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Denysyuk HV, Pires IM, Garcia NM. A roadmap for empowering cardiovascular disease patients: a 5P-Medicine approach and technological integration. PeerJ 2024; 12:e17895. [PMID: 39224824 PMCID: PMC11368085 DOI: 10.7717/peerj.17895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
This article explores the multifaceted concept of cardiovascular disease (CVD) patients' empowerment, emphasizing a shift from compliance-oriented models to active patient participation. In recognizing that cardiovascular disease is a paramount global health challenge, this study illuminates the pressing need for empowering patients, underscoring their role as active participants in their healthcare journey. Grounded in 5P-Medicine principles-Predictive, Preventive, Participatory, Personalized, and Precision Medicine-the importance of empowering CVD patients through analytics, prevention, participatory decision making, and personalized treatments is highlighted. Incorporating a comprehensive overview of patient empowerment strategies, including self-management, health literacy, patient involvement, and shared decision making, the article advocates for tailored approaches aligned with individual needs, cultural contexts, and healthcare systems. Technological integration is examined to enhance patient engagement and personalized healthcare experiences. The critical role of patient-centered design in integrating digital tools for CVD management is emphasized, ensuring successful adoption and meaningful impact on healthcare outcomes. The conclusion proposes vital research questions addressing challenges and opportunities in CVD patient empowerment. These questions stress the importance of medical community research, understanding user expectations, evaluating existing technologies, defining ideal empowerment scenarios, and conducting a literature review for informed advancements. This article lays the foundation for future research, contributing to ongoing patient-centered healthcare evolution, especially in empowering individuals with a 5P-Medicine approach to cardiovascular diseases.
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Affiliation(s)
- Hanna V. Denysyuk
- Instituto de Telecomunicações, Universidade da Beira Interior, Covilhã, Portugal
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Escola Superior de Tecnologia e Gestão de Águeda, Universidade de Aveiro, Águeda, Portugal
| | - Nuno M. Garcia
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
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Smalls BL, Kruse-Diehr A, Ortz CL, Douthitt K, McLouth C, Shelton R, Taylor Z, Williams E. Older adults using social support to improve self-care (OASIS): Adaptation, implementation and feasibility of peer support for older adults with T2D in appalachia: A feasibility study protocol. PLoS One 2024; 19:e0300196. [PMID: 38498512 PMCID: PMC10947915 DOI: 10.1371/journal.pone.0300196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes (T2D) is 17% higher in rural dwellers compared to their urban counterparts, and it increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. In rural Kentucky, up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are vital when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors and clinical and psychosocial outcomes related to T2D; however, literature also suggests self-selected social support can be obstructive when engaging in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used to prioritize older adults, especially those living in rural communities. METHOD To address this gap, we conducted formative research with stakeholders, and collaboratively identified an acceptable and feasible peer support EBI-peer health coaching (PHC)-that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. The goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. Testing the PHC components of the peer support intervention will be instrumental in promoting care for older adults in Appalachia, as it will allow for a larger scale intervention, which if effective, could be disseminated to community partners in Appalachia. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov (NCT06003634) in August 2023.
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Affiliation(s)
- Brittany L. Smalls
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Aaron Kruse-Diehr
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Courtney L. Ortz
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Key Douthitt
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Christopher McLouth
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States of America
| | - Rachel Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zoe Taylor
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Edith Williams
- Center for Community Health and Prevention, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States of America
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Gkiouleka A, Wong G, Sowden S, Kuhn I, Moseley A, Manji S, Harmston RR, Siersbaek R, Bambra C, Ford JA. Reducing health inequalities through general practice: a realist review and action framework. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-104. [PMID: 38551093 DOI: 10.3310/ytww7032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences and Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annie Moseley
- Patient and Public Involvement Representative, Norwich, UK
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | - Rikke Siersbaek
- Health System Foundations for Sláintecare Implementation, Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John A Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kim EK, Hills NK, Cheng Z, Tucker C, Gutierrez M, Alba D, Murphy E, Kim S. Effects of Pharmacotherapy for the Treatment of Obesity in an Urban, Safety-Net Population. Cureus 2023; 15:e47922. [PMID: 38034269 PMCID: PMC10682737 DOI: 10.7759/cureus.47922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To evaluate the effect of common weight loss pharmacotherapies among low-income, racially diverse adult patients at an urban safety-net weight management clinic. METHODS Our retrospective review from 2015 to 2019 examined patients who took either GLP-1 analog (GL) or phentermine/topiramate (PT) for ≥90 days and patients who exclusively pursued non-pharmacologic treatment for comparison. Changes in weight, blood pressure, and hemoglobin A1c at 1-year follow-up were reported. RESULTS We analyzed 22 GL and 26 PT patients and included 40 patients who pursued only lifestyle modifications (LM). All three groups achieved significant weight loss at one year: GL -3.69 (interquartile range (IQR): -11.0, -1.77) kg (p=0.0004), PT -7.01 (IQR: -13.4, -1.45) kg (p<0.001), and LM -3.01 (IQR: -6.81, 1.13) kg (p=0.005). There was no significant difference in the median weight loss (p=0.11) between the three groups. We observed no significant changes in systolic blood pressure but saw a significant change of -0.75 in hemoglobin A1c (IQR: -1.35, -0.25) (p=0.01) among patients with diabetes in the GL group. CONCLUSIONS Our real-world applications of GLP-1 and phentermine/topiramate suggest that both are effective weight loss medication regimens in low-socioeconomic status patients.
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Affiliation(s)
- Eric K Kim
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, USA
| | - Nancy K Hills
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Zoe Cheng
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Caroline Tucker
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Maria Gutierrez
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Diana Alba
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Elizabeth Murphy
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Sarah Kim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
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Gkiouleka A, Wong G, Sowden S, Bambra C, Siersbaek R, Manji S, Moseley A, Harmston R, Kuhn I, Ford J. Reducing health inequalities through general practice. Lancet Public Health 2023; 8:e463-e472. [PMID: 37244675 DOI: 10.1016/s2468-2667(23)00093-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/29/2023]
Abstract
Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved. We reviewed interventions influencing health and care inequalities in general practice and developed an action framework for health professionals and decision makers. We conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. We then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus (Cochrane Equity Methods Group) categories. 159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, we found that to reduce health inequalities, general practice needs to be informed by five key principles: involving coordinated services across the system (ie, connected), accounting for differences within patient groups (ie, intersectional), making allowances for different patient needs and preferences (ie, flexible), integrating patient worldviews and cultural references (ie, inclusive), and engaging communities with service design and delivery (ie, community-centred). Future work should explore how these principles can inform the organisational development of general practice.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, Cambridge, UK
| | - Geoff Wong
- University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | | | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, Cambridge, UK
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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Ayre E, Lee JJ, Frie K, Aveyard P, Albury CVA. GP delivered brief weight loss advice: associations between in-consultation behaviour change techniques and patient weight loss in recorded primary care discussions. Health Psychol Behav Med 2023; 11:2213751. [PMID: 37223642 PMCID: PMC10201997 DOI: 10.1080/21642850.2023.2213751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Background Primary care clinicians are encouraged to intervene opportunistically, offering weight-loss advice to people living with obesity. The BWeL trial showed patients receiving brief weight-loss advice from their general practitioner lost weight at one year follow-up. We examined the behaviour change techniques (BCTs) clinicians used to identify which BCTs are associated with this weight loss. Methods We coded 224 audio recorded interventions from the BWeL trial using the behavioural change techniques version one taxonomy (BCTTv1) and the 'refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours' (CALOR-RE taxonomy). Linear and logistic regressions were performed to analyse associations between behaviour change techniques used in these taxonomies and patient weight loss. Results Mean intervention length was 86 s. We identified 28 different BCTs BCTTv1 and 22 from CALOR-RE. No BCTs or BCT domains were associated with mean weight loss at 12 months, loss of 5% bodyweight, or action taken at 3 months. The BCT 'Feedback on outcomes of behaviour (future)' was associated with an increased likelihood that the patient reported taking action to lose weight by 12 months (OR = 6.10, 95%CI = 1.20, 31.0). Conclusion Although we found no evidence to support the use of particular BCTs, our results suggest that it is the brief intervention itself, rather than specific content, which may motivate weight loss. This can support clinicians to confidently intervene without needing complex training. Offering follow-up appointments can support positive changes to health behaviours, even if these are not associated with weight loss.
