Factors influencing participant enrolment in a diabetes prevention program in general practice: lessons from the Sydney diabetes prevention program

Background: The effectiveness of lifestyle interventions in reducing diabetes incidence has been well established. Little is known, however, about factors influencing the reach of diabetes prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based diabetes prevention program conducted in general practice, New South Wales, Australia from 2008&ndash;2011.Methods: SDPP was an effectiveness trial. Participating general practitioners (GPs) from three Divisions of General Practice invited individuals aged 50&ndash;65 years without known diabetes to complete the Australian Type 2 Diabetes Risk Assessment tool. Individuals at high risk of diabetes were invited to participate in a lifestyle modification program. A multivariate model using generalized estimating equations to control for clustering of enrolment outcomes by GPs was used to examine independent predictors of enrolment in the program. Predictors included age, gender, indigenous status, region of birth, socio-economic status, family history of diabetes, history of high glucose, use of anti-hypertensive medication, smoking status, fruit and vegetable intake, physical activity level and waist measurement.Results: Of the 1821 eligible people identified as high risk, one third chose not to enrol in the lifestyle program. In multivariant analysis, physically inactive individuals (OR: 1.48, P = 0.004) and those with a family history of diabetes (OR: 1.67, P = 0.000) and history of high blood glucose levels (OR: 1.48, P = 0.001) were significantly more likely to enrol in the program. However, high risk individuals who smoked (OR: 0.52, P = 0.000), were born in a country with high diabetes risk (OR: 0.52, P = 0.000), were taking blood pressure lowering medications (OR: 0.80, P = 0.040) and consumed little fruit and vegetables (OR: 0.76, P = 0.047) were significantly less likely to take up the program.Conclusions: Targeted strategies are likely to be needed to engage groups such as smokers and high risk ethnic groups. Further research is required to better understand factors influencing enrolment in diabetes prevention programs in the primary health care setting, both at the GP and individual level.<br /

Assessment and intervention issues and models in School Psychology : the case of Europe and North America

As práticas da Psicologia Escolar parecem ser cada vez mais marcadas pelas necessidades de referenciação/diagnóstico de crianças para o subsistema de educação especial, em detrimento do desenho e implementação de intervenções dirigidas aos problemas específicos dos alunos. A aparente insatisfação dos psicólogos escolares com essa tendência, bem como as dificuldades na utilização de modelos categoriais de diagnóstico em contexto escolar, têm dado origem à progressiva implementação de modelos alternativos de avaliação e intervenção, principalmente de modelos Response to Intervention, Curriculum-Based Measurement e Problem Solving. A controvérsia quanto à natureza verdadeiramente alternativa desses modelos parece, no entanto, longe de se esgotar. Neste artigo são discutidas vantagens e limitações dos diferentes modelos, de acordo com a melhor evidência disponível na literatura, e são ainda equacionadas as suas implicações nas práticas da Psicologia Escolar. Practices in School Psychology seem to be increasingly restricted to referrals/diagnosis of children for the sub-system of special education instead of being focused on the design and implementation of interventions for students with specific problems. The apparent dissatisfaction of school psychologists with this trend and the difficulties dealing with categorical diagnostic models within the school context have stimulated a movement toward the implementation of alternative assessment and intervention models, such as Response to Intervention, Curriculum-Based Measurement and Problem-Solving. However, the controversy about the true alternative nature of these models seems far from being exhausted. The aim of this paper is to discuss the benefits and limitations of the different models according to the best evidence available. We also consider the implications for practices in School PsychologyPractices in School Psychology seem to be increasingly restricted to referrals/diagnosis of children for the sub-system of special education instead of being focused on the design and implementation of interventions for students with specific problems. The apparent dissatisfaction of school psychologists with this trend and the difficulties dealing with categorical diagnostic models within the school context have stimulated a movement toward the implementation of alternative assessment and intervention models, such as Response to Intervention, Curriculum-Based Measurement and Problem-Solving. However, the controversy about the true alternative nature of these models seems far from being exhausted. The aim of this paper is to discuss the benefits and limitations of the different models according to the best evidence available. We also consider the implications for practices in School Psychology(undefined

Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis

Background: The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. Methods and Findings: In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%–7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. Conclusions: DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective