1995: Amanda Frye, MS, RD
"Nutri-Net" (Proposed Use of a Geographic Information System (GIS) to Link Dietitians)
Overview of the Proposed Nutri-Net Project
The purpose of the proposed Nutri-Net project is twofold: 1) to create a database of nutrition and dietetic professionals throughout the world, and 2) to allow dietetic and nutrition professionals to create interactive databases about the populations they serve. Both of these databases will be stored, manipulated and accessed using a geographic information system (GIS). The Internet will serve as the vehicle to connect Nutri-Net and the users.
GIS is a computer software based system that manages, stores, queries, analyzes, organizes and displays data within a geographic context. The advantage of using a GIS is that multiple data sets can be integrated, overlaid, and visualized to clearly demonstrate interrelationships among the data layers. GIS offers the ability to study multiple data sets and detect interrelationships in them that would otherwise go unnoticed using traditional research techniques. The ability of GIS to visualize data leads to an easy understanding of these relationships (1).
Nutri-Net will be an interactive database system of the world's nutrition and dietetic professionals. Nutri-Net will afford nutrition and dietetic professionals the tools to conduct in-depth demographic analyses; to develop spatial and statistical models; and to solve routing and allocation problems. Nutri-Net is interactive because any nutrition/dietetic professional or student belonging to a nutrition/dietetic organization will have the opportunity to access the system via a Nutri-Net World Wide Web (WWW) home page established on the Internet (2,3). Dietetic and nutrition professionals will be able to contribute information, seek answers to questions, solve problems, discuss research or exchange ideas with other professionals.
Dietetic and nutrition professionals will be able to create multiple data sets that contain information about population subgroups they serve. Nutritionists and dietitians working within the same area of practice will be able to create, propagate and share data sets. This data can be analyzed and used to see trends that will enable professionals to make proactive decisions for solving problems. Nutri-Net offers great potential to improve the public's nutritional health throughout the world.
Nutri-Net has the potential to be a valuable asset in emergency situations. GIS has been used extensively in past emergency situations such as earthquakes, floods and hurricanes (4). Nutri-Net could be linked to existing the GISs to better respond to a crisis. Since Nutri-Net uses a GIS, it will allow quick access to a roster of nutrition professionals that could respond to a crisis or offer advice in emergency situations that pose threats to a population's nutritional health e.g., famine, earthquake, floods, hurricanes, etc.
A model of the proposed Nutri-Net system is shown in Figure 1. The following discussion will examine the Nutri-Net components in more detail. The role of GIS in the Nutri-Net system will be demonstrated throughout this discussion.
Nutri-Net Input
Nutrition Professionals Data Base {NPDB}
Nutri-Net will provide access to a database of dietetic and nutrition professionals throughout the world by using a geographic information system (GIS) linked to the Internet via a World Wide Web homepage (2,3). The Nutri-Net World Wide Web site will provide the means for dietitians and nutritionists throughout the world to access Nutri-Net. The World Wide Web home page will serve as the directory for the Nutri-Net system.
The main data base for Nutri-Net is the nutrition professionals data base (NPDB). NPDB will be compiled from membership rosters of nutrition, dietetic and health organizations throughout the world. The International Committee of Dietetic Associations (ICDA) and National Dietetic Associations will serve as valuable resources in creating the NPDB (5). Persons affiliated with more than one organization will only have one listing in the database. The NPDB will include membership demographic information, and areas of professional expertise. The NPDB will also include each member's electronic mail (e-mail) address in order to provide access via the Internet. E-mail will also provide users an inexpensive mode of communication.
One potential issue in developing a database like NPDB is protecting an individual's privacy (6). Nutri-Net will circumvent these privacy issues by having members consent to the inclusion of their name listed in the database. Data such as salary ranges, specialties will have to be provided by members on a voluntary basis.
Nutri-Net's Interactive Database {IDB}
A second database in the Nutri-Net project will be an interactive database (IDB). The IDB has the potential to be the most powerful component of the Nutri-Net project. Dietetic and nutrition professionals will be able to build their own interactive databases by entering information derived from the populations they serve. Therefore, dietitians will be able to collaborate with their peers worldwide to build databases of mutual interest. These databases will be kept current, continuous, and provide data for dietetic and nutrition professionals working in the same area throughout the world. Nutritionists and dietitians will be able to analyze and discuss relevant problems and trends without waiting for national and international studies to be released several years later.
Various IDBs could be set up as template databases. A template database identifies what information is needed for the collection and entry into the database. Template databases could be developed for any area of practice or research interest. Practice Groups could take an active role in establishing these template IDBs to meet research needs.
Government and Other Databases
Government databases such as census data, city and county economic data, zip-code- based data are available via the Internet. Many other government and private databases are also obtainable through the Internet. These databases can be linked to and incorporated into the Nutri-Net's GIS or referred to as stand-alone references. These data sets can be combined with other data in the Nutri-Net GIS to make multi-layered analysis possible.
Meeting ADA Priorities Using Nutri-Net's NPDB and IDB
In 1994, the American Dietetic Association's (ADA) Council on Research identified the highest priority research areas for dietetics(7). The Nutri-Net system would serve as a centralized collection point for data being collected from dietitians across the country .Each research project would have its own individualized IDB that would be stored in the Nutri-Net's GIS. Dietitians at all levels could be a part of the concerted effort to build needed databases and to meet research needs. This method of collecting data would be extremely economical. The following discusses several examples of how Nutri-Net can be used to carryout priorities identified by the ADA.
