The Role of Dietary Compliance in Survival of Hemodialysis Patients.

The goal of the current study was to gain knowledge of the role that dietary compliance plays in the survival of end-stage renal failure patients receiving chronic in-center hemodialysis. As a result of this type of research, health care professionals may better understand the individual and collective influence that various aspects of dietary compliance have on survival. This knowledge would also be helpful in the identification and intervention of dietary noncompliance in hemodialysis patients. The present study investigated the relation of three commonly employed physiological parameters of dietary compliance to survival on hemodialysis and how well these dietary variables independently and relative to important demographic/medical history variables, predict survival in these patients. Subjects in this study included 110 hemodialysis patients from two hemodialysis centers in a large southern city. Predictor variables included three dietary variables, serum potassium, interdialysis weight gain, blood urea nitrogen; three demographic variables, age, sex, race; and three medical history variables, age at onset of chronic dialysis, years on dialysis, and number of concurrent diagnoses. The criterion variable was group, survivors or deceased, for the discriminant function analyses conducted or length of survival for the regression analyses. Correlational procedures, discriminant function analyses, and multiple regression analyses were employed to investigate the role that dietary compliance plays in the survival of hemodialysis patients. In general, the results suggest that dietary compliance variables, as measured in this study, play a minimal role in the survival of end-stage renal failure patients. The three dietary variables studied offered little to the prediction of survival after the effects of important demographic/medical history variables were considered. The results also garnered support for the use of multiple measures of dietary variables instead of single data points when conducting this type of research. In summary, the current study failed to provide support for the validity of dietary compliance variables as good predictors of survival in hemodialysis patients. The current findings should be interpreted conservatively, however, pending further research on the reliability and validity of the employed measures of dietary compliance

Diabetes Related Distress and Co-Occurrence with Depressive Symptoms in Urban Low-Income African American and Hispanic/Latinx Adults with Type 2 Diabetes

Introduction. Burden of diabetes in the U.S. is greater in racial-ethnic minority populations than non-Hispanic Whites. Depression and diabetes-related distress (DRD) are recognized as relatively common and important psychosocial areas to address in people living with diabetes. Limited research in the U.S. has focused on DRD in racial-ethnic minority populations. The purpose of this study is to describe patterns of DRD and co-occurrence with depressive symptoms in urban low-income African American and Hispanic/Latinx adults with type 2 Diabetes Mellitus (T2DM). Method. We examined the baseline data collected for a randomized clinical trial (RCT) studying the impact of a culturally tailored diabetes self-care intervention. Individuals with T2DM who self-identified as African American or Hispanic/Latinx were recruited from Federally Qualified Health Centers (FQHCs). Measurement scales included the Patient Health Questionnaire (PHQ-9) and Diabetes Distress Scale (DDS). Participants were categorized into four groups based on the PHQ-9 and DDS: high distress (without probable clinical depression), probable clinical depression (without high distress), both high distress and probable depression, or neither high distress nor probable depression. Baseline variables were summarized by sex, age and racial-ethnic group. Analyses included independent sample t-tests, Chi-square tests, and one-way Analysis of Variance (ANOVA). Results. The study sample included 247 participants with 118 (47.8%) Hispanic/Latinx and 129 (52.2%) African American adults with T2DM. The mean age was 52.9 years (SD=12.2) and 68.0% were female. Based on PHQ-9 scores, 51.4% had none to minimal, 23.5% mild, and 25.1% moderate-severe depressive symptomatology. Based on the DDS, 37.7% had little to no DRD, 27.1% moderate, and 35.2% high DRD. There was not a statistically significant relationship between sex and depression or DRD levels. There was not a statistically significant difference between age and depression; however, there was a statistically significant difference between age and DRD (p=.002). When examining the co-occurrence of DRD and depression, over half of the participants did not experience high distress nor probable clinical depression (57.5%), 17.8% experienced both high distress and depression, 17.4% experienced high distress without depression, and 7.3% experienced depression without distress. There was no statistically significant relationship found between sex and co-occurrence groups; however, there was a statistically significant difference for age (p=.003). Discussion. A substantial proportion of individuals from both racial-ethnic groups experienced high DRD and/or probable clinical depression with some differences for age. Patterns found for specific DRD areas and co-occurrence of DRD and depressive symptoms can help clinicians better understand and address these challenges

A cross-sectional study of depressive symptoms and diabetes self-care in African Americans and Hispanics/Latinos with diabetes: the role of self-efficacy