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Affiliation(s)
- Eleanor Ayre
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph J. Lee
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kerstin Frie
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Petroni ML, Brodosi L, Armandi A, Marchignoli F, Bugianesi E, Marchesini G. Lifestyle Intervention in NAFLD: Long-Term Diabetes Incidence in Subjects Treated by Web- and Group-Based Programs. Nutrients 2023; 15:792. [PMID: 36771497 PMCID: PMC9919358 DOI: 10.3390/nu15030792] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Behavioral programs are needed for prevention and treatment of NAFLD and the effectiveness of a web-based intervention (WBI) is similar to a standard group-based intervention (GBI) on liver disease biomarkers. OBJECTIVE We aimed to test the long-term effectiveness of both programs on diabetes incidence, a common outcome in NAFLD progression. METHODS 546 NAFLD individuals (212 WBI, 334 GBI) were followed up to 60 months with regular 6- to 12-month hospital visits. The two cohorts differed in several socio-demographic and clinical data. In the course of the years, the average BMI similarly decreased in both cohorts, by 5% or more in 24.4% and by 10% or more in 16.5% of cases available at follow-up. After excluding 183 cases with diabetes at entry, diabetes was newly diagnosed in 48 cases during follow-up (31 (16.6% of cases without diabetes at entry) in the GBI cohort vs. 17 (9.7%) in WBI; p = 0.073). Time to diabetes was similar in the two cohorts (mean, 31 ± 18 months since enrollment). At multivariable regression analysis, incident diabetes was significantly associated with prediabetes (odds ratio (OR) 4.40; 95% confidence interval (CI) 1.97-9.81; p < 0.001), percent weight change (OR 0.57; 95% CI 0.41-0.79; p < 0.001) and higher education (OR 0.49; 95% CI 0.27-0.86; p = 0.014), with no effect of other baseline socio-demographic, behavioral and clinical data, and of the type of intervention. The importance of weight change on incident diabetes were confirmed in a sensitivity analysis limited to individuals who completed the follow-up. CONCLUSION In individuals with NAFLD, WBI is as effective as GBI on the pending long-term risk of diabetes, via similar results on weight change.
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Affiliation(s)
| | - Lucia Brodosi
- IRCCS-Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Angelo Armandi
- Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy
| | | | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, 40138 Bologna, Italy
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Deverts DJ, Heisler M, Kieffer EC, Piatt GA, Valbuena F, Yabes JG, Guajardo C, Ilarraza-Montalvo D, Palmisano G, Koerbel G, Rosland AM. Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial. Trials 2022; 23:841. [PMID: 36192769 PMCID: PMC9527393 DOI: 10.1186/s13063-022-06764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management. METHODS This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes. DISCUSSION This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described. TRIAL REGISTRATION ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.
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Affiliation(s)
| | | | | | | | - Felix Valbuena
- Community Health and Social Services Center, Inc., Detroit, MI USA
| | | | - Claudia Guajardo
- Community Health and Social Services Center, Inc., Detroit, MI USA
| | | | - Gloria Palmisano
- Community Health and Social Services Center, Inc., Detroit, MI USA
| | - Glory Koerbel
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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González-Rivas JP, Pavlovska I, Polcrova A, Nieto-Martínez R, Mechanick JI. Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221095048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in type 2 diabetes (T2D) care is a global problem across diverse cultures. The Dysglycemia-Based Chronic Disease (DBCD) model promotes early and sustainable interventions along the insulin resistance (stage 1), prediabetes (stage 2), T2D (stage 3), and complications (stage 4) spectrum. In this model, lifestyle medicine is the cornerstone of preventive care to reduce DBCD progression and the socioeconomic/biological burden of disease. A comprehensive literature review, spanning 2000 to 2021, was performed and 55 studies were included examining the effects of lifestyle medicine and their cultural adaptions with different prevention modalities. In stage 1, primordial prevention targets modifiable primary drivers (behavior and environment), unhealthy lifestyles, abnormal adiposity, and insulin resistance with educational and motivational health promotion activities at individual, group, community, and population-based scales. Primary, secondary, and tertiary prevention targets individuals with mild hyperglycemia, severe hyperglycemia, and complications, respectively, using programs that incorporate structured lifestyle interventions. Culturally adapted lifestyle change in primary and secondary prevention improved quality of life and biomarkers, but with a limited impact of tertiary prevention on cardiovascular events. In conclusion, lifestyle medicine with cultural adaptations is an integral part of preventive care in patients with T2D. However, considerable research gaps exist, especially for tertiary prevention.
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Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Iuliia Pavlovska
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anna Polcrova
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Ramfis Nieto-Martínez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN, USA
| | - Jeffrey I. Mechanick
- he Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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11
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Halbert CH, Allen CG. Basic behavioral science research priorities in minority health and health disparities. Transl Behav Med 2021; 11:2033-2042. [PMID: 34850925 PMCID: PMC8634304 DOI: 10.1093/tbm/ibab143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Achieving health equity among disparity populations has been a national, regional, and local priority for several years. Health promotion and disease prevention behaviors play an important role in achieving health equity; the first generation of behavioral science studies in minority health and health disparities have provided important insights about the nature and distribution of risk exposure behaviors in disparity populations. Interventions have also been developed to enhance health promotion and disease prevention behaviors using behavioral counseling, tailored health communications, and interventions that are developed collaboratively with community stakeholders. Although intervention development and evaluation are components of transdisciplinary translational behavior research, discovery science is a critical first step in translational research. Consistent with this, conceptual models and frameworks of minority health and health disparities have evolved to include multilevel determinants that include basic behavioral mechanisms such as stress responses and stress reactivity that have physiological, psychological, and behavioral components that are relevant to minority health and health disparities. This report describes priorities, opportunities, and barriers to conducting transdisciplinary translational behavioral research during the next generation of minority health and health disparities research.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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12
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Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness. Public Health Nutr 2021; 25:422-436. [PMID: 34435943 PMCID: PMC8883766 DOI: 10.1017/s1368980021003682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To evaluate the cultural tailoring methods used in type 2 diabetes (T2D), prevention and management interventions for populations of Black African ancestry and to examine their effectiveness on measures of glycaemia. Design: Three databases were searched in October 2020; eligible studies used a randomised controlled trial (RCT) design to evaluate the effectiveness of culturally tailored lifestyle interventions compared with usual care for the prevention or management of T2D in adults of Black African ancestry. Cultural tailoring methods were evaluated using the Facilitator-Location-Language-Messaging (FiLLM) framework, whereby facilitator refers to delivery by individuals from the target community, language focuses on using native language or language appropriate to literacy levels, location refers to delivery in meaningful settings, and messaging is tailoring with relevant content and modes of delivery. Results: Sixteen RCT were identified, all from USA. The mean age of participants was 55 years, majority female. Six of fifteen RCT reported significant improvements in glycated haemoglobin (HbA1c) at 6 and 8 months; one, in prediabetes, reported significantly improved fasting plasma glucose. Diabetes knowledge improvement (5/7 studies) was associated with HbA1c improvement. The majority tailored to location (12/16), facilitators (11/16), messaging (9/16) and language (6/16) domains of FiLLM. Those with ethnically matched facilitators and those which tailored to more than one domain showed the greatest HbA1C benefits. Conclusion: This evidence supports the effectiveness of culturally tailored lifestyle interventions for T2D management in populations of Black African ancestry, with further RCT needed to evaluate interventions for T2D prevention and for communities outside of the USA.
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Raghavan S, Jablonski K, Delahanty LM, Maruthur NM, Leong A, Franks PW, Knowler WC, Florez JC, Dabelea D. Interaction of diabetes genetic risk and successful lifestyle modification in the Diabetes Prevention Programme. Diabetes Obes Metab 2021; 23:1030-1040. [PMID: 33394545 PMCID: PMC8852694 DOI: 10.1111/dom.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
AIM To test whether diabetes genetic risk modifies the association of successful lifestyle changes with incident diabetes. MATERIALS AND METHODS We studied 823 individuals randomized to the intensive lifestyle intervention (ILS) arm of the Diabetes Prevention Programme who were diabetes-free 1 year after enrolment. We tested additive and multiplicative interactions of a 67-variant diabetes genetic risk score (GRS) with achievement of three ILS goals at 1 year (≥7% weight loss, ≥150 min/wk of moderate leisure-time physical activity, and/or a goal for self-reported total fat intake) on the primary outcome of incident diabetes over 3 years of follow-up. RESULTS A lower GRS and achieving each or all three ILS goals were each associated with lower incidence of diabetes (all P < 0.05). Additive interactions were significant between the GRS and achievement of the weight loss goal (P < 0.001), physical activity goal (P = 0.02), and all three ILS goals (P < 0.001) for diabetes risk. Achievement of all three ILS goals was associated with 1.8 (95% CI 0.3, 3.4), 3.1 (95% CI 1.5, 4.7), and 3.9 (95% CI 1.6, 6.2) fewer diabetes cases/100-person-years in the first, second and third GRS tertiles (P < 0.001 for trend). Multiplicative interactions between the GRS and ILS goal achievement were significant for the diet goal (P < 0.001), but not for weight loss (P = 0.18) or physical activity (P = 0.62) goals. CONCLUSIONS Genetic risk may identify high-risk subgroups for whom successful lifestyle modification is associated with greater absolute reduction in the risk of incident diabetes.
