Social cohesion among peers profoundly influences decision making during adolescence. Despite this, the current research is very limited concerning the association of social cohesion and intimacy among rural adolescent peers with dietary intake and weight outcomes. This is problematic because social cohesion could be an unknown contributing factor in obesity among rural adolescents. The purpose of this study was to investigate how social cohesion and intimacy among rural adolescents in Kentucky and North Carolina affects the outcomes of a text message intervention aimed at improving fruit, vegetable, fast food and sugar sweetened beverage intake. Additionally, to determine if social cohesion is an independent contributing factor to dietary intakes and weight outcomes among rural adolescents. It was found that the intervention had no effect on fruit and vegetable consumption and purchases and sugar sweetened beverage calories. However, the intervention did have a modest effect on the amount of times fast food was consumed per week.

<p><strong>Bakgrund</strong>: Verksamhetschefer, sjuksköterskor, utvecklingsledare och kostombud har påbörjat ett förbättringsarbete gällande kosten på ett särskilt boende för äldre i en mellansvensk kommun. <strong>Syftet</strong>: Att beskriva omvårdnadspersonalens uppfattning om förbättringar, försämringar samt inflytande gällande måltidsmiljön, efter att riktlinjer kring kosthållningen införts. <strong>Metod</strong>: Studien genomfördes med en kvalitativ ansats och en beskrivande design. Tjugofem omvårdnadspersonal intervjuades om sina uppfattningar. <strong>Resultat</strong>: Det framkom i studien att omvårdnadspersonalen till största del uppfattade att förbättringar skett kring kosthållningen efter införandet av de nya riktlinjerna. Omvårdnadspersonalen uppfattade att det hade påverkat de äldres vardag positivt genom: trevligare måltidsmiljö, hälsosammare och godare mat, kortare nattfasta samt ökat självbestämmande för de äldre. Det som uppfattades negativt var att det nya arbetssättet uppfattades som stressigt för viss personal på grund ökad disk och längre måltider. Flertalet av omvårdnadspersonalen uppfattade att de inte varit delaktiga i utformningen av riktlinjerna och det fanns svårigheter att få all personal till att arbeta enligt riktlinjerna. <strong>Slutsats:</strong> Författaren menar att denna studie har visat att det går att utföra förändringsarbete med gott resultat.</p> / <p><strong>Background</strong>: In one district of Sweden, improvements in the diets of the older people in a nursing home are being implemented by staff.  The staff included managers, nurses, dietary assistants and development workers. <strong>Aim</strong>: To explore nursing assistant perceptions of the advantages, disadvantages and influence around the meal environment after implementing new guidelines. <strong>Method</strong>: A descriptive design with a qualitative approach Twenty-five nursing assistants were interviewed about their perceptions. <strong>Results</strong>: It was found that the perceptions of the majority of the nursing assistants’ were some improvement in the wake of the new dietary guidelines. Furthermore, it was reported that the guidelines had appeared to affect the elderly in a positive fashion by improving the meal time environment, by providing healthier and better quality food, shortening the period between meals at night and increased their autonomy. The disadvantages of the new guidelines were that some staff found the new approach stressful owing to an increased amount of cleaning and longer meal times. In addition, the majority of staff felt that they were not included in the creation of the guidelines and there were also difficulties in implementing them across all staff members. <strong>Conclusion</strong>: According to the author this study shows that it is possible to work for change to the better in the care for older people.</p>

Bakgrund: Verksamhetschefer, sjuksköterskor, utvecklingsledare och kostombud har påbörjat ett förbättringsarbete gällande kosten på ett särskilt boende för äldre i en mellansvensk kommun. Syftet: Att beskriva omvårdnadspersonalens uppfattning om förbättringar, försämringar samt inflytande gällande måltidsmiljön, efter att riktlinjer kring kosthållningen införts. Metod: Studien genomfördes med en kvalitativ ansats och en beskrivande design. Tjugofem omvårdnadspersonal intervjuades om sina uppfattningar. Resultat: Det framkom i studien att omvårdnadspersonalen till största del uppfattade att förbättringar skett kring kosthållningen efter införandet av de nya riktlinjerna. Omvårdnadspersonalen uppfattade att det hade påverkat de äldres vardag positivt genom: trevligare måltidsmiljö, hälsosammare och godare mat, kortare nattfasta samt ökat självbestämmande för de äldre. Det som uppfattades negativt var att det nya arbetssättet uppfattades som stressigt för viss personal på grund ökad disk och längre måltider. Flertalet av omvårdnadspersonalen uppfattade att de inte varit delaktiga i utformningen av riktlinjerna och det fanns svårigheter att få all personal till att arbeta enligt riktlinjerna. Slutsats: Författaren menar att denna studie har visat att det går att utföra förändringsarbete med gott resultat. / Background: In one district of Sweden, improvements in the diets of the older people in a nursing home are being implemented by staff.  