INTRODUCTION: Celiac disease (CD), an inflammatory condition of the small bowel, is now recognized as the most common of the autoimmune disorders (Kenrick & Day, 2014). Unfortunately, due to poor awareness among primary care providers (PCPs) this disease remains highly underdiagnosed despite its increasing prevalence (Catassi & Fasano, 2008). Aims of this quality improvement project were to examine current knowledge and practices of nurse practitioners in the primary care setting that influence the screening and diagnosis of CD. METHODS: A 32-item survey was sent out to nurse practitioner primary care providers (NP- PCPs) in the Dallas-Fort Worth Metroplex over a four-week period. The survey assessed demographic characteristics, knowledge and clinical practices of nurse practitioners as it relates to CD diagnosis. Data was analyzed using SPSS and descriptive statistics. RESULTS: Eighteen valid responses were received for analysis. The majority of respondents reported having no familiarity with the American College of Gastroenterology (ACG) and National Institute for Health and Care Excellence (NICE) guidelines. Two thirds of the respondents reported their education did not properly prepare them to accurately diagnose celiac disease. The vast majority also reported they do not test patients, pediatric or adult, using any celiac related blood test. The same results were true for patients being sent for intestinal biopsy. Although able to list typical symptoms of CD, many respondents were unaware of atypical symptoms. Most also omitted family history as important when considering celiac related testing. CONCLUSIONS: Overall NP-PCPs are not aware of and therefore do not follow clinical guidelines related celiac disease. It is clear that NP-PCPs need to be made aware of the prevalence of this disease and should be directed to follow evidence-based practice guidelines in their primary care practices. One step for doing this includes providing better education for NP- PCP students. Educators should include lectures or discussions about CD in their curriculum and provide students with resources such as the NICE and ACG guidelines. For practicing NPs, free continuing education can be offered. Lastly, clinicians who are aware of the high rates of underdiagnosis can present CD related information at conferences and meetings.

While many health benefits have been associated with increased whole grain consumption, current researchers have not considered if the consumption of whole grains in currently recommended or higher amounts actually leads to health problems, specifically to a correlated increase in gluten sensitivity. The purpose of this study was to determine if diets high in whole grains or those that met the recommended daily intake of whole grains help minimize or increase gluten sensitivity, and when whole grains are consumed as recommended if they cause more harm than good. The theoretical basis for this quantitative, cross sectional design was the precaution adoption process model, allowing for the examination of preventive behaviors as a series of cognitive steps over time. Individuals (N = 5,746) from the National Health and Nutrition Examination Survey 2007 to 2012 were assessed for daily intake of whole grains before and after the release of the 2010 Dietary Guidelines for Americans, and from 2007 to 2010 for bowel health and sensitivity to whole grains. SAS correlations and regression analysis at p < .05 were analyzed. There was an increase in whole grain intake by 7.4% and in bowel sensitivity with 50% reporting increases in gas, but more data are needed to determine exact amounts that caused these increases in symptoms. Understanding the complete picture, policy makers and others will be more informed about current recommendations and the way that Americans eat, as well as if changes are needed for the future.

The diploma thesis deals with quality of life in patients with gluten intolerance in the Czech republic. It is divided into two parts, theoretical and practical. In the theoretical part is discussed the quality of life in general, development of interest of this theme and of the different definitions and the levels of the dimensions of quality of life. In the theoretical section below, the evaluation of the quality of life and the evaluation instruments are being described. This chapter is followed by a section dedicated to health, the development of the perspective on health, theories defining health and the concept of HRQoL. Then, the theme of somatic disease is being discussed. The theoretical part then focuses on the gluten intolerance, its types, health problems often associated with the gluten intolerance and research, which aim was the evaluation of the quality of life of people with gluten intolerance in the world and in the Czech republic. The last chapter of the theoretical part is dedicated to improving the quality of life of people with gluten intolerance in Europe and in the Czech republic. The practical part deals with the quality of life of patients with gluten intolerance in the Czech republic. For the purpose of mapping the quality of life of people with gluten intolerance in the...