Feasibility of type 2 diabetes prevention : processes for detection, self-management and support in socioeconomically disadvantaged areas

Background: Type 2 diabetes (T2D) is on the rise globally, affecting disadvantaged populations to a higher extent. Both T2D and prediabetes are often undiagnosed. Early detection of T2D and prediabetes is of importance to avoid complications due to metabolic disturbances caused by elevated glucose values. Self-management support and lifestyle interventions to manage and prevent diabetes have proven to be effective strategies in high income settings. Aim: To determine the feasibility of early detection and implementation of a self-management support intervention for T2D and persons at risk in socioeconomically disadvantaged areas in Stockholm. Methods: Mixed methods were utilized. In study 1, 15 qualitative interviews were conducted with persons living with a high risk of developing diabetes over a period of ten years. The data were analyzed using qualitative content analysis. Study 2 compared data from community screening and facility-based screening generated from 2,564 participants to investigate screening reach using descriptive statistics. In study 3 a tool was developed to assess participant satisfaction of a telephone-facilitated health coaching intervention. Study 4 consisted of testing a tool to understand different dimensions of interaction between facilitators and participants in the health coaching intervention. Interaction scoring was performed and thematic analysis applied on quality assurance meetings with facilitators. Exploratory factor analyses were conducted for both study 3 and study 4 for tool development and interpretation of results. Results: The main theme developed from the qualitative interviews was that the risk of T2D is not concrete enough to motivate lifestyle modification without other external triggers. Persons born in Africa and Asia were reached to a higher extent through community screening, while persons born in Sweden and other European countries were reached more through facility-based screening. Participants reported the health coaching intervention as acceptable, although the perceived burden was higher among younger individuals and those at high risk compared to participants with T2D. Differences in coaching styles were found between facilitators in intervention delivery, particularly in goal setting, and limitations in language skills were a hinder in the communication between facilitators and participants. Conclusions: The potential of reversing diabetes and prediabetes should be highlighted and more clearly defined to serve as motivators for lifestyle modification. Community- and facilitybased screening are complementary methods in reaching people at high risk. Telephonefacilitated health coaching is an acceptable support intervention in socioeconomically disadvantaged population groups and should be considered when planning prevention and management strategies. Tailoring the intervention to meet participant needs is important and language skilled facilitators are needed to reduce hinders in intervention delivery

A construction of bullying in a primary school in an underprivileged community : an ecological case study

This article is based on a master’s dissertation completed through the University of Pretoria. Conversations around behavioural problems in three primary schools in Mamelodi, an underprivileged community in South Africa, explored contextually relevant ideas, in the form of discourse, focusing on the experience of bullying from the perspective of the participants (children identified by the school as engaging in bullying behaviour, school staff, and the children’s families). Semi-structured interviews were conducted with the principals (school gatekeepers), and with other participants identified by each other during the interview process. Two figures prominent in the media on the topic at the time of this study were also included to provide discourses on bullying from wider society. An ecological approach within a post-modern social constructionist theoretical framework was used. In this article one ecological case study from one of the three schools was used to explore the aims. Discourse analysis was used in the construction of the various discourses emerging from the conversations. The participants’ ideas around bullying are described, focusing on the discourse themes of “community and bullying”, “profile of teachers in the community”, “bad child, good child”, “undefined problems” and “family discord”. The aim of this article is to provide an ecological description of bullying, through discourse, in the context of this case study by exploring the participants’ ideas on and experience of bullying in a primary school situated in the township of Mamelodi. Implications for intervention are considered.http://www.journals.co.za/ej/ejour_sapsyc.htm

Ultrafast manipulation of mirror domain walls in a charge density wave

Domain walls (DWs) are singularities in an ordered medium that often host exotic phenomena such as charge ordering, insulator-metal transition, or superconductivity. The ability to locally write and erase DWs is highly desirable, as it allows one to design material functionality by patterning DWs in specific configurations. We demonstrate such capability at room temperature in a charge density wave (CDW), a macroscopic condensate of electrons and phonons, in ultrathin 1T-TaS$_2$. A single femtosecond light pulse is shown to locally inject or remove mirror DWs in the CDW condensate, with probabilities tunable by pulse energy and temperature. Using time-resolved electron diffraction, we are able to simultaneously track anti-synchronized CDW amplitude oscillations from both the lattice and the condensate, where photo-injected DWs lead to a red-shifted frequency. Our demonstration of reversible DW manipulation may pave new ways for engineering correlated material systems with light

Liver Phenotypes of European Adults Heterozygous or Homozygous for Pi∗Z Variant of AAT (Pi∗MZ vs Pi∗ZZ genotype) and Noncarriers

Homozygosity for the Pi∗Z variant of the gene that encodes the alpha-1 antitrypsin peptide (