The staff included managers, nurses, dietary assistants and development workers. Aim: To explore nursing assistant perceptions of the advantages, disadvantages and influence around the meal environment after implementing new guidelines. Method: A descriptive design with a qualitative approach Twenty-five nursing assistants were interviewed about their perceptions. Results: It was found that the perceptions of the majority of the nursing assistants’ were some improvement in the wake of the new dietary guidelines. Furthermore, it was reported that the guidelines had appeared to affect the elderly in a positive fashion by improving the meal time environment, by providing healthier and better quality food, shortening the period between meals at night and increased their autonomy. The disadvantages of the new guidelines were that some staff found the new approach stressful owing to an increased amount of cleaning and longer meal times. In addition, the majority of staff felt that they were not included in the creation of the guidelines and there were also difficulties in implementing them across all staff members. Conclusion: According to the author this study shows that it is possible to work for change to the better in the care for older people.

Cette étude vise à évaluer l’impact de l’état nutritionnel et de son évolution durant l’attente d’une transplantation pulmonaire sur la mortalité et la morbidité postopératoire. Nous avons examiné les 209 dossiers de patients greffés pulmonaires au Programme de Transplantation Pulmonaire du CHUM entre 2000 et 2007 et regardé la mortalité et les complications post-transplantation en fonction de l’IMC, des apports protéino-énergétiques, de certains paramètres biochimiques et selon l’évolution pondérale durant la période d’attente. Les résultats montrent que la mortalité augmente en fonction de l’augmentation des strates d’IMC avec un risque relatif de décès au cours du séjour hospitalier de 3,31 (IC95% 1,19-9,26) pour un IMC 25-29,9 et de 8,83 (IC95% 2,98-26,18) pour un IMC ≥ 30 avec une issue postopératoire plus sombre en terme de complications chirurgicales (p=0,003), de durée de séjour aux soins intensifs (p=0,031) et de durée de séjour à l’hôpital (p<0,001) chez les patients avec IMC ≥ 30 comparativement aux patients de poids normal. Les patients ayant présenté une évolution inadéquate de l’IMC durant la période d’attente ont connu une durée de séjour hospitalier prolongée (p=0,015). Ceux dont les apports nutritionnels étaient sous-optimaux en pré-greffe ont aussi connu une durée de séjour hospitalier prolongée (p=0,002) et davantage de complications infectieuses (p=0,038), digestives (p=0,003) et chirurgicales (p=0,029) mais sans impact détectable sur la mortalité. Nos résultats suggèrent que l’obésité et l’embonpoint ainsi qu’une évolution inadéquate de l’IMC durant la période d’attente de même que des apports protéino-énergétiques sous-optimaux affectent négativement l’issue d’une transplantation pulmonaire. / This study aims to assess the impact of nutritional status and its evolution while awaiting a lung transplant on the post-operative mortality and morbidity. We reviewed 209 consecutive cases of lung transplantation at the Centre Hospitalier de l’Universite de Montreal between 2000 and 2007 and looked at the mortality and rate of complications post-operatively according to BMI, intake of protein and energy, biochemical parameters and weight changes during the waiting period. The risk of death increased with increasing BMI strata with a relative risk of death during the hospital stay of 3,31 (IC95% 1,19-9,26) for BMI 25-29.9 and 8,83 (IC95% 2,98-26,18) for BMI ≥ 30 with a worse postoperative outcome in terms of surgical complications (p=0,003), length of stay in intensive care unit (p=0,031) and length of hospital stay (p<0,001) for patients with BMI ≥ 30 compared with patients of normal weight. Patients in whom the BMI evolved inadequately during the waiting period experienced a prolonged hospital stay (p=0,015). Patients whose intake was suboptimal in the pre-transplant period have also a prolonged hospital stay (p=0,002) and more infectious (p=0,038), digestives (p=0,003) and surgicals (p=0,029) complications but no detectable impact on the mortality. Our results suggest that obesity and overweight as well as inadequate changes of BMI during the waiting period and suboptimal protein-energy intakes negatively affect the outcome of lung transplantation.