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Affiliation(s)
- Sridharan Raghavan
- Department of Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO
- Colorado Cardiovascular Outcomes Research Consortium, Aurora, CO
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, Colorado School of Public Health, Aurora, CO
| | - Kathleen Jablonski
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Linda M. Delahanty
- Diabetes Unit and Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nisa M. Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron Leong
- Diabetes Unit and Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Paul W. Franks
- Genetic & Molecular Epidemiology Unit, Lund University Diabetes Center, Department of Clinical Science, Malmö, Sweden
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Jose C. Florez
- Diabetes Unit and Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA
| | - Dana Dabelea
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, Colorado School of Public Health, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
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14
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Maula A, Kendrick D, Kai J, Griffiths F. Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus. Diabet Med 2021; 38:e14394. [PMID: 32871624 DOI: 10.1111/dme.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community-based interventions work through several interconnected stages. An individual's actions in response to an intervention depend on many known and unknown factors, which vary among individuals. AIM To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes. METHODS A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention's resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and 'mechanisms' were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories. RESULTS Mechanisms that were repeatedly identified included high-frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes-related modifiable risk factors, motivational interviewing and counselling, goal-setting, self-monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalising each intervention component to the participants' gender, culture and family setting. CONCLUSION This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context.
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Affiliation(s)
- Asiya Maula
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Beverly EA, Ritholz MD, Cook K, Johnson LK, Ruhil A, Singh RP, Berryman DE. Diabetes in Appalachia: providers' perspectives. Prim Health Care Res Dev 2020; 21:e11. [PMID: 32404218 PMCID: PMC7232122 DOI: 10.1017/s1463423620000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers' experiences treating people with diabetes in this region. This study explored providers' perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. METHODS We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). RESULTS Qualitative analysis revealed four themes: (1) patients' diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers' cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population. CONCLUSIONS Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
| | - Marilyn D. Ritholz
- Department of Behavioral Health, Joslin Diabetes Center, Boston, MA02215, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA02215, USA
| | - Karie Cook
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
| | - Lesli K. Johnson
- Voinovich School of Leadership and Public Affairs, Ohio University, Athens, OH45701, USA
| | - Anirudh Ruhil
- Voinovich School of Leadership and Public Affairs, Ohio University, Athens, OH45701, USA
| | - Rashmi P. Singh
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
| | - Darlene E. Berryman
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
- Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
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16
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Maula A, Kai J, Woolley AK, Weng S, Dhalwani N, Griffiths FE, Khunti K, Kendrick D. Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabet Med 2020; 37:623-635. [PMID: 31785118 PMCID: PMC7154644 DOI: 10.1111/dme.14193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/31/2022]
Abstract
AIM The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes. METHODS This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. RESULTS Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I2 = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I2 = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I2 = 85%) appeared most effective. CONCLUSION Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.
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Affiliation(s)
- A. Maula
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - J. Kai
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - A. K. Woolley
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - S. Weng
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - N. Dhalwani
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Real World EvidenceEvideraLondonUK
| | - F. E. Griffiths
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK
- School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | - K. Khunti
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - D. Kendrick
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
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Heine M, Lupton-Smith A, Pakosh M, Grace SL, Derman W, Hanekom SD. Exercise-based rehabilitation for major non-communicable diseases in low-resource settings: a scoping review. BMJ Glob Health 2019; 4:e001833. [PMID: 31798993 PMCID: PMC6861093 DOI: 10.1136/bmjgh-2019-001833] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION While there is substantial evidence for the benefits of exercise-based rehabilitation in the prevention and management of non-communicable disease (NCD) in high-resource settings, it is not evident that these programmes can be effectively implemented in a low-resource setting (LRS). Correspondingly, it is unclear if similar benefits can be obtained. The objective of this scoping review was to summarise existing studies evaluating exercise-based rehabilitation, rehabilitation intervention characteristics and outcomes conducted in an LRS for patients with one (or more) of the major NCDs. METHODS The following databases were searched from inception until October 2018: PubMed/Medline, Embase, CINAHL, Cochrane Library, PsycINFO and trial registries. Studies on exercise-based rehabilitation for patients with cardiovascular disease, diabetes, cancer or chronic respiratory disease conducted in an LRS were included. Data were extracted with respect to study design (eg, type, patient sample, context), rehabilitation characteristics (eg, delivery model, programme adaptations) and included outcome measures. RESULTS The search yielded 5930 unique citations of which 60 unique studies were included. Study populations included patients with cardiovascular disease (48.3%), diabetes (28.3%), respiratory disease (21.7%) and cancer (1.7%). Adaptations included transition to predominant patient-driven home-based rehabilitation, training of non-conventional health workers, integration of rehabilitation in community health centres, or triage based on contextual or patient factors. Uptake of adapted rehabilitation models was 54%, retention 78% and adherence 89%. The majority of the outcome measures included were related to body function (65.7%). CONCLUSIONS The scope of evidence suggests that adapted exercise-based rehabilitation programmes can be implemented in LRS. However, this scope of evidence originated largely from lower middle-income, urban settings and has mostly been conducted in an academic context which may hamper extrapolation of evidence to other LRS. Cost-benefits, impact on activity limitations and participation restrictions, and subsequent mortality and morbidity are grossly understudied.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Division of Physiotherapy, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Alison Lupton-Smith
- Division of Physiotherapy, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Maureen Pakosh
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- IOC Research Center, South Africa
| | - Susan D Hanekom
- Division of Physiotherapy, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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West DS, Dutton G, Delahanty LM, Hazuda HP, Rickman AD, Knowler WC, Vitolins MZ, Neiberg RH, Peters A, Gee M, Cassidy Begay M. Weight Loss Experiences of African American, Hispanic, and Non-Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity (Silver Spring) 2019; 27:1275-1284. [PMID: 31338998 PMCID: PMC6658112 DOI: 10.1002/oby.22522] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups. METHODS Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors. RESULTS All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women. CONCLUSIONS Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.
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Affiliation(s)
- Delia Smith West
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Gareth Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda M Delahanty
- Diabetes Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen P Hazuda
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Amy D Rickman
- Department of Exercise & Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, NIDDK, Phoenix, Arizona, USA
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Molly Gee
- Behavioral Medicine Research Center, Baylor College of Medicine, Houston, Texas, USA
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Hassaballa I, Davis L, Francisco V, Schultz J, Fawcett S. Examining implementation and effects of a comprehensive community intervention addressing type 2 diabetes among high-risk minority patients in Durham County, NC. J Prev Interv Community 2019; 49:20-42. [DOI: 10.1080/10852352.2019.1633069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Vincent Francisco
- University of Kansas (KU) Center for Community Health & Development, Lawrence, KS, USA
| | - Jerry Schultz
- University of Kansas Center for Community Health & Development, Lawrence, KS, USA
| | - Stephen Fawcett
- University of Kansas Center for Community Health & Development, Lawrence, KS, USA
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Porter GC, Laumb K, Michaud T, Brito F, Petreca D, Schwieger G, Bartee T, Yeary KHK, Estabrooks PA. Understanding the impact of rural weight loss interventions: A systematic review and meta-analysis. Obes Rev 2019; 20:713-724. [PMID: 30633845 PMCID: PMC7565480 DOI: 10.1111/obr.12825] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023]
Abstract
Rural adults have a higher risk of developing obesity than urban adults. Several evidence-based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE-AIM-related data were abstracted from each article. We performed a meta-analysis to examine effectiveness. Sixty-four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta-analyses revealed the interventions achieved a significant weight reduction, and longer-duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.
