Interventions for self-management of type 2 diabetes: An integrative review

Background Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? Purpose/Objectives The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. Design An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. Procedures A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). Results Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. Conclusions Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies

Indirect music therapy practice and skill-sharing in dementia care

Public interest in the benefits of music for people with dementia has rapidly increased in recent years. In addition to clinical work with clients, music therapists are often required to support and train staff, families, and volunteers and skill-share some music therapeutic skills. Six music therapy researchers from six countries agreed it was timely to organize a roundtable and share their indirect music therapy practice and examples of skill-sharing in dementia care. This article was developed following the roundtable at the World Congress of Music Therapy in 2017 and further discussion among the authors. This process highlighted the diversity and complexity of indirect music therapy practice and skill-sharing, but some common components emerged, including: 1) the importance of making clinical decisions about when direct music therapy is necessary and when indirect music therapy is appropriate, 2) supporting the transition from direct music therapy to indirect music therapy, 3) the value of music therapy skill-sharing in training care home staff, 4) the need for considering potential risks and burdens of indirect music therapy practice, and 5) expanding the role of music therapist and cultivating cross-professional dialogues to support organizational changes. In indirect music therapy practice, a therapist typically works with carers and supporters to strengthen their relationships with people with dementia and help them further develop their self-awareness and sense of competence. However, the ultimate goal of indirect music therapy practice in dementia care remains the wellbeing of people living with dementia

Predictors of Driving in Individuals with Relapsing–Remitting Multiple Sclerosis

Evaluations on fitness-to-drive of individuals with multiple sclerosis (MS) usually involve the administration of several physical, visual, and cognitive tests. In some instances, a practical road test is also administered. The use of several tests, many of which are only remotely driving-related, increases the time, cost, and human resources involved in the evaluation process, and sometimes lead to erroneous decisions. In this study, we investigated the usefulness of using a short battery of a few highly predictive tests to predict fitness-to-drive of individuals with MS. Fortyfour individuals with relapsing–remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the Stroke Driver Screening Assessment (SDSA) battery. Performance on 12 cognitive and three visual tests were significantly associated with participants’ performance on a practical road test. The Stroop Color test, Direction, Compass, and Road Sign Recognition tests from the SDSA, and the Speed of Processing test from Useful Field of View test battery together explained 59% of the variance and predicted the pass or fail outcome on the road test with 91% accuracy, 70% sensitivity, and 97% specificity. The five psychometric/off-road tests, which together can be administered in less than 45 minutes, cost approximately $150, and is 91% accurate, can be used as a screening battery. Those who pass should be further tested on-road to finally decide their fitness-to-drive while those of fail should be further evaluated, trained, or advised on alternative transportation means. Future studies are needed to confirm and validate the findings in this study

Using Ripple Effects Maps to Identify Story Threads: A Framework to Link Private to Public Value

Extension professionals must demonstrate organizational value to garner public awareness and support. Measuring and communicating outcomes that have public value can be challenging. In this study, Ripple Effects Mapping incorporating the Community Capitals Framework was used to evaluate a childhood obesity prevention study, iCook 4-H, of youth-adult pairs in Maine. The objective was to describe the process of generating impact statements through story threads about program benefits to the participants and the potential benefits to nonparticipants, such as family members, friends, and other community members. Extension professionals can use storylines, or story threads, as a qualitative research technique to generate stories about private and public value from participants’ actions, experiences, and emotions following community programs. The story threads process can be used across disciplines to leverage community program data into public value messaging

An Impact Mapping Method to Generate Robust Qualitative Evaluation of Community-Based Research Programs for Youth and Adults

Ripple Effect Mapping (REM) is an evaluation approach that has traditionally been used in community settings to visually map the impact of programming and community interventions. This manuscript utilizes the Community Capitals Framework (CCF) to inform REM and to better highlight the changes and impact between various levels of a community, following a childhood obesity prevention intervention. The addition of in-depth qualitative analyses makes this approach particularly useful for the evaluation of interventions with a research–community partnership focus. The objective of this study was to describe a CCF-informed REM approach with detailed protocol, training, and application to the community-based, childhood obesity prevention intervention, iCook 4-H, which targeted youth and adult pairs. This protocol includes the steps required to prepare for REM sessions of, ideally, six youth and adult pairs, one facilitator, and one or two evaluators/note takers. REM sessions typically begin with an icebreaker and appreciative inquiry activities that inform the REM mapping process that follows. In-depth qualitative analysis of the notes and map images captured during REM sessions ensure the rigor required for research-related interventions. Researchers, community members, and participants can use CCF-informed REM collectively as a robust evaluation tool to demonstrate, through visual mapping, the positive effects of community-partnered research programs

Ripple Effect Mapping Outcomes of a Childhood Obesity Prevention Program From Youth and Adult Dyads Using a Qualitative Approach: iCook 4-H

Objective: To describe the impact of the iCook 4-H intervention study based on data gathered through ripple effect mapping focus groups through an explorative approach. Design: Youth–adult dyads responded about ways in which iCook had affected the individual, family, and community. Three questions were asked: (1) What were people doing differently as a result of iCook? (2) Who benefited from iCook and how? (3) Were there changes in the way community groups and institutions did things as a result of iCook?Setting: Ripple effect mapping sessions took place across 5 states (Maine, Nebraska, South Dakota, Tennessee, and West Virginia). Participants: Seventy dyad participants (n = 35 youth, n = 35 adults) from the iCook 4-H intervention. Main Outcome Measure: Three core themes of iCook 4-H were assessed: cooking, eating, and playing together. Analysis: Direct content analysis and word frequencies were used. Results: Seven categories emerged: improved health, increased community involvement, increased knowledge, increased communication, changed motivation, financial mindfulness, and increased appreciation for family. An overarching theme that was determined was that learning new skills together through trying new things (cooking, eating, and playing) leads to positive individual family and community change. Conclusions and Implications: Ripple effect mapping was effective in determining the perceived impact of iCook 4-H on oneself, family, and community

Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention

The objective was to describe the development process of a curriculum (iCook 4-H) targeted to low-income, rural, and/or diverse youths and their adult primary meal preparer to promote cooking, eating, and playing together. Lessons learned highlighted the importance of grounding the curriculum in Social Cognitive Theory and applying the experiential 4-H learning model using a multiphased, community-based participatory approach with cyclical development and evaluation, and key modifications made for dissemination and distribution. Findings across 4 testing phases over 6 years and 5 states demonstrated the time-intensive, cyclical process that required flexibility with fidelity to form a hands-on, interactive curriculum

Low Diversity in theMitogenome of Sperm Whales Revealed by Next-Generation Sequencing

Large population sizes and global distributions generally associate with high mitochondrial DNA control region (CR) diversity. The sperm whale (Physeter macrocephalus) is an exception, showing low CR diversity relative to other cetaceans; however, diversity levels throughout the remainder of the sperm whale mitogenome are unknown. We sequenced 20 mitogenomes from 17 sperm whales representative of worldwide diversity using Next Generation Sequencing (NGS) technologies (Illumina GAIIx, Roche 454 GS Junior). Resequencing of three individuals with both NGS platforms and partial Sanger sequencing showed low discrepancy rates (454-Illumina: 0.0071%; Sanger-Illumina: 0.0034%; and Sanger-454: 0.0023%) confirming suitability of both NGS platforms for investigating low mitogenomic diversity. Using the 17 sperm whale mitogenomes in a phylogenetic reconstruction with 41 other species, including 11 new dolphin mitogenomes, we tested two hypotheses for the low CR diversity. First, the hypothesis that CR-specific constraints have reduced diversity solely in the CR was rejected as diversity was low throughout the mitogenome, not just in the CR [overall diversity pi]=0.096%; protein-coding 3rd codon =0.22%; CR =0.35%), and CR phylogenetic signal was congruent with protein-coding regions. Second, the hypothesis that slow substitution rates reduced diversity throughout the sperm whale mitogenome was rejected as sperm whales had significantly higher rates of CR evolution and no evidence of slow coding region evolution relative to other cetaceans. The estimated time to most recent common ancestor for sperm whale mitogenomes was 72,800 to 137,400 years ago (95% highest probability density interval), consistent with previous hypotheses of a bottleneck or selective sweep as likely causes of low mitogenome diversity.Keywords: Nucleotide diversity, Mitochondrial genome, Population genetics, Cetacean, Substitution rates, Physeter macrocephalus, mtDNA, Bayesian phylogenetic

What influences the worldwide genetic structure of sperm whales (Physeter macrocephalus)?

The interplay of natural selection and genetic drift, influenced by geographic isolation, mating systems and population size, determines patterns of genetic diversity within species. The sperm whale provides an interesting example of a long-lived species with few geographic barriers to dispersal. Worldwide mtDNA diversity is relatively low, but highly structured among geographic regions and social groups, attributed to female philopatry. However, it is unclear whether this female philopatry is due to geographic regions or social groups, or how this might vary on a worldwide scale. To answer these questions, we combined mtDNA information for 1091 previously published samples with 542 newly obtained DNA profiles (394-bp mtDNA, sex, 13 microsatellites) including the previously unsampled Indian Ocean, and social group information for 541 individuals. We found low mtDNA diversity (π = 0.430%) reflecting an expansion event <80 000 years bp, but strong differentiation by ocean, among regions within some oceans, and among social groups. In comparison, microsatellite differentiation was low at all levels, presumably due to male-mediated gene flow. A hierarchical amova showed that regions were important for explaining mtDNA variance in the Indian Ocean, but not Pacific, with social group sampling in the Atlantic too limited to include in analyses. Social groups were important in partitioning mtDNA and microsatellite variance within both oceans. Therefore, both geographic philopatry and social philopatry influence genetic structure in the sperm whale, but their relative importance differs by sex and ocean, reflecting breeding behaviour, geographic features and perhaps a more recent origin of sperm whales in the Pacific. By investigating the interplay of evolutionary forces operating at different temporal and geographic scales, we show that sperm whales are perhaps a unique example of a worldwide population expansion followed by rapid assortment due to female social organization.Genetic samples from the 'Voyage of the Odyssey' were collected under permit #0751-1614 from the US National Marine Fisheries Service

Temporal patterns of bat activity on the High Plains of Texas

Texas is home to more wind turbines and more bat species than any other state in the United States. Insectivorous bats provide an important economical ecosystem service in this region through agricultural pest regulation. Unfortunately, bats can be impacted negatively by wind turbines, and migratory bat species particularly so. To understand how bat activity changes throughout the year in western Texas, activity was monitored through echolocation calls and opportunistic mist-netting efforts over a period of four years (2012–2015). Peaks in activity were observed from March through April, and again in September, which coincides with previously documented migratory periods for many species native to the High Plains of Texas. Findings presented herein suggest that urban habitats are preferred stopover sites for migratory bat species while traversing arid regions such as those occurring in western Texas. In addition to human-made structures, urban habitats harbor non-native trees that provide suitable roost sites, aggregations of insect prey swarming outdoor light sources, and artificial water sources. It is important to understand bat activity in western Texas, not only for the benefit of agricultural pest suppression, but also to predict how the expansion of wind energy may affect bat populations in this region