The Effects of Nutrition and Physical Activity Education on Knowledge and Glycemic Control Among Persons with Type 2 Diabetes

Diabetes affects millions of people worldwide. Approximately 29.1 million people or 9.3% of the United States population has diabetes (Centers for Disease Control (CDC), 2014). Diabetes was the seventh leading cause of death in the United States in 2010 and is projected by the World Health Organization (WHO) to be the seventh leading cause of death globally by 2030. The purpose of this evidence-based project was to provide nutrition and physical activity education in an effort to improve diabetes knowledge and glycemic control among persons with type 2 diabetes. Hemoglobin A1c levels and Diabetes Knowledge Test scores were compared from the pre-intervention phase of nutrition and physical activity education to the post-intervention phase three months later. For this project, Stetler’s Model was employed as the theoretical framework to support implementation of the EBP, and Pender’s Health Promotion Model (HPM) was used to guide the intervention. Participants were recruited from a private, primary care office in Lake County, Indiana. Seventeen participants (n=17) were recruited and completed the intervention phase of this project. Data was analyzed using the Wilcoxon signed-rank test. Results demonstrated a statistically significant increase in diabetes knowledge among participants three months following the intervention (z-score=-2.546, p\u3c0.05). However, due to several factors including health maintenance compliance from the participants or their healthcare providers, changes in glycemic control among the participants were able to be determined in only two participants. The findings suggest that implementation of diabetes education in primary care practice can improve diabetes knowledge

Development of theory-based health messages: three-phase programme of formative research

Online health behaviour interventions have great potential but their effectiveness may be hindered by a lack of formative and theoretical work. This paper describes the process of formative research to develop theoretically and empirically based health messages that are culturally relevant and can be used in an online intervention to promote healthy lifestyle behaviours among new university students. Drawing on the Theory of Planned Behaviour, a three-phase programme of formative research was conducted with prospective and current undergraduate students to identify (i) modal salient beliefs (the most commonly held beliefs) about fruit and vegetable intake, physical activity, binge drinking and smoking, (ii) which beliefs predicted intentions/behaviour and (iii) reasons underlying each of the beliefs that could be targeted in health messages. Phase 1, conducted with 96 pre-university college students, elicited 56 beliefs about the behaviours. Phase 2, conducted with 3026 incoming university students, identified 32 of these beliefs that predicted intentions/behaviour. Phase 3, conducted with 627 current university students, elicited 102 reasons underlying the 32 beliefs to be used to construct health messages to bolster or challenge these beliefs. The three-phase programme of formative research provides researchers with an example of how to develop health messages with a strong theoretical- and empirical base for use in health behaviour change interventions

A rapid review of challenges faced by early-career international medical graduates in general practice and opportunities for supporting them.

BACKGROUND British General Practice is facing a workforce crisis against a backdrop of an ageing population experiencing increasingly complex health challenges. The National Health Service must increase the supply of General Practitioners (GPs), including International Medical Graduate (IMG) GPs, by increasing recruitment and retention. IMG GPs face distinct challenges during training and their early careers. Understanding these challenges as well as the help and support offered to early-career IMG GPs is crucial to building and sustaining the general practice workforce. AIM To understand the challenges facing early-career IMG GPs and the help and support they can access. DESIGN & SETTING Rapid review. METHOD Six databases and four websites were searched. Titles and abstracts were screened according to inclusion and exclusion criteria, followed by the full study where applicable. The included studies were analysed using a thematic synthesis approach to identify the challenges faced by early-career IMG GPs, as well as the help and support available. RESULTS The database search yielded 234 studies, with 38 additional studies identified via handsearching of websites. Twenty-one studies were included. Seven challenges were identified, as well as a range of help and support available. Early-career IMG GPs face a range of psychological, social, and practical challenges which may not be adequately addressed by the help and support currently offered by the NHS. CONCLUSION Further research is required to understand the extent to which early-career IMG GPs access the help and support offered, and if it adequately addresses the unique challenges they face

Investigating sound and structure in concert: A pupillometry study of relativeclause attachment

Listeners must integrate multiple sources of information toconstruct an interpretation of a sentence. We concentrate hereon the alignment of prosodic and syntactic grouping duringonline sentence comprehension. We present the results from apupillometry study on the use of prosodic boundaries in resolv-ing well-known attachment ambiguities. Using growth curveanalyses to capture the non-linear dynamics of pupil dilation,we found increased pupil excursions for sentences that weredisambiguated towards the dispreferred, non-local relation, es-pecially when accompanied by supporting prosodic informa-tion. However, when prosodic and structural information didnot align, pupillary response was muted, potentially indicatinga failure to commit to a specific interpretation. More generally,the study shows how the currently under-utilized pupillometrymethod offers insights into spoken language comprehension