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Affiliation(s)
- Gwenndolyn C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Karen Laumb
- Laumb Consulting, LLC, Minneapolis, Minnesota, USA
| | - Tzeyu Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fabiana Brito
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel Petreca
- Nucleus of Research in Collective Health & Environment, University of Contestado, Mafra-SC, Brazil
| | - Gina Schwieger
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Todd Bartee
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, Nebraska, USA
| | - Karen H K Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
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21
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Clark DO, Keith N, Weiner M, Xu H. Outcomes of an RCT of videoconference vs. in-person or in-clinic nutrition and exercise in midlife adults with obesity. Obes Sci Pract 2019; 5:111-119. [PMID: 31019728 PMCID: PMC6469332 DOI: 10.1002/osp4.318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE New communication technologies have shown some promise in lifestyle weight loss interventions but may be most effective when leveraging face-to-face communications. The study reported here sought to test whether weight loss programme attendance and outcomes are greater when offered in-person at community sites or remotely via videoconference vs. in Federally Qualified Health Centers (FQHCs). In a three-arm randomized trial among 150 FQHC adults, intervention delivery in community-sites or via videoconference was tested against a clinic-based lifestyle intervention (enhanced usual care [EUC]). METHODS Twice weekly, a nutrition topic was reviewed, and exercise sessions were held in a 20-week programme delivered either in community settings or via videoconference. The primary outcome was the proportion of participants losing more than 2 kg at 6 (end of treatment) and 12 months in intent-to-treat analyses. RESULTS Mean (SD) age was 53 years, 82% were women, 65% were African-American, 50% reported $18,000 or less household income and 49% tested low in health literacy, and mean (SD) body mass index was 39 kg m-2. The proportion losing more than 2 kg of weight in the community site, videoconference and EUC groups was 33%, 34% and 24%, respectively, at 6 months and 29%, 34% and 29% at 12 months. No differences reached significance. Attendance was poor in all groups; 45% of community site, 58% of videoconference and 16% of EUC participants attended at least one session. CONCLUSION Videoconference and community-based delivery were as effective as an FQHC-based weight loss programme.
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Affiliation(s)
- D. O. Clark
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- Department of Medicine, Division of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisINUSA
| | - N. Keith
- Indiana University Center for Aging ResearchIndianapolisINUSA
- Regenstrief Institute, Inc.IndianapolisINUSA
- School of Health and Human SciencesIndiana University‐Purdue University IndianapolisIndianapolisINUSA
| | - M. Weiner
- William M. Tierney Center for Health Services ResearchIndiana University School of Medicine, Regenstrief Institute, Inc.IndianapolisINUSA
| | - H. Xu
- Department of BiostatisticsIndiana University School of MedicineIndianapolisINUSA
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Wang J, Cai C, Padhye N, Orlander P, Zare M. A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial. JMIR Mhealth Uhealth 2018; 6:e92. [PMID: 29636320 PMCID: PMC5915674 DOI: 10.2196/mhealth.4478] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/15/2018] [Accepted: 03/10/2018] [Indexed: 01/07/2023] Open
Abstract
Background Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community. Objective The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults with type 2 diabetes mellitus living in underserved communities. Methods We conducted a randomized controlled trial to examine the feasibility and preliminary efficacy of a behavioral lifestyle intervention. Overweight or obese patients with type 2 diabetes mellitus were recruited from an underserved minority community health center in Houston, Texas. They were randomly assigned to one of the three groups: (1) behavior intervention with smartphone-based self-monitoring, (2) behavior intervention with paper diary-based self-monitoring, and (3) usual care group. Both the mobile and paper groups received a total of 11 face-to-face group sessions in a 6-month intervention. The mobile group received an Android-based smartphone with 2 apps loaded to help them record their diet, physical activity, weight, and blood glucose, along with a connected glucometer, whereas the paper group used paper diaries for these recordings. Primary outcomes of the study included percentage weight loss and glycated hemoglobin (HbA1c) changes over 6 months. Results A total of 26 patients were enrolled: 11 in the mobile group, 9 in the paper group, and 6 in the control group. We had 92% (24/26) retention rate at 6 months. The sample is predominantly African Americans with an average age of 56.4 years and body mass index of 38.1. Participants lost an average of 2.73% (mobile group) and 0.13% (paper group) weight at 6 months, whereas the control group had an average 0.49% weight gain. Their HbA1c changed from 8% to 7 % in mobile group, 10% to 9% in paper group, and maintained at 9% for the control group. We found a significant difference on HbA1c at 6 months among the 3 groups (P=.01). We did not find statistical group significance on percentage weight loss (P=.20) and HbA1c changes (P=.44) overtime; however, we found a large effect size of 0.40 for weight loss and a medium effect size of 0.28 for glycemic control. Conclusions Delivering a simplified behavioral lifestyle intervention using mobile health–based self-monitoring in an underserved community is feasible and acceptable and shows higher preliminary efficacy, as compared with paper-based self-monitoring. A full-scale randomized controlled trial is needed to confirm the findings in this pilot study. Trial Registration ClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648 (Archived by WebCite at http://www.webcitation.org/6ySidjmT7)
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Affiliation(s)
- Jing Wang
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chunyan Cai
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Philip Orlander
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mohammad Zare
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Leahey TM, LaRose JG, Mitchell MS, Gilder CM, Wing RR. Small Incentives Improve Weight Loss in Women From Disadvantaged Backgrounds. Am J Prev Med 2018; 54:e41-e47. [PMID: 29338951 PMCID: PMC5818321 DOI: 10.1016/j.amepre.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Women from lower-income backgrounds have the highest rates of obesity. Thus, effective programs for this high-risk population are urgently needed. Evidence suggests that adding financial incentives to treatment helps to engage and promote health behavior change in lower-income populations; however, this has never been tested in women for obesity treatment. The purpose of this study was to examine whether adding small financial incentives to Internet weight loss treatment yields better weight loss outcomes in women from lower-income backgrounds compared with the same treatment without incentives. Weight losses in lower-versus higher-income women were also compared. METHODS Data were pooled from two randomized trials in which women (N=264) received either Internet behavioral weight loss treatment (IBWL) or IBWL plus incentives (IBWL+$). Weight was objectively assessed. Data were collected and analyzed from 2011 to 2017. RESULTS Women from lower-income backgrounds had significantly better weight loss outcomes in IBWL+$ compared with IBWL alone (6.4 [SD=4.9%] vs 2.6 [SD=4.6%], p=0.01). Moreover, a greater percentage achieved a ≥5% weight loss in IBWL+$ vs IBWL alone (52.6% vs 38.1%, p=0.01). Interestingly, the comparison between lower-income versus higher-income groups showed that, in IBWL alone, women with lower income achieved significantly poorer weight losses (3.4 [SD=4.2%] vs 4.9 [SD=4.0%], p=0.03). By contrast, in IBWL+$, weight loss outcomes did not differ by income status (5.0 [SD=5.6%] vs 5.3 [SD=3.8%], p=0.80), and a similar percentage of lower- versus higher-income women achieved a ≥5% weight loss (52.6% vs 53.8%, p=0.93). CONCLUSIONS An Internet behavioral weight loss program plus financial incentives may be an effective strategy to promote excellent weight losses in women with lower income, thereby enhancing equity in treatment outcomes in a vulnerable, high-risk population. These data also provide important evidence to support federally funded incentive initiatives for lower-income, underserved populations.
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Affiliation(s)
- Tricia M Leahey
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut.
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Marc S Mitchell
- Department of Kinesiology, Western University, Ontario, Canada
| | - Carnisha M Gilder
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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Utumatwishima JN, Chung ST, Bentley AR, Udahogora M, Sumner AE. Reversing the tide - diagnosis and prevention of T2DM in populations of African descent. Nat Rev Endocrinol 2018; 14:45-56. [PMID: 29052590 DOI: 10.1038/nrendo.2017.127] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.
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Affiliation(s)
- Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Margaret Udahogora
- Dietetics Program, University of Maryland, College Park, 0112 Skinner Building, Office 0125 Skinner Building, College Park, Maryland 20742, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
- National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
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Sumlin LL, Brown SA. Culture and Food Practices of African American Women With Type 2 Diabetes. THE DIABETES EDUCATOR 2017; 43:565-575. [PMID: 28929866 PMCID: PMC8401831 DOI: 10.1177/0145721717730646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose The goals of this descriptive ethnographic study were to (1) describe the day-to-day selection, preparation, and consumption of food among African American women (AAW) with type 2 diabetes mellitus (T2DM); (2) identify their typical food selections and consumption practices when dining out at restaurants and at social gatherings (ie, church functions, holidays); (3) highlight the valued behaviors and beliefs that influence these women's food practices; and (4) determine how social interactions influence those food practices. Methods Symbolic interactionism, a sensitizing framework, guided this study. Purposeful sampling was used to recruit 20 AAW from 35 to 70 years of age diagnosed with T2DM who shopped and prepared meals for their families and attended church functions where food was served. Data collection consisted of one-on-one interviews and observations of participants during church fellowship dinners, grocery shopping, and food preparation. A social anthropological approach to content analysis was used to describe behavioral regularities in food practices. Results Informants exhibited a constant struggle in food practices, particularly within the home setting. Difficulties in making dietary modifications resulted from conflicts between the need to change dietary practices to control diabetes and personal food preferences, food preferences of family members, and AAW's emotional dedication to the symbolism of food derived from traditional cultural food practices passed down from generation to generation. Conclusions African American women are the gatekeepers for family food practices, holding the keys to healthy dietary practices. This study helps to fill the research gap regarding cultural dietary food practices within this population.
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Affiliation(s)
- Lisa L Sumlin
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Sumlin, Dr Brown)
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Sumlin, Dr Brown)
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27
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Halbert CH, Bellamy S, Briggs V, Delmoor E, Purnell J, Rogers R, Weathers B, Johnson JC. A comparative effectiveness education trial for lifestyle health behavior change in African Americans. HEALTH EDUCATION RESEARCH 2017; 32:207-218. [PMID: 28335038 PMCID: PMC5914351 DOI: 10.1093/her/cyx039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a community-based sample of 530 adult African Americans. Outcomes variables were physical activity (PA) and fruit and vegetable intake. Outcomes were evaluated at baseline and 1-month following interventions about shared risk factors for cancer and cardiovascular disease (CVD) (integrated, INT) or CVD only (disease-specific). Significant increases were found in the proportion of participants who met PA guidelines from baseline (47.4%) to follow-up (52.4%) (P = 0.005). In the stratified analysis that were conducted to examine interaction between education and intervention group assignment, this effect was most apparent among participants who had ≤high school education and were randomized to INT (OR = 2.28, 95% CI = 1.04, 5.00, P = 0.04). Completing the intervention was associated with a 1.78 odds of meeting PA guidelines (95% CI = 1.02, 3.10, P = 0.04). Education about risk factors for chronic disease and evidence-based strategies for health behavior change may be useful for addressing obesity-related behaviors among African Americans.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Ralph H. Johnson Veteran Administration Medical Center, Charleston, SC 29425, USA
| | - Scarlett Bellamy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vanessa Briggs
- Health Promotion Council of Southeastern Pennsylvania, Philadelphia, PA 19102, USA
| | - Ernestine Delmoor
- National Black Leadership Initiative on Cancer, Philadelphia Chapter, Philadelphia, PA 19104, USA
| | | | - Rodney Rogers
- Christ of Calvary Community Development Corporation, Philadelphia, PA 19143, USA
| | - Benita Weathers
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jerry C. Johnson
- Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Ahn S, Lee J, Bartlett-Prescott J, Carson L, Post L, Ward KD. Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes. Am J Health Promot 2017; 32:409-422. [DOI: 10.1177/0890117117696250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a “real-world” setting. Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants. Setting: Urban/metropolitan city in the United States. Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months. Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months. Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c. Results: The treatment group demonstrated reductions in BMI (percentage change = −2.1%, P < .001) and HbA1c (−0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = −0.08, P = .025). Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.
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Affiliation(s)
- SangNam Ahn
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Joonhyung Lee
- Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA
| | | | - Lisa Carson
- Methodist Le Bonheur Healthcare Hospital, Memphis, TN, USA
| | - Lindsey Post
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA
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Cradock KA, ÓLaighin G, Finucane FM, Gainforth HL, Quinlan LR, Ginis KAM. Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis. Int J Behav Nutr Phys Act 2017; 14:18. [PMID: 28178985 PMCID: PMC5299734 DOI: 10.1186/s12966-016-0436-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight. METHODS We performed a systematic review of papers published between 1975-2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight were meta-analysed and examined in relation to use of BCTs. RESULTS Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1.11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, P < 0.00001]) in intervention groups compared to control groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002). Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: 'instruction on how to perform a behaviour', 'behavioural practice/rehearsal', 'demonstration of the behaviour' and 'action planning', as were intervention features 'supervised physical activity', 'group sessions', 'contact with an exercise physiologist', 'contact with an exercise physiologist and a dietitian', 'baseline HbA1c >8 %' and interventions of greater frequency and intensity. CONCLUSIONS Diet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.
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Affiliation(s)
- Kevin A. Cradock
- Physiology, School of Medicine, NUI Galway, University Road, Galway, Ireland
- Electrical & Electronic Engineering, School of Engineering & Informatics, NUI Galway, University Road, Galway, Ireland
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering & Informatics, NUI Galway, University Road, Galway, Ireland
- National Centre for Biomedical Engineering Science, NUI Galway, University Road, Galway, Ireland
| | - Francis M. Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland
| | - Heather L. Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, ART 129– 1147, Research Road, Kelowna, BC V1V 1 V7 Canada
| | - Leo R. Quinlan
- Physiology, School of Medicine, NUI Galway, University Road, Galway, Ireland
| | - Kathleen A. Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, ART 129-1147 Research Road, Kelowna, BC V1V 1 V7 Canada
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Il'yasova D, Wong BJ, Waterstone A, Kinev A, Okosun IS. Systemic F 2-Isoprostane Levels in Predisposition to Obesity and Type 2 Diabetes: Emphasis on Racial Differences. DIVERSITY AND EQUALITY IN HEALTH AND CARE 2017; 14:91-101. [PMID: 32523692 DOI: 10.21767/2049-5471.100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review focuses on racial differences in systemic levels of lipid peroxidation markers F2-isoprostanes as metabolic characteristics predisposing to obesity and type 2 diabetes. Elevated levels F2-isoprostanes were found in obesity, type 2 diabetes and their comorbidities. It was hypothesized that increased F2-isoprostane levels reflect the obesity-induced oxidative stress that promotes the development of type 2 diabetes. However, African Americans have lower levels of systemic F2-isoprostane levels despite their predisposition to obesity and type 2 diabetes. The review summarizes new findings from epidemiological studies and a novel interpretation of metabolic determinants of systemic F2-isoprostane levels as a favorable phenotype. Multiple observations indicate that systemic F2-isoprostane levels reflect intensity of oxidative metabolism, a major endogenous source of reactive oxygen species, and specifically, the intensity of fat utilization. Evidence from multiple human studies proposes that targeting fat metabolism can be a productive race-specific strategy to address the existing racial health disparities. Urinary F2-isoprostanes may provide the basis for targeted interventions to prevent obesity and type 2 diabetes among populations of African descent.
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Affiliation(s)
- Dora Il'yasova
- School of Public Health, Georgia State University, 140 Decatur St, Atlanta, GA, USA
| | - Brett J Wong
- Department of Kinesiology and Health, Georgia State University, 140 Decatur St, Atlanta, GA, USA
| | - Anna Waterstone
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | | | - Ike S Okosun
- School of Public Health, Georgia State University, 140 Decatur St, Atlanta, GA, USA
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O'Neil CE, Nicklas TA. State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827607306433.] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.