Purpose The purpose of this study is to examine the relationship between depressive symptoms and diabetes self-care in African American and Hispanic/Latino patients with type 2 diabetes and whether the association, if any, is mediated by diabetes-related self-efficacy. Methods The sample included self-report baseline data of African American and Hispanic/Latino patients with type 2 diabetes who were aged ≥18 years and enrolled in a diabetes self-management intervention study. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire. The Summary of Diabetes Self-care Activities measured engagement in healthy eating, physical activity, blood glucose checking, foot care, and smoking. The Diabetes Empowerment Scale–Short Form assessed diabetes-related psychosocial self-efficacy. Indirect effects were examined with the Baron and Kenny regression technique and Sobel testing. Results Sample characteristics (n = 250) were as follows: mean age of 53 years, 68% women, 54% African American, and 74% with income <$20 000. Depressive symptoms showed a significant inverse association with the self-care domains of general diet, specific diet, physical activity, and glucose monitoring in the African American group. In Hispanics/Latinos, depression was inversely associated with specific diet. Self-efficacy served a significant mediational role in the relation between depression and foot care among African Americans. Conclusions Self-efficacy mediated the relationship between depression and foot care in the African American group but was not found to be a mediator of any self-care areas within the Hispanic/Latino group. In clinical practice, alleviation of depressive symptoms may improve self-care behavior adherence. Diabetes education may consider inclusion of components to build self-efficacy related to diabetes self-care, especially among African American patients

Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects

BACKGROUND: Despite a growing literature on the efficacy of behavioral weight loss interventions, we still know relatively little about the long terms effects they have on HRQL. Therefore, we conducted a study to investigate the immediate post-intervention (6 months) and long-term (12 and 24 months) effects of clinically based weight management programs on HRQL. METHODS: We conducted a randomized clinical trial in which all participants completed a 6 month clinical weight loss program and were randomized into two 6-month extended care groups. Participants then returned at 12 and 24 months for follow-up assessments. A total of 144 individuals (78% women, M age = 50.2 (9.2) yrs, M BMI = 32.5 (3.8) kg/m(2)) completed the 6 month intervention and 104 returned at 24 months. Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses. RESULTS: There was complete data on 91 participants through the 24 months of the study. At baseline the participants scored lower than U.S. age-specific population norms for bodily pain, vitality, and mental health. At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning, general health, vitality, and mental health subscales of the SF-36. Despite some weight regain, the improvements in the mental composite scale as well as the physical functioning, vitality, and mental health subscales were maintained at 24 months. There were no significant main effects or interactions by extended care treatment group or weight loss group (whether or not they maintained 5% loss at 24 months). CONCLUSION: A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months. Maintaining a significant weight loss (> 5%) was not necessary to have and maintain improvements in HRQL

Healthy coping: issus and implications in diabetes education and care

Psychological, emotional, and social factors not only impact quality of life, but also often play a role in chronic illness outcomes. Diabetes care, in particular, is greatly influenced by psychosocial factors when they hinder a person’s ability to manage the disease and achieve metabolic control. Healthy coping, defined as responding to a psychological and physical challenge by recruiting available resources to increase the probability of favorable outcomes in the future, is essential to effective self-management by people with diabetes. In June 2009, the American Association of Diabetes Educators convened a multidisciplinary expert panel to discuss healthy coping in diabetes. The panel included diabetes educators and behavioral science and mental health professionals. Drawing on their knowledge and experiences, as well as information presented at the symposium, the panel probed several aspects of healthy coping including what it entails, common barriers, assessment, population diversity, and clinical applications. A team approach to addressing the patient’s coping is critical. Team involvement relieves the diabetes educator of the entire burden of supporting the patient in this regard. The team should be broadly defined and include those who are formally and informally involved. Healthy coping is a complex, qualitative behavior that cannot be easily quantified. Future efforts to address the issue of healthy coping should add to the body of literature regarding diabetes self-management at the individual and population- based levels. (Population Health Management 2010;13:227–233

