Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education

AuthorsJill Christensen MD MPH Providence Milwaukie HospitalHeidi Davis MSW Providence Milwaukie HospitalCharlotte Navarre RN Providence Milwaukie HospitalHsin-Fang Li PHD Providence Medical Data Research CenterKathy Schwab MPH RDN Providence Health EducationRichard O’Neil MBA Providence Planning Analyst Title Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education Purpose The Providence Milwaukie Community Teaching Kitchen offers health-focused, budget friendly cooking classes for patients. In 2019, we piloted diabetes education classes with an added hands-on culinary session. This study compares the change in hemoglobin A1c for patients who participated in the pilot with those in the standard curriculum and those referred to diabetes education but did not enroll. Methods This retrospective analysis compared change in hemoglobin A1c for all patients referred to diabetes education in the Providence Northern Oregon region in 2019. Patients referred to diabetes education but not enrolled were considered a control group. To balance patient characteristics (e.g. age, gender, and pre-A1c score), two-to-one propensity score matching method was used to identify two matched controls for each enrollee. Change in hemoglobin A1c from baseline to 3-6 months were compared among matched comparison groups. Results 13,582 patients were identified including 19 patients enrolled in diabetes education plus kitchen class, 640 patients in traditional diabetes education, and 12,923 patients referred but did not enroll. After matching, 1,318 matched patients were selected from the non-enrollees as the control group. The change in hemoglobin A1c was -0.49, -0.81, and -0.95 for the control group, diabetes education group, and diabetes education group with kitchen classes, respectively. Compared to the control group, both diabetes education groups had a greater reduction in hemoglobin A1c (difference of 0.32, 95% Confidence Interval [CI]=0.17, 0.48 for the diabetes education group; difference of 0.46, 95% CI=-0.28, 1.19) for the diabetes plus kitchen class group). Even though the diabetes education plus kitchen intervention had the largest reduction in hemoglobin A1c, the sample was small with large variation. Conclusions Integrating a teaching kitchen component into the traditional diabetes education curriculum is a promising approach that can further improve initial biometric outcomes. Future studies are warranted to demonstrate clinical effectiveness of this enhanced intervention. Financial Support Health Share Oregon Coordinated Care Organizationhttps://digitalcommons.psjhealth.org/milwaukie_family/1004/thumbnail.jp

Marker-dependent associations among oxidative stress, growth and survival during early life in a wild mammal

Oxidative stress (OS) is hypothesized to be a key physiological mechanism mediating life-history trade-offs, but evidence from wild populations experiencing natural environmental variation is limited. We tested the hypotheses that increased early life growth rate increases OS, and that increased OS reduces first-winter survival, in wild Soay sheep (Ovis aries) lambs. We measured growth rate and first-winter survival for four consecutive cohorts, and measured two markers of oxidative damage (malondialdehyde (MDA), protein carbonyls (PC)) and two markers of antioxidant (AOX) protection (total AOX capacity (TAC), superoxide dismutase (SOD)) from blood samples. Faster lamb growth was weakly associated with increased MDA, but not associated with variation in the other three markers. Lambs with higher SOD activity were more likely to survive their first winter, as were male but not female lambs with lower PC concentrations. Survival did not vary with MDA or total TAC. Key predictions relating OS to growth and survival were therefore supported in some OS markers, but not others. This suggests that different markers capture different aspects of the complex relationships between individual oxidative state, physiology and fitness, and that overarching hypotheses relating OS to life-history variation cannot be supported or refuted by studying individual markers

School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis

Depression and anxiety often emerge for the first time during youth. The school environment provides an ideal context to deliver prevention programs, with potential to offset the trajectory towards disorder. The aim of this review was to provide a comprehensive evaluation of randomised-controlled trials of psychological programs, designed to prevent depression and/or anxiety in children and adolescents delivered in school settings. Medline, PsycINFO and the Cochrane Library were systematically searched for articles published until February 2015. Eighty one unique studies comprising 31,794 school students met inclusion criteria. Small effect sizes for both depression (g = 0.23) and anxiety (g = 0.20) prevention programs immediately post-intervention were detected. Small effects were evident after 12-month follow-up for both depression (g = 0.11) and anxiety (g = 0.13). Overall, the quality of the included studies was poor, and heterogeneity was moderate. Subgroup analyses suggested that universal depression prevention programs had smaller effect sizes at post-test relative to targeted programs. For anxiety, effect sizes were comparable for universal and targeted programs. There was some evidence that externally-delivered interventions were superior to those delivered by school staff for depression, but not anxiety. Meta-regression confirmed that targeted programs predicted larger effect sizes for the prevention of depression. These results suggest that the refinement of school-based prevention programs have the potential to reduce mental health burden and advance public health outcome

Positive tipping points in a rapidly warming world

Unidad de excelencia María de Maeztu MdM-2015-0552The challenge of meeting the UNFCCC CoP21 goal of keeping global warming 'well below 2 °C and to pursue efforts towards 1.5 °C' ('the 2-1.5 °C target') calls for research efforts to better understand the opportunities and constraints for fundamental transformations in global systems dynamics which currently drive the unsustainable and inequitable use of the Earth's resources. To this end, this research reviews and introduces the notion of positive tipping points as emergent properties of systems-including both human capacities and structural conditions - which would allow the fast deployment of evolutionary-like transformative solutions to successfully tackle the present socio-climate quandary. Our research provides a simple procedural synthesis to help identify and coordinate the required agents' capacities to implement transformative solutions aligned with such climate goal in different contexts. Our research shows how to identify the required capacities, conditions and potential policy interventions which could eventually lead to the emergence of positive tipping points in various social-ecological systems to address the 2-1.5 °C policy target. Our insights are based on the participatory downscaling of global Shared Socio-economic Pathways (SSPs) to Europe, the formulation of pathways of solutions within these scenarios and the results from an agent-based economic modelling

Characteristics of Kepler Planetary Candidates Based on the First Data Set: The Majority are Found to be Neptune-Size and Smaller

In the spring of 2009, the Kepler Mission commenced high-precision photometry on nearly 156,000 stars to determine the frequency and characteristics of small exoplanets, conduct a guest observer program, and obtain asteroseismic data on a wide variety of stars. On 15 June 2010 the Kepler Mission released data from the first quarter of observations. At the time of this publication, 706 stars from this first data set have exoplanet candidates with sizes from as small as that of the Earth to larger than that of Jupiter. Here we give the identity and characteristics of 306 released stars with planetary candidates. Data for the remaining 400 stars with planetary candidates will be released in February 2011. Over half the candidates on the released list have radii less than half that of Jupiter. The released stars include five possible multi-planet systems. One of these has two Neptune-size (2.3 and 2.5 Earth-radius) candidates with near-resonant periods.Comment: Paper to accompany Kepler's June 15, 2010 data release; submitted to Astrophysical Journal Figures 1,2,& 3 revised. Improved labeling on all figures. Slight changes to planet frequencies in result

Expression of Emotion: When It Causes Trauma and When It Helps

The idea that clients should be encouraged to express strong emotion regarding the traumas they have suffered is widely assumed. This paper asks whether the empirical literature supports the underlying assumption that emotional expression leads to positive outcomes (better health and dissipation of distress). Studies in which individuals who have been given an opportunity to express emotions about past traumas are compared with subjects placed in appropriate control conditions are reviewed. The empirical literature suggests that eliciting emotion is harmful when it is not associated with reappraisal of past trauma, but helpful when the reappraisal occurs. The following guideline emerges: if trauma is to be revisited, it should be accompanied by reappraisal. Since this is sometimes difficult to engineer, alternative approaches for working with victims of trauma, not involving revisiting the trauma, are offered. Additionally, it is suggested that it can be helpful to identify the nature of the problem arising from the traumatic experience, and then provide therapeutic intervention that addresses the problem

Planetary Candidates Observed by Kepler, III: Analysis of the First 16 Months of Data

New transiting planet candidates are identified in sixteen months (May 2009 - September 2010) of data from the Kepler spacecraft. Nearly five thousand periodic transit-like signals are vetted against astrophysical and instrumental false positives yielding 1,091 viable new planet candidates, bringing the total count up to over 2,300. Improved vetting metrics are employed, contributing to higher catalog reliability. Most notable is the noise-weighted robust averaging of multi-quarter photo-center offsets derived from difference image analysis which identifies likely background eclipsing binaries. Twenty-two months of photometry are used for the purpose of characterizing each of the new candidates. Ephemerides (transit epoch, T_0, and orbital period, P) are tabulated as well as the products of light curve modeling: reduced radius (Rp/R*), reduced semi-major axis (d/R*), and impact parameter (b). The largest fractional increases are seen for the smallest planet candidates (197% for candidates smaller than 2Re compared to 52% for candidates larger than 2Re) and those at longer orbital periods (123% for candidates outside of 50-day orbits versus 85% for candidates inside of 50-day orbits). The gains are larger than expected from increasing the observing window from thirteen months (Quarter 1-- Quarter 5) to sixteen months (Quarter 1 -- Quarter 6). This demonstrates the benefit of continued development of pipeline analysis software. The fraction of all host stars with multiple candidates has grown from 17% to 20%, and the paucity of short-period giant planets in multiple systems is still evident. The progression toward smaller planets at longer orbital periods with each new catalog release suggests that Earth-size planets in the Habitable Zone are forthcoming if, indeed, such planets are abundant.Comment: Submitted to ApJS. Machine-readable tables are available at http://kepler.nasa.gov, http://archive.stsci.edu/kepler/results.html, and the NASA Exoplanet Archiv