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Affiliation(s)
- Carol E. O'Neil
- Department of Pediatrics, Children's Nutrition Research Center, Baylor
College of Medicine, Houston, Texas (TAN)
| | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, 1100
Bates Avenue, Baylor College of Medicine, Houston, TX 77030-2600,
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O'Neil PM, Miller-Kovach K, Tuerk PW, Becker LE, Wadden TA, Fujioka K, Hollander PL, Kushner RF, Timothy Garvey W, Rubino DM, Malcolm RJ, Weiss D, Raum WJ, Salyer JL, Hermayer KL, Rost SL, Veliko JL, Sora ND. Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes. Obesity (Silver Spring) 2016; 24:2269-2277. [PMID: 27804264 DOI: 10.1002/oby.21616] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Modest weight loss from clinical interventions improves glycemic control in type 2 diabetes (T2DM). Data are sparse on the effects of weight loss via commercial weight loss programs. This study examined the effects on glycemic control and weight loss of the standard Weight Watchers program, combined with telephone and email consultations with a certified diabetes educator (WW), compared with standard diabetes nutrition counseling and education (standard care, SC). METHODS In a 12-month randomized controlled trial at 16 U.S. research centers, 563 adults with T2DM (HbA1c 7-11%; BMI 27-50 kg/m2 ) were assigned to either the commercially available WW program (regular community meetings, online tools), plus telephone and email counseling from a certified diabetes educator, or to SC (initial in-person diabetes nutrition counseling/education, with follow-up informational materials). RESULTS Follow-up rate was 86%. Twelve-month HbA1c changes for WW and SC were -0.32 and +0.16, respectively; 24% of WW versus 14% of SC achieved HbA1c <7.0% (P = 0.004). Weight losses were -4.0% for WW and -1.9% for SC (Ps < 0.001). 26% of WW versus 12% of SC reduced diabetes medications (P < 0.001). WW participants had greater reductions in waist circumference (P < 0.001) and C-reactive protein (P = 0.02) but did not differ on other cardiovascular risk factors. CONCLUSIONS Widely available commercial weight loss programs with community and online components, combined with scalable complementary diabetes education, may represent accessible and effective components of management plans for adults with overweight/obesity and T2DM.
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Affiliation(s)
- Patrick M O'Neil
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | - Peter W Tuerk
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Lynne E Becker
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ken Fujioka
- Scripps Clinical Research, La Jolla, California, USA
| | | | - Robert F Kushner
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Domenica M Rubino
- Washington Center for Weight Management & Research, Arlington, Virginia, USA
| | - Robert J Malcolm
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Weiss
- Your Diabetes Endocrine Nutrition Group, Mentor, Ohio, USA
| | | | - Jonny L Salyer
- Lovelace Scientific Resources, Albuquerque, New Mexico, USA
| | - Kathie L Hermayer
- Division of Endocrinology, Diabetes & Medical Genetics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Jan L Veliko
- Weight Watchers International, New York, New York, USA
| | - Nicoleta D Sora
- Division of Endocrinology, Diabetes & Medical Genetics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Olry de Labry Lima A, Bermúdez Tamayo C, Pastor Moreno G, Bolívar Muñoz J, Ruiz Pérez I, Johri M, Quesada Jiménez F, Cruz Vela P, de Los Ríos Álvarez AM, Prados Quel MÁ, Moratalla López E, Domínguez Martín S, Lopez de Hierro JA, Ricci Cabello I. Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level. GACETA SANITARIA 2016; 31:40-47. [PMID: 27477476 DOI: 10.1016/j.gaceta.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. METHODS 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. RESULTS The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. CONCLUSIONS In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Clara Bermúdez Tamayo
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | - Julia Bolívar Muñoz
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Isabel Ruiz Pérez
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mira Johri
- Division of Global Health, University of Montreal; Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | | | | | | | | | | | | | | | - Ignacio Ricci Cabello
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
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Rodrigues AL, Ball J, Ski C, Stewart S, Carrington MJ. A systematic review and meta-analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities. Prev Med 2016; 87:22-34. [PMID: 26876624 DOI: 10.1016/j.ypmed.2016.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) prevention programmes have been effective in urban residents, their effectiveness in non-urban settings, where cardio-metabolic risk is typically elevated, is unknown. We systematically reviewed the effectiveness of primary prevention programmes aimed at reducing risk factors for CVD/T2DM, including blood pressure, body mass index (BMI), blood lipid and glucose, diet, lifestyle, and knowledge in adults residing in non-urban areas. METHODS Twenty-five manuscripts, globally, from 1990 were selected for review (seven included in the meta-analyses) and classified according to: 1) study design (randomised controlled trial [RCT] or pre-/post-intervention); 2) intervention duration (short [<12months] or long term [≥12months]), and; 3) programme type (community-based programmes or non-community-based programmes). RESULTS Multiple strategies within interventions focusing on health behaviour change effectively reduced cardio-metabolic risk in non-urban individuals. Pre-/post-test design studies showed more favourable improvements generally, while RCTs showed greater improvements in physical activity and disease and risk knowledge. Short-term programmes were more effective than long-term programmes and in pre-/post-test designs reduced systolic blood pressure by 4.02mmHg (95% CI -6.25 to -1.79) versus 3.63mmHg (95% CI -7.34 to 0.08) in long-term programmes. Community-based programmes achieved good results for most risk factors except BMI and (glycated haemoglobin) HbA1c. CONCLUSION The setting for applying cardio-metabolic prevention programmes is important given its likelihood to influence programme efficacy. Further investigation is needed to elucidate the individual determinants of cardio-metabolic risk in non-urban populations and in contrast to urban populations.
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Affiliation(s)
- Andre L Rodrigues
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Chantal Ski
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Simon Stewart
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Melinda J Carrington
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
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Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. PATIENT EDUCATION AND COUNSELING 2016; 99:926-43. [PMID: 26658704 DOI: 10.1016/j.pec.2015.11.003] [Citation(s) in RCA: 512] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/16/2015] [Accepted: 11/05/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Assess effect of diabetes self-management education and support methods, providers, duration, and contact time on glycemic control in adults with type 2 diabetes. METHOD We searched MEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO to December 2013 for interventions which included elements to improve participants' knowledge, skills, and ability to perform self-management activities as well as informed decision-making around goal setting. RESULTS This review included 118 unique interventions, with 61.9% reporting significant changes in A1C. Overall mean reduction in A1C was 0.74 and 0.17 for intervention and control groups; an average absolute reduction in A1C of 0.57. A combination of group and individual engagement results in the largest decreases in A1C (0.88). Contact hours ≥10 were associated with a greater proportion of interventions with significant reduction in A1C (70.3%). In patients with persistently elevated glycemic values (A1C>9), a greater proportion of studies reported statistically significant reduction in A1C (83.9%). CONCLUSIONS This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels. PRACTICE IMPLICATIONS The data suggest mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.
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Affiliation(s)
| | - Dawn Sherr
- American Association of Diabetes Educators, 200 W. Madison Street, Chicago, IL 60606, USA.
| | - Ruth D Lipman
- American Association of Diabetes Educators, 200 W. Madison Street, Chicago, IL 60606, USA.
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Madden AM, Riordan AM, Knowles L. Outcomes in coeliac disease: a qualitative exploration of patients' views on what they want to achieve when seeing a dietitian. J Hum Nutr Diet 2016; 29:607-16. [PMID: 27196120 DOI: 10.1111/jhn.12378] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Coeliac disease (CD) is managed by life-long adherence to a gluten-free diet and dietitians have the potential to facilitate this. Patient involvement through shared decision-making is central to behaviour-change skills used by dietitians, although there is little evidence supporting its inclusion in evaluating dietetic interventions. The present study aimed to explore patients' preferences for diet and nutrition-related outcomes in CD. METHODS Adults with CD or adult carers of children with CD were invited through support networks. Participants took part in a telephone, face-to-face interview or focus group which was audio-recorded and transcribed. Themes were developed using a framework method. Ethical approval was obtained. RESULTS Twenty-nine adult patients and five parents of CD children participated 0-34 years after diagnosis. Four main outcome-related themes emerged: (i) Participants wanted information specific to their lifestyle and time since diagnosis, focussing on food containing gluten, practical issues, prescribable items and general nutrition. (ii) The degree of satisfaction with the consultation process impacted on participants' experience, including the dietitian's CD expertise, consistency of the dietitian seen, and the frequency and length of appointments. (iii) Health concerns were important to participants and focussed on risk of osteoporosis, unwanted weight gain, and the fat and sugar content of manufactured gluten-free products. (iv) Clinical monitoring, including bone scans and antibody measurements, was mentioned but was not described as being of importance for most participants. CONCLUSIONS The outcomes preferred by CD patients and carers focussed primarily on information and resources received and satisfaction with their dietetic consultation.