In the foodservice area, the Council on Research identified a need to develop a data collecting and reporting system to support a database for valid comparison of different foodservice systems. A IDB could be established by dietetic professionals working in foodservice. A template of the information to be collected could be established. The foodservice professionals at established sites could then collect needed information and enter it into a foodservice template database. Data collected then would be ready for analysis.
The Council on Research also expressed the need for the development of a National Nutrition Monitoring System to provide ongoing surveillance of food behavior and health status of children and adults. Once again, the Nutri-Net System provides an excellent means to establish a National Nutrition Monitoring System. Existing nutrition monitoring systems would become more accessible through Nutri-Net (8).
Information from the IDBs can also be used to provide accurate and timely support for legislative issues. Current data can be quickly assembled, analyzed, and displayed in easy to read maps and charts. Nutri-Net's output of maps, charts, and graphics is important because graphical information is more quickly and effectively conveyed to its intended audience than text and difficult to interpret tables.
Nutri-Net will provide a forum for dietetic professionals to collaborate with colleagues throughout the world. Global research efforts can be facilitated by use of Nutri-Net's IDB system. Students will have the opportunity to communicate with other students and professionals throughout the world. These communications will provide a greater understanding of other cultures and their nutritional concerns. Through Nutri-Net, dietitians and nutrition professionals will have the opportunity to make a difference in the health of individuals throughout the world.
GIS and its role in Nutri-Net
GIS is a suite of geographic and spatial analysis tools that have steadily grown and evolved in number and scope over the past 25 years. Through multiple systems, GIS applies tools to store, organize, and retrieve data in a geographic context. Within this context, data may be analyzed, overlaid, manipulated, queried and finally displayed to communicate the results. Today the use of GIS technology is pervasive in federal, state, and local government, academia, emergency response management, and business (9, 10, 11, 12, 13).
The use of GIS technology in the nutrition fields has been minimal with use primarily confined to public health epidemiology and foodservice marketing. Geographic information systems offers many applications to improve a population's nutritional health. GIS can be used to isolate at-risk populations, and more importantly locate the professionals that can help the at-risk populations.
For instance, during the aftermath of a hurricane nutrition professionals could link into the local disaster management team's GIS system and identify the locations and best routes to groups of people who need their services (11). Such disaster management GISs have been in use for the past five years including Hurricane Andrew, the Northridge Earthquake, and the Oklahoma City bombing (4, 13). Dietitians are faced with a variety of challenges during an emergency crisis (14, 15). Dietitians could use Nutri-Net to link into other GISs to find best routes for vendors to access a facility, to discover populations needing nutritional service, to find other professionals who could help in the crisis, to solicit advice from professionals who had been through a similar situation, and to find out updated information about the extent and severity of the crisis at hand.
The use of GIS allows dietetic professionals to quickly locate and communicate with other colleagues using the NPDB. GIS affords the advantage of the storage, maintenance, and operation of the NPDB and IDB. GIS provides unique and necessary services for both databases. The following is a fictitious example to demonstrate how Nutrl-Net's GIS would be used to locate and communicate with other professionals while improving public health.
A dietitian in Minnesota, noticed a trend in lead poisoning among members of the Latino and Hmong communities. Many of the dietitian's clients treat their children with homeopathic remedies. One person told the dietitian that she gave her daughter "Greta", a yellow powder, to treat her daughter's colic. Not knowing what "Greta" was, the dietitian accessed the Nutri-Net system to find out if anyone else had noticed high levels of lead poisoning among Latinos and Asian Indians. She also sent a message to find out what "Greta" really was. The dietitian targeted colleagues in the Mexico City and the Los Angeles areas to consult with nutritionists that typically dealt with a large number of these ethnic populations. The dietitian found that in the Hmong community the lead threat may come from the home remedy "Pay-loo-ah." Then, the dietitian discovered that "Greta" was almost 100% lead and so was another homeopathic remedy, Azacron. Both of these potentially lethal powders are used as treatment for stomachaches (empocho} among the Latino community .The dietitian was able to consult with other professionals to discover the cause of an alarming lead poisoning trend. The dietitian was also able to analyze and map the lead poisoning incidences. Nutri-Net provided the dietitian the tools necessary to curb the use of the dangerous lead powders throughout the world.
Nutri-Net Output
Output is the procedure that allows the information from the GIS to be presented in a form suitable to convey the intended information to the user. Data from a GIS can be displayed in one of three formats: hardcopy, softcopy, or electronic files. Hardcopy allows for a permanent means of display. Maps, tables, charts and text are common hardcopy outputs. Softcopy output is the format of data viewed on the computer monitor. Electronic files can be stored using a variety of media such as floppy discs or tapes. These electronic files can be used to transfer data to another computer system for additional storage or analysis or to produce hardcopy output at a remote location (1).
Data can be statistically analyzed in the GIS and results directly displayed in graphical form. Maps are one way to effectively display data and demonstrate interrelationships of the data. The attached map demonstrates how data can be visualized through mapping. This map demonstrates lead poisoning locations and incidences among different ethnic groups.
Summary
The proposed Nutri-Net project uses a GIS and the Internet to link dietitians and nutritionists throughout the world. Nutrl-Net consists of two databases [interactive database (IDB) and nutrition professionals databases (NPDB)] that are stored, manipulated and analyzed using a GIS. Nutri-Net is an excellent way to link dietitians and nutrition professionals throughout the world, to build international alliances throughout the dietetic community, to promote public health through nutrition by utilizing interactive data bases, and to provide a better understanding of the dietetic profession and the populations they serve.
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