisions are driven by data, and the Internet has much to offer in supporting data collection. There are websites that allow patients to enter their food intake and physical activity to assess their carbohydrate and/or caloric balance. Other websites allow patients to download data from their blood glucose meters. There is also the personal side of diabetes data, which includes feelings, quality of life, and willingness and ability to carry out recommendations. Some websites touch on this type of data through assessing readiness to change and then personalize recommendations and provide a means of tracking progress. 23

24. Evaluating Websites There are literally millions of websites that address the topics of health, nutrition, or diabetes. A Google search offers > 3 million websites on the topic of nutrition and diabetes and > 200 million on the topic of nutrition alone. Such sites are sponsored by health care facilities, health organizations, food companies, pharmaceutical companies, health device companies, specialty companies, and individuals with diabetes, and there are also bulletin boards, e-communities, and blogs on the topic. This great array of choices offers both opportunities and challenges. Decision-point: How can you judge a website’s quality? 24

25. How can you judge a website’s quality? A variety of evaluation tools have been developed for evaluating health websites and can be found by doing an Internet search using the terms “evaluate health websites” or other similar words of your choice. The evaluation criteria typically include credibility of the author/sponsor, purpose, objectivity, quality of information, graphics and design, and ease of use. An easy clue to identify a reputable site is to look for those with URLs that end in “.gov.” These are government-sponsored sites, such as: National Institutes of Health (www.niddk.nih.gov/http://medlineplus.gov), the U.S. Department of Health and Human Services (www.healthfinder.gov) the Centers for Disease Control and Prevention (www.cdc.gov/diabetes). 25

26. How can you judge a website’s quality? … Another easy clue is to go to sites sponsored by national health organizations, such as: the American Diabetes Association (www.diabetes.org) or educational sites with URLs that end in “.edu,” which means they are maintained by educational institutions. Reasons to be skeptical about health information on a website: No author or date Vague or sweeping generalizations Overstated significance Extreme tone or language Absence of source documentation, especially for numbers or statistics Personal testimonials as the only source of information Purported miracle cures recommended in lieu of prescribed medicine 26

27. Technology must be used with caution, especially for individuals with a chronic condition, such as diabetes. It is well known that not all websites provide safe and reliable health information. Health professionals should try to stay informed about their patients’ use of Internet technology because it may affect their care. For example, if patients are able to successfully initiate health behavior changes that result in weight loss or increased levels of physical activity, their diabetes medications may need to be adjusted. Technology will continue to move forward at a rapid rate. The future might well include devices that can be worn by individuals to electronically record actual food intake, medications, physical activity, blood glucose levels, and other health information that can be uploaded in a secure platform and shared in real time with health professionals. 27

28. Information technology in nutrition and dietetic education Dietary program: Diet5 for Windows Help students to explore the food tables and learn about the relative nutritional contents of different foods at the same time. There are graphical presentations to illustrate the foods before selection for a diet and to show the relative contributions of foods to the nutrient contents of each meal and recipe. Information about typical portion weights is given and photographs of foods of different weights are available to help students visualize them better. Usefulness To calculate nutrient contents of meals and recipes. How they could improve the diet and also include analysis of that diet. 28

29. Enhancement of scientific writing skills Word for nutritionists: a Microsoft Word programs. There is a menu of different situations for which references must be written; the course standardized all references on the British Journal ofNutrition, so there are examples of references written in that style for twenty-six different situations; a few situations students face, like referencing the Internet, have been added. When the student chooses one, the example is placed in the document and can be edited; even the title is already in italics and the volume number in bold. Another menu item leads to a help file containing examples of how to cite references in the text, Another gives ‘nutritional’ examples of poor English and how it can be corrected. It appears that most students considered ‘Word for nutritionists’ to be a simple program to use 29