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Affiliation(s)
- A M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - A M Riordan
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - L Knowles
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Sutton SM, Magwood GS, Jenkins CH, Nemeth LS. A Scoping Review of Behavioral Weight Management Interventions in Overweight/Obese African American Females. West J Nurs Res 2016; 38:1035-66. [DOI: 10.1177/0193945916635160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
African American females are adversely affected by overweight and obesity and accompanying physical, psychosocial, and economic consequences. Behavioral weight management interventions are less effective in addressing the needs of overweight and obese African American females. The objective of this scoping review was to explore weight management research in this population to identify key concepts, gaps in the literature, and implications for future research. Analyses revealed a broad array in purpose, theoretical frameworks, settings, study designs, interventions, intervention strategies, and outcome variables, making comparison difficult. Many of the articles included in this review did not provide a rich description of methods, which hinder their use in the development of future studies. Consistent application of a combined theory may address the gaps identified in this review by providing a reliable method for assessing needs, developing interventions, and evaluating the effectiveness and fidelity of behavioral weight management interventions in overweight and obese African American females.
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Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, Chordiya P, Dhakal S, Hartling L, Nuspl M, Featherstone R, Dryden DM. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med 2015; 163:848-60. [PMID: 26414227 DOI: 10.7326/m15-1400] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. PURPOSE To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. DATA SOURCES 6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists. STUDY SELECTION Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. DATA EXTRACTION One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. DATA SYNTHESIS Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants). LIMITATIONS All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. CONCLUSION Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).
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Affiliation(s)
- Jennifer Pillay
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Marni J. Armstrong
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Lois E. Donovan
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Ronald J. Sigal
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Ben Vandermeer
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Pritam Chordiya
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Sanjaya Dhakal
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Lisa Hartling
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Megan Nuspl
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Robin Featherstone
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
| | - Donna M. Dryden
- From the University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, and Alberta Health Services, Calgary Zone, and University of Calgary, Calgary, Alberta, Canada
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A workplace health promotion application of the Precede-Proceed model in a regional and remote mining company in Whyalla, South Australia. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2015. [DOI: 10.1108/ijwhm-08-2014-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Workplace health promotion enables the dissemination of health-related information to a large portion of society and provides a vehicle for translating results of efficacy studies to effective lifestyle interventions under less controlled real-world conditions. To achieve effectiveness there needs to be a systematic approach to the design, implementation, and evaluation of workplace health promotion interventions. The purpose of this paper is to describe the development of a workplace programme in a mining and steel making town in regional South Australia.
Design/methodology/approach
– The Precede-Proceed model (PPM) was used as a framework to design the development, implementation, and evaluation of the programme.
Findings
– Quality of life issues and antecedents of modifiable behavioural and environmental factors to be targeted by interventions were identified. Relevant socio-behavioural theories were used to guide intervention development and evaluation. An intervention programme was planned to enable the delivery of educational and skills-development strategies by peers within structured organisational work units.
Originality/value
– This research utilises the PPM to develop, implement, and evaluate intervention strategies targeting the development of diabetes and cardiometabolic risk in a remotely located workplace population. Novel to this approach is the utilisation of the entire PPM in the research; the multiple baseline, interrupted time series design of the study; and its application in a workplace environment noted for increased health risk factors, within a community at high risk of development of type 2 diabetes.
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Kuo CC, Lin CC, Tsai FM. Effectiveness of empowerment-based self-management interventions on patients with chronic metabolic diseases: a systematic review and meta-analysis. Worldviews Evid Based Nurs 2015; 11:301-15. [PMID: 25327253 DOI: 10.1111/wvn.12066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects. AIM To evaluate the effects of EBSMIs on patients with chronic metabolic diseases. METHODS A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2. FINDINGS Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients' hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales. LINKING EVIDENCE TO ACTION EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.
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Affiliation(s)
- Chia-Chi Kuo
- Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center, and doctoral candidate, School of Nursing, Kaohsiung Medical University, and Assistant Professor, Department of Nursing, Chang Jung Christian University, Tainan, Taiwan
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Weight Loss Intervention Efficacy Among Black Women. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2015.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Steinsbekk A, Rygg LØ, Lisulo M, By Rise M, Fretheim A. WITHDRAWN: Group based diabetes self-management education compared to routine treatment, waiting list control or no intervention for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2015; 2015:CD003417. [PMID: 26125655 PMCID: PMC10658837 DOI: 10.1002/14651858.cd003417.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The review authors of this review update are unable to continue with their work. The Cochrane Metabolic and Endocrine Disorders Review Group is seeking very experienced new authors to perform an update on this complex intervention review. At June 2015, this review has been withdrawn. This review is out of date although it is correct as the date of publication. The latest version is available in the 'Other versions' tab on the Cochrane Library, and may still be useful to readers. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Aslak Steinsbekk
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Lisbeth Ø. Rygg
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Monde Lisulo
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Marit By Rise
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Atle Fretheim
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitOsloNorway
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Lepard MG, Joseph AL, Agne AA, Cherrington AL. Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review. Curr Diab Rep 2015; 15:608. [PMID: 25948497 PMCID: PMC5373659 DOI: 10.1007/s11892-015-0608-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In rural communities, high rates of diabetes and its complications are compounded by limited access to health care and scarce community resources. We systematically reviewed the evidence for the impact of diabetes self-management education interventions designed for patients living in rural areas on glycemic control and other diabetes outcomes. Fifteen studies met inclusion criteria. Ten were randomized controlled trials. Intervention strategies included in-person diabetes (n = 9) and telehealth (n = 6) interventions. Four studies demonstrated between group differences for biologic outcomes, four studies demonstrated changes in behavior, and three studies demonstrated changes in knowledge. Intervention dose was associated with improved A1c or weight loss in two studies and session attendance in one study. Interventions that included collaborative goal-setting were associated with improved metabolic outcomes and self-efficacy. Telehealth and face-to-face diabetes interventions are both promising strategies for rural communities. Effective interventions included collaborative goal-setting. Intervention dose was linked to better outcomes and higher attendance.
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Affiliation(s)
- Morgan Griesemer Lepard
- University of Tennessee Health Science Center School of Medicine, 910 Madison, Suite 1002, Memphis, TN, 38163, USA,
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Newton RL, Johnson WD, Hendrick C, Harris M, Andrews E, Johannsen N, Rodarte RQ, Hsia DS, Church TS. A randomized controlled exercise training trial on insulin sensitivity in African American men: The ARTIIS study: Major category: study design, statistical design, study protocols. Contemp Clin Trials 2015; 43:75-82. [PMID: 25979318 DOI: 10.1016/j.cct.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/06/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lack of regular physical activity at prescribed intensity levels is a modifiable risk factor for insulin resistance and the development of diabetes. African American men are at increased risk for developing diabetes and most African American men are not meeting the current recommended levels of physical activity. The primary objective of the Aerobic Plus Resistance Training and Insulin Resistance in African American Men (ARTIIS) study is to determine the effectiveness of an exercise training intervention aimed at reducing diabetes risk factors in African American men at risk for developing diabetes. METHODS Insufficiently active 35-70 year old African American men with a family history of diabetes were eligible for the study. The 5-month randomized controlled trial assigns 116 men to an exercise training or healthy living control arm. The exercise training arm combines aerobic and resistance training according to the current national physical activity recommendations and is conducted in community (YMCA) facilities. The healthy living arm receives information promoting healthy lifestyle changes. OUTCOMES Insulin response to an oral glucose load is the primary outcome measure, and changes in physiological parameters, cardiorespiratory fitness, strength, body composition, and psychological well-being comprise the secondary outcomes. CONCLUSIONS The ARTIIS study is one of the first adequately powered, rigorously designed studies to investigate the effects of an aerobic plus resistance exercise training program and to assess adherence to exercise training in community facilities, in African American men.
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Affiliation(s)
- Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
| | - William D Johnson
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
| | - Chelsea Hendrick
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
| | - Melissa Harris
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
| | - Emanuel Andrews
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA.
| | - Neil Johannsen
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA; Louisiana State University, 112 Huey P. Long Field House, Baton Rouge, LA, 70803, USA.
| | - Ruben Q Rodarte
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA; ACAP Health, 12712 Park Central Dr., Suite 100, Dallas, TX 75251, USA.
| | - Daniel S Hsia
- Louisiana State University, 112 Huey P. Long Field House, Baton Rouge, LA, 70803, USA.
| | - Timothy S Church
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA; ACAP Health, 12712 Park Central Dr., Suite 100, Dallas, TX 75251, USA.