Cette étude vise à évaluer l’impact de l’état nutritionnel et de son évolution durant l’attente d’une transplantation pulmonaire sur la mortalité et la morbidité postopératoire. Nous avons examiné les 209 dossiers de patients greffés pulmonaires au Programme de Transplantation Pulmonaire du CHUM entre 2000 et 2007 et regardé la mortalité et les complications post-transplantation en fonction de l’IMC, des apports protéino-énergétiques, de certains paramètres biochimiques et selon l’évolution pondérale durant la période d’attente. Les résultats montrent que la mortalité augmente en fonction de l’augmentation des strates d’IMC avec un risque relatif de décès au cours du séjour hospitalier de 3,31 (IC95% 1,19-9,26) pour un IMC 25-29,9 et de 8,83 (IC95% 2,98-26,18) pour un IMC ≥ 30 avec une issue postopératoire plus sombre en terme de complications chirurgicales (p=0,003), de durée de séjour aux soins intensifs (p=0,031) et de durée de séjour à l’hôpital (p<0,001) chez les patients avec IMC ≥ 30 comparativement aux patients de poids normal. Les patients ayant présenté une évolution inadéquate de l’IMC durant la période d’attente ont connu une durée de séjour hospitalier prolongée (p=0,015). Ceux dont les apports nutritionnels étaient sous-optimaux en pré-greffe ont aussi connu une durée de séjour hospitalier prolongée (p=0,002) et davantage de complications infectieuses (p=0,038), digestives (p=0,003) et chirurgicales (p=0,029) mais sans impact détectable sur la mortalité. Nos résultats suggèrent que l’obésité et l’embonpoint ainsi qu’une évolution inadéquate de l’IMC durant la période d’attente de même que des apports protéino-énergétiques sous-optimaux affectent négativement l’issue d’une transplantation pulmonaire. / This study aims to assess the impact of nutritional status and its evolution while awaiting a lung transplant on the post-operative mortality and morbidity. We reviewed 209 consecutive cases of lung transplantation at the Centre Hospitalier de l’Universite de Montreal between 2000 and 2007 and looked at the mortality and rate of complications post-operatively according to BMI, intake of protein and energy, biochemical parameters and weight changes during the waiting period. The risk of death increased with increasing BMI strata with a relative risk of death during the hospital stay of 3,31 (IC95% 1,19-9,26) for BMI 25-29.9 and 8,83 (IC95% 2,98-26,18) for BMI ≥ 30 with a worse postoperative outcome in terms of surgical complications (p=0,003), length of stay in intensive care unit (p=0,031) and length of hospital stay (p<0,001) for patients with BMI ≥ 30 compared with patients of normal weight. Patients in whom the BMI evolved inadequately during the waiting period experienced a prolonged hospital stay (p=0,015). Patients whose intake was suboptimal in the pre-transplant period have also a prolonged hospital stay (p=0,002) and more infectious (p=0,038), digestives (p=0,003) and surgicals (p=0,029) complications but no detectable impact on the mortality. Our results suggest that obesity and overweight as well as inadequate changes of BMI during the waiting period and suboptimal protein-energy intakes negatively affect the outcome of lung transplantation.