Le rôle de la matrice extracellulaire dans la régénération des nerfs moteurs

International audienceThe motor neurons (MN) form the ultimate route to convey the commands from the central nervous system to muscles. During development, MN extend axons that follow stereotyped trajectories to their muscle targets, guided by various attractive and repulsive molecular cues. Extracellular matrix (ECM) is a major source of guidance cues, but its role in axonal development and regeneration remains poorly documented. Regenerating axons are able to return to their synaptic target following their original trajectory. The same guidance cues could be thus involved in motor nerve regeneration. Zebrafish has become a popular model system in understanding the development of the peripheral nervous system. Thanks to the generation of fluorescent transgenic lines and the optical transparency of embryos and larvae, it allows direct visualization of axonogenesis. Additionally, and contrary to humans, its remarkable capacity to regenerate makes it well suited for the study of nerve regeneration. A laser method to ablate nerves in living zebrafish larvae has been developed in our laboratory that, combined with the use of the fluorescent mnx1:gfp zebrafish transgenic line, allows the follow up of the dynamics of the nerve regeneration process. To study the role of ECM proteins present in the axonal path, mutant lines for different ECM proteins (already available in our laboratory or generated in mnx1:gfp fish using CRISPR-Cas9 method) will be used to analyze their role during the regeneration process. These mutant lines for ECM will be crossed with existing fluorescent transgenic lines to visualize different cell types involved in the nerve regeneration, such as macrophages ( mfap4:mcherry ), neutrophils ( mpx:gfp ) or even Schwann cells ( sox10:mrfp ). Overall, this study will depict the role of ECM in nerve regeneration and will provide essential knowledge for the development of new biomaterials to promote the regeneration of injured motor nerves

Characteristics of smoking in low-income pregnant latina and white women

Smoking during pregnancy is hazardous as it poses numerous risks to both the mother and the unborn child. Formerly, interventions that were successful for White smokers were thought to be equally appropriate for all smokers. It is now acknowledged that there is a need to tailor interventions for distinct ethnic and cultural groups. This study1 was designed to identify variables that are associated with smoking status in a low-income sample of pregnant Latina and White women. Results indicate that Latinas had lower levels of addiction to cigarettes and were less likely to have partners who smoked than White women. Identifying differences in the characteristics of ethnically diverse pregnant smokers will assist in the development of interventions that are tailored for women who attend prenatal clinics

Stage of change, low income and benefit status : a profile of women's smoking in early pregnancy.

Smoking cessation interventions in the UK are being developed in the context of widening socio-economic differentials in both prevalence and cessation. These differ entials are evident among pregnant women, the group targeted for interventions directed at women. Recent research has suggested that, among the disadvantages associated with low socio-economic status, being dependent on means-tested benefits may be a particularly powerful influence on snuokimg status and a major barrier to quitting. Intervention programmes have been heavily influenced by the transtheoretical model, which maps the quitting process as a patterned sequeuce of 'stages of change'. However, little is known about the stage-of-change profile in the UK population or about the socio- economic patterning of the profile. This paper begins to fill these gaps in the knowledge base of health promotion with respect to women in pregnancy. It reports on a survey of 2000 expectant mothers conducted in 1996 in the West Midlands. First pregnancy was found to have an intervention-like effect, with a high proportion of first-time expectant mothers who entered pregnancy as smokers either planning to quit or having done so. This intervention-like effect was moderated by women's socio-economic circumstances. Being in receipt of means-tested benefits increased the odds of a woman not intending to give up smoking in the foreseeable future

Impact of a simulation-based education approach for health sciences: demo, debrief, and do

Abstract Background Skill-based practice (e.g., communication skills) is important for individuals to incorporate into students' learning and can be challenging in large classes. Simulation-based education (SBE) is a method where students can learn and practice skills in a safe environment to use in real world settings with assistance of peer coaching. The COVID-19 pandemic presented challenges to providing students with sufficient SBE. The purpose of this paper is to: a.) describe a SBE approach for health coaching referred to as “Demo, Debrief, and Do” (DDD), b.) discuss how this approach became important in COVID-19 classroom experiences, c.) describe the impact of DDD activity on students in a health sciences curriculum. DDD is a collaborative activity where graduate health coaching students demonstrate coaching skills, debrief their demonstration, and support undergraduate students to demonstrate (or do) their own coaching skills in a small virtual online setting. Methods Qualitative feedback from 121 undergraduate students enrolled in 3 sections of a behavior change strategies course and quantitative surveys to examine their confidence in applying the skills and overall satisfaction with DDD were gathered. Results The overall average confidence level following the lab was 31.7 (0–35). The average satisfaction level following the lab was 23.3 (0–25 range). The most common highlight of this DDD experience described was observing the coaching demonstration (i.e., demo), followed by the feedback (i.e., debrief), and the practice (i.e., do). Conclusion The (DDD) simulation approach fulfilled an educational need during the COVID 19 pandemic and filled a gap in offering SBE opportunities for both graduate and undergraduate students while learning effective client-communication skills health coaching delivery