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Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial. Public Health Nutr 2015; 19:142-55. [DOI: 10.1017/s1368980015000956] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA1c), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus.DesignA randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2–2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic).SettingTwo community health centres, Moretele sub-district (North West Province), South Africa.SubjectsAdults (aged 40–70 years) with type 2 diabetes, HbA1c ≥8 %.ResultsDifferences in HbA1c (primary outcome) were −0·64 % (P=0·15) at 6 months and −0·63 % (P=0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P=0·005) at 6 months and 9·9 v. 11·9 servings/d (P=0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P=0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed.ConclusionsNutrition education was not efficacious on HbA1c; however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.
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Terranova CO, Brakenridge CL, Lawler SP, Eakin EG, Reeves MM. Effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2015; 17:371-8. [PMID: 25523815 DOI: 10.1111/dom.12430] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 12/14/2014] [Indexed: 12/13/2022]
Abstract
AIMS To provide a systematic review and meta-analysis of recent evidence on the effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes. METHODS A search of the literature from January 2003 to July 2013 was conducted (PubMed, Embase, CINAHL and Web of Science). The studies considered eligible were randomized controlled trials evaluating weight loss interventions (diet and physical activity, with or without behavioural strategies) of ≥12 weeks duration, compared with usual care or another comparison intervention. Ten studies were included for review. Some heterogeneity was present in the sample, therefore, random-effects models were used to calculate pooled effects. RESULTS Intervention duration ranged from 16 weeks to 9 years, with all but one delivered via individual or group face-to-face sessions. From six studies comparing lifestyle intervention with usual care the pooled effect on weight (n = 5795) was -3.33 kg [95% confidence interval (CI) -5.06, -1.60 kg], and on glycated haemoglobin (HbA1c; n = 5784) was -0.29% (95% CI -0.61, 0.03%), with both attenuated in sensitivity analyses. The pooled within-group effect on weight (n = 3063) from all 10 lifestyle intervention groups was -5.33 kg (95% CI -7.33, -3.34 kg), also attenuated in sensitivity analyses. None of the participant or intervention characteristics examined explained the heterogeneity. Only one study assessed whether intervention effects were maintained after the end of the intervention. CONCLUSIONS Lifestyle-based weight loss intervention trials in type 2 diabetes achieve, on average, modest reductions in weight and HbA1c levels, but results were heavily influenced by one trial. Evidence-based approaches for improving the effectiveness of lifestyle-based interventions in type 2 diabetes are needed, along with future studies reporting on maintenance and cost-effectiveness.
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Affiliation(s)
- C O Terranova
- Cancer Prevention Research Centre, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Aldoory L, Braun B, Maring EF, Duggal M, Briones RL. Empowerment in the process of health messaging for rural low-income mothers: an exploratory message design project. Women Health 2015; 55:297-313. [PMID: 25738660 DOI: 10.1080/03630242.2014.996725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rural, low-income mothers face challenges to their health equal to or greater than those of low-income mothers from urban areas. This study put health message design into the hands of low-income rural mothers. The current study filled a research gap by analyzing a participatory process used to design health messages tailored to the everyday lives of rural low-income mothers. A total of forty-three mothers participated in nine focus groups, which were held from 2012 to 2013, in eight states. The mothers were from different racial and ethnic backgrounds. Participants discussed food security, physical activity, and oral health information. They created messages by considering several elements: visuals, length of message, voice/perspective, self-efficacy and personal control, emotional appeals, positive and negative reinforcements, and steps to health behavior change. This study was innovative in its focus on empowerment as a key process to health message design.
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Affiliation(s)
- Linda Aldoory
- a Department of Behavioral & Community Health, School of Public Health , University of Maryland , College Park , Maryland , USA
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Thomson JL, Goodman MH, Tussing-Humphreys L. Diet Quality and Physical Activity Outcome Improvements Resulting From a Church-Based Diet and Supervised Physical Activity Intervention for Rural, Southern, African American Adults: Delta Body and Soul III. Health Promot Pract 2015; 16:677-88. [PMID: 25603798 DOI: 10.1177/1524839914566851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the effects of a 6-month, church-based, diet and supervised physical activity intervention, conducted between 2011 and 2012, on improving diet quality and increasing physical activity of Southern, African American adults. Using a quasi-experimental design, eight self-selected, eligible churches were assigned to intervention or control. Assessments included dietary, physical activity, anthropometric, and clinical measures. Mixed model regression analysis and McNemar's test were used to determine if within and between group differences were significant. Cohen's d effect sizes for selected outcomes also were computed and compared with an earlier, lower dose intervention. Retention rates were 84% (102/122) for control and 76% (219/287) for intervention participants. Diet quality components, including fruits, vegetables, discretionary calories, and total quality, improved significantly in the intervention group. Strength/flexibility physical activity also increased in the intervention group, while both aerobic and strength/flexibility physical activity significantly decreased in the control group. Effect sizes for selected health outcomes were larger in the current intervention as compared to an earlier, less intense iteration of the study. Results suggest that more frequent education sessions as well as supervised group physical activity may be key components to increasing the efficacy of behavioral lifestyle interventions in rural, Southern, African American adults.
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Affiliation(s)
- Jessica L Thomson
- Delta Human Nutrition Research Program, U.S. Department of Agriculture, Agricultural Research Service, Stoneville, MS, USA
| | - Melissa H Goodman
- Delta Human Nutrition Research Program, U.S. Department of Agriculture, Agricultural Research Service, Stoneville, MS, USA
| | - Lisa Tussing-Humphreys
- Department of Medicine and Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
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Booth HP, Prevost TA, Wright AJ, Gulliford MC. Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis. Fam Pract 2014; 31:643-53. [PMID: 25298510 PMCID: PMC4240316 DOI: 10.1093/fampra/cmu064] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Overweight and obesity have negative health effects. Primary care clinicians are best placed to intervene in weight management. Previous reviews of weight loss interventions have included studies from specialist settings. The aim of this review was to estimate the effect of behavioural interventions delivered in primary care on body weight in overweight and obese adults. METHODS The review included randomized controlled trials (RCTs) of behavioural interventions in obese or overweight adult participants in a primary care setting, with weight loss as the primary outcome, and a minimum of 12 months of follow-up. A systematic search strategy was implemented in Medline, Embase, Web of Science and the Cochrane Central Registry of Controlled Trials. Risk of bias was assessed using the Cochrane Risk of Bias tool and behavioural science components of interventions were evaluated. Data relating to weight loss in kilograms were extracted, and the results combined using meta-analysis. RESULTS Fifteen RCTs, with 4539 participants randomized, were selected for inclusion. The studies were heterogeneous with respect to inclusion criteria and type of intervention. Few studies reported interventions informed by behavioural science theory. Pooled results from meta-analysis indicated a mean weight loss of -1.36 kg (-2.10 to -0.63, P < 0.0001) at 12 months, and -1.23 kg (-2.28 to -0.18, P = 0.002) at 24 months. CONCLUSION Behavioural weight loss interventions in primary care yield very small reductions in body weight, which are unlikely to be clinically significant. More effective management strategies are needed for the treatment of overweight and obesity.
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Affiliation(s)
- Helen P Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK.
| | - Toby A Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Samuel-Hodge CD, Johnson CM, Braxton DF, Lackey M. Effectiveness of Diabetes Prevention Program translations among African Americans. Obes Rev 2014; 15 Suppl 4:107-24. [PMID: 25196409 DOI: 10.1111/obr.12211] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 01/01/2023]
Abstract
The Diabetes Prevention Program (DPP) demonstrated risk reduction for incident diabetes through weight loss among all participants, including African Americans. Several DPP translations have been conducted in less controlled settings, including primary care practices and communities; however, there is no detailed compilation of how effective these translations have been for African Americans. This systematic literature review evaluated DPP translations from 2003 to 2012. Eligible records were retrieved using a search strategy of relevant databases and gray literature. Retrieved records (n=1,272) were screened using a priori criteria, which resulted in 21 full-text studies for review. Seventeen studies were included in the full-text qualitative synthesis. Seven studies had 100% African American samples and 10 studies had mixed samples with African American subgroups. African American participants' average weight loss was roughly half of that achieved in the DPP intervention. However, with few higher-quality studies, small sample sizes and differences in intervention designs and implementation, comparisons across interventions were difficult. The suboptimal effectiveness of DPP translations among African American adults, particularly women, signals the need for enhancements to existing evidence-based interventions and more high-quality research that includes other at-risk African American subgroups such as men and younger adults of lower socioeconomic status.
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Affiliation(s)
- C D Samuel-Hodge
- Department of Nutrition, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA; Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, NC, USA
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