The prognostic and therapeutic implications of distinct patterns of argininosuccinate synthase 1 (ASS1) and arginase-2 (ARG2) expression by cancer cells and tumor stroma in non-small-cell lung cancer

Background Arginine (Arg) is essential for cancer cell growth and also for the activation of T cells. Thus, therapies aiming to reduce Arg utilization by cancer may prove detrimental for the immune response. Methods We examined the expression of two major enzymes involved in arginine depletion and replenishment, namely arginase ARG2 and argininosuccinate synthase ASS1, respectively, in a series of 98 NSCLCs. Their association with immune infiltrates and the postoperative outcome were also studied. Results ARG2 was expressed mainly by cancer-associated fibroblasts (CAFs) (58/98 cases; 59.2%), while ASS1 by cancer cells (75/98 cases; 76.5%). ASS1 and ARG2 expression patterns were not related to hypoxia markers. Auxotrophy, implied by the lack of expression of ASS1 in cancer cells, was associated with high angiogenesis (p < 0.02). ASS1 expression by cancer cells was associated with a high density of iNOS-expressing tumor-infiltrating lymphocytes (iNOS+TILs). ARG2 expression by CAFs was inversely related to the TIL-density and linked with poorer prognosis (p = 0.02). Patients with ASS1 expression by cancer cells had a better prognosis especially when CAFs did not express ARG2 (p = 0.004). Conclusions ARG2 and ASS1 enzymes are extensively expressed in NSCLC stroma and cancer cells, respectively. Auxotrophic tumors have a poor prognosis, potentially by utilizing Arg, thus reducing Arg-dependent TIL anti-tumor activity. ASS1 expression in cancer cells would allow Arg fueling of iNOS+TILs and enhance anti-tumor immunity. However, upregulation of ARG2 in CAFs may divert Arg from TILs, allowing immune escape. Identification of these three distinct phenotypes may be useful in the individualization of Arg-targeting therapies and immunotherapy

Evaluation of an interactive E-book as an effective resource for student engagement and learning in anatomy.

Use of E-books (or electronic textbooks) is increasing in tertiary education, and are starting to replace conventional paper textbooks. E-textbooks have several advantages over conventional paper textbooks, including portability and being able to incorporate interactive mediums (sound and videos). Additionally, if academics develop their own E-books, they can only include material that is very specific for their subject, have links to relevant websites, and include practice tests (Alkadi & Johnson 2009). However, it is very time consuming for academics to generate their own e-books, and there is limited evidence on the effectiveness of using E-books as a teaching resource in tertiary education. Thus, it comes as no surprise that current literature shows little uptake of e-books in tertiary education (Chong 2008). Empirical data is needed to demonstrate the effectiveness of E-Books in tertiary education

Care Works: Come Home for Care

Essential to executing the mission and vision of an academic medical center (AMC) is attracting and retaining the highest quality employees. As demonstrated by VCU’s commitment to the Great Place Initiative, the University has recognized that employees in today’s highly competitive environment demand competitive salary and benefit packages. Research has shown that access to high quality, on-site healthcare services provides significant benefits to both employees and employers, such as increased productivity and reduced wellness costs[1]. Yet, a query of de-identified patient records indicated that only a small percentage of VCU employees (~18%) utilized the health services provided by VCU Health System in 2016. VCU’s peer-institutions, other distinguished AMCs, and industry employers have implemented a variety of programs such as concierge services, expedited appointments, on-campus clinics, and lower copays to remain competitive and responsive to their employees. In light of the depth of these programs, Team CareWorks completed a comparative review of health and wellness related employee-specific benefits to determine how VCU might enhance its benefits through initiatives such as on-site medical clinics, prioritized appointments, telehealth, and on-site pharmacies. Informed by the comparative analysis, Team CareWorks will provide recommendations that VCU can use to: capitalize on the integrated relationship with VCU Health to enrich the health and wellness of its outstanding assets (the employees); and provide enhanced benefits to employees by making VCU Health more easily accessible and more appealing as a Medical Home. [1]Berry, Leonard, Ann M. Mirabito, & William B. Baun. “What\u27s the Hard Return on Employee Wellness Programs?” (2010). Harvard Business Review, December 2010.. Available at SSRN: https://ssrn.com/abstract=206487