a pilot program for: activity, nutrition, and diabetes in pregnant oklahoma city women andpow josh...
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A Pilot Program for:A Pilot Program for:
AActivity, ctivity, NNutrition, and utrition, and DDiabetes in iabetes in PPregnant regnant OOklahoma City klahoma City WWomenomen
ANDPOWANDPOW
Josh New, Virginia Landrum, Lindsay Clifton, & Josh New, Virginia Landrum, Lindsay Clifton, & Taylor LileTaylor Lile
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OKC has ~21,000 American Indians (AI)28.4% in poverty (state-wide)
Needs assessment of adults in OK:6th most obese state (67.8%)8th worst in diabetes (11.5%)9th worst in hypertension (35.5%)AIs highest prevalence in:
Hypertension (36.2%)Diabetes (17.5%)
What’s NeededWhat’s Needed
Robert Wood Johnson Foundation, 2013;National Health Statistics Reports, 2010 ;
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Needs assessment (con’t.)18% of pregnancies affected by diabetes16.3% of AI women have gestational diabetes
Brief survey provided to participantsDay/timeBackground/familyEducation level
What’s NeededWhat’s Needed
National Health Statistics Reports, 2010 ;Thompson et al., 2008;
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Nutrition therapy is an effective treatment
Providing easy, affordable options for preventing complications and risk factors associated with gestational diabetes is needed for American Indian women.
What’s NeededWhat’s Needed
Buchanan, 2012
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Pregnant, American Indian women ages 18-49 years in the Oklahoma City area attending the Oklahoma City Indian Clinic
Target PopulationTarget Population
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Classes will be at the OKC Indian ClinicThursday nights from 7-8 p.m. (tentative)
Initial 15 minutes to eat and confab30-35 minutes for the education session5-10 minutes for wrap-up & Q/A
Incentives:Provide dinner each week through catered food plattersProvide childcare during the session
Program PlanProgram Plan
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Participants recruited/informedIn-person at OKC Indian Clinic
8-10 a.m. & 4:30-5:30 p.m. on alternating days for one week
RecruitmentRecruitment
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Reserved classroomNo cost – approval required
Proposal placed in advanceAllow time for planningSubmit in writing
Oklahoma City Indian ClinicOklahoma City Indian Clinic
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Place a request with Clinic SupervisorMust include:
PurposeGoals/ObjectivesProposed dates/timesCovered topicsTentative agendaMethod of recruitmentFunding
The Chain of CommandThe Chain of Command
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Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program.
Program GoalsProgram Goals
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Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations.
The dietitian will have one assistant for each education session, whom is a student pursuing a nutrition degree.
Program GoalsProgram Goals
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Educate participants by conducting individual nutrition/exercise information sessions on the following topics (5 total classes) -
Program GoalsProgram Goals
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Objectives & SessionsObjectives & Sessions
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What is gestational diabetes?
Gestational NutritionGestational Nutrition
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1st trimester needs2 cups of fruit2½ cups Vegetables6 oz Grains5 ½ oz Meat & Beans3 cups Dairy
2nd and 3rd trimester needs2 cups Fruit3 cups Vegetables8 oz Grains6 ½ oz Meat & Beans3 cups Dairy
Gestational NutritionGestational Nutrition
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3 oz cooked meat = deck of cards1 c cooked rice or pasta = tennis ball1 oz cheese = 4 dice or 1 domino Medium piece of fruit = baseball1 tsp butter/margarine = 1 die1 small baked potato = computer mouse2 tbsp (PB, salad dressing…) = golf ball1 oz chocolate = packet of floss
Serving Size ComparisonsServing Size Comparisons
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Label Reading: The breakdownLabel Reading: The breakdown
Serving sizes are not
“typical” food portion sizes
Calories reference
serving sizes and not the
entire package
Daily Value (DV) is for a 2,000 calorie diet reference
Daily Value (DV) is for a 2,000 calorie diet reference
The food profile: How things break
down
Use the 5-20 rule!
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Logic ModelLogic Model
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Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program.
Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations.
Program GoalsProgram Goals
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Screening instruments:Height/weight and BMIGlucometer Electronic blood pressure cuffPhysical activity in the last 3 days: amount of physical activity in minutes, type of physical activity, and number of times engaged in physical activity3 day dietary recall:
Caloric intake/macro- and micronutrient breakdown in FoodWorks softwareNumber of fruits/vegetables eaten daily
ToolsTools
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1. What is gestational diabetes?
a) A form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas
b) A metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency
c) Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy
2. What are the five food groups?
a) Grains, fruits, vegetables, dairy, protein
b) Grains, fruits, vegetables, dairy, meat
c) Bread, fruits, vegetables, milk, meat
d) Bread, fruits, vegetables, dairy, protein
3. What is the recommended serving of vegetables throughout pregnancy that should be consumed each day?
a) 2-3 servings
b) 3-4 servings
c) 4-5 servings
d) 5-6 servings
4. A woman of average weight should gain how many pounds during her pregnancy?
a) 10-20 lbs
b) 15-25 lbs
c) 25-35 lbs
d) 35-45 lb
5. Folic acid, a key nutrient to the growth of your baby, can be found in which foods?
a) Dark, leafy greens
b) Peas and beans
c) Citrus fruits and juices
d) Whole-grain breads and cereals
e) All of the above
QuestionnaireQuestionnaire
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QuestionnaireQuestionnaire 6. What is a normal fasting blood glucose during pregnancy?
a) <130 mg/dLb) 130-145 mg/dLc) >145 mg/dL
7. Which food is considered not safe to consume during pregnancy?a) Hard-boiled eggsb) Caesar salad made with raw eggsc) Pasteurized egg products
8. How many extra calories should a woman consume during each trimester?a) 1st trimester: 350 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 350 calories per dayb) 1st trimester: no additional calories, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per dayc) 1st trimester: no additional calories, 2nd trimester: 200 calories per day, 3rd trimester: 350 calories per dayd) 1st trimester: 200 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per day
9. Fish highest in mercury should be avoided during pregnancy. Which of the following fish below are highest in mercury?a) Marlin, tuna, swordfish, mackerelb) Catfish, crab, oysters, tilapiac) Shrimp, snapper, sea trout, lobsterd) Tilapia, shrimp, lobster, crab
10. What is a normal blood pressure?a) 110/90 mmHgb) 130/70 mmHgc) <140/90 mmHgd) <120/80 mmHg
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Outcome VariablesOutcome VariablesNumber of servings of dairy consumed per day?
0-1 servings 1-2 servings
2-3 servings 3-4 servings
4-5 servings 5+ servings
Number of servings of grains do you consumed per day?
0-1 servings 1-2 servings
2-3 servings 3-4 servings
4-5 servings 5+ servings
Number of servings of protein/meat consumed per day?
0-1 servings 1-2 servings
2-3 servings 3-4 servings
4-5 servings 5+ servings
What is the fasting blood glucose?
What is the blood pressure? Systolic ⁄ Diastolic
Body Mass Index (BMI) (weight in kg) / (height in m2)
0= BMI less than 19.5 1= BMI 19.5 or less than 25
2= BMI 25 to less than 30 3= BMI 30 or greater
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Pre- & Post MeasuresPre- & Post Measures
Weight gain/loss during the last 3 months
0 = weight loss greater than 3 kg (6.6 lbs) 1= does not know
2= weight loss between 1 and 3 kg (2.2 and 6.6 lbs) 3= no weight loss
Activity Times Per Week Minutes Per Session
Brisk Walking
Aerobics
Run
Dance
Bicycle
Stretching
Weight lifting
Team sports: basketball, football, soccer, volleyball, etc.
Swimming
Golf
Tennis
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Lead Dietitian - Michelle Denison RD/LD, BC/
ADM, CDE (Harold Hamm Diabetes Center)Researcher - Gina Herbert, RN
Maternal Fetal Medicine (OU College of Medicine, OBGYN)
Exercise Physiologist - Josh New, CI-CPT
ManagingManaging
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The Cost of InterventionThe Cost of Intervention
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NIH – NIDDK - Translational Research to Improve Diabetes and Obesity-related Outcomes; PA-13-352 - (R01) Research Project Grant
Eligibility for the grant:Research for “practical, sustainable, and cost-efficient strategies or approaches…”
Research focused on the “prevention or reversal…”
Research that focuses on “prevention or delay of the complications of these conditions…”
“Approaches must have potential for wide dissemination/implementation in communities at-risk”
How do we Fund it?How do we Fund it?
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Proposed TimelineProposed Timeline
Step 1: Evaluate needs assessment and determine goals/objectives
Step 2: Obtain funds and supporting partnerships with local agency
Step 3: Develop program materials
Step 4: Implement education program
Step 5: Begin evaluation of program
Step 6: Final evaluation of impact/effectiveness