Results of the Northern Manhattan Diabetes Community Outreach Project: A Randomized Trial Studying a Community Health Worker Intervention to Improve Diabetes Care in Hispanic Adults

OBJECTIVE: The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult Hispanics. RESEARCH DESIGN AND METHODS: Participants were adult Hispanics, ages 35–70 years, with recent hemoglobin A(1c) (A1C) ≥8% (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels. RESULTS: There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40%), as compared with usual care (from 8.58 to 8.53%) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04). CONCLUSIONS: The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations

Qualidade de vida e esgotamento profissional entre docentes da rede pública de Ensino Médio e Fundamental no Sul do Brasil Quality of life and burnout among public high school and primary school teachers in Southern Brazil

Para investigar os níveis de qualidade de vida entre docentes de escolas estaduais e municipais e relacioná-los com características sociodemográficas e do processo de trabalho, realizou-se um estudo transversal com 601 docentes da rede pública de Ensino Fundamental e Médio da zona urbana de Pelotas, Rio Grande do Sul, Brasil. Os domínios da escala de qualidade de vida WHOQOL-bref - físico, psicológico, relações sociais e ambiente - foram analisados. Os índices médios foram: 69,2 (desvio-padrão - DP = 16,8) para o domínio físico, 70,6 (DP = 14,0) para o psicológico, 72,5 (DP = 17,3) para o domínio relações sociais e 60,7 (DP = 14,0) para o ambiente. Idade, tempo de docência e total de alunos não se associaram significativamente à qualidade de vida. Docentes das escolas municipais pontuaram mais no domínio físico do que os da rede estadual (p = 0,026). Os homens estavam melhores do que as mulheres somente nos domínios físico e psicológico. Quanto maior a renda familiar, mais alta a pontuação na qualidade de vida. Quanto maior a carga horária na escola, melhor a pontuação nos domínios físico e ambiente.<br>In order to investigate quality of life among public schoolteachers in relation to socio-demographic characteristics and work conditions, a cross-sectional study was conducted in a sample of 601 primary and secondary teachers from the State and Municipal public school system in the urban area of Pelotas, Rio Grande do Sul State, Brazil. The study analyzed the following domains from the WHOQOL-BREF scale: physical health, psychological health, social relationships, and environment. The mean indices were: 69.2 (SD = 16.8) for physical health, 70.6 (SD = 14.0) for psychological health, 72.5 (SD = 17.3) for social relationships, and 60.7 (SD = 14.0) for environment. Age, time in the teaching career, and total number of students were not significantly associated with quality of life. Teachers in municipal schools scored higher than their counterparts in the State public schools in the physical health domain (p = 0.026). Men scored higher than women in the physical and psychological health domains. Higher family income was associated with better quality of life. Higher classroom workload was associated with better scores in the physical health and environment domains

The Effects of a Roundtrip Trans-American Jet Travel on Physiological Stress, Neuromuscular Performance and Recovery

The purpose was to examine the effects of a round trip trans-American jet travel on performance, hormonal alterations, and recovery. Ten matched pairs of recreationally trained men were randomized to either a compression group (COMP) (n = 10; age: 23.1 ± 2.4 yr; height: 174.8 ± 5.3 cm; body mass: 84.9 ± 10.16 kg; body fat: 15.3 ± 6.0%) or control group (CONT) (n = 9; age: 23.2 ± 2.3 yr; height: 177.5 ± 6.3 cm; weight: 84.3 ± 8.99 kg; body fat: 15.1 ± 6.4%). Subjects flew directly from Hartford, CT to Los Angeles, CA 1 day before a simulated sport competition (SSC) designed to create muscle damage and returned the next morning on an overnight flight back home. Both groups demonstrated jet lag symptoms and associated decreases in sleep quality at all time points. Melatonin significantly (P < 0.05) increased over the first 2 days and then remained constant until after the SSC. Epinephrine, testosterone, and cortisol values significantly increased above resting values before and after the SSC with norepinephrine increases only after the SSC. Physical performances significantly decreased from control values on each day for the CONT group with COMP group exhibiting no significant declines. Muscle damage markers were significantly elevated following the SSC with the COMP group having significantly lower values while maintaining neuromuscular performance measures that were not different from baseline testing. Trans-American jet travel has a significant impact on parameters related to jet lag, sleep quality, hormonal responses, muscle tissue damage markers, and physical performance with an attenuation observed with extended wear compression garments.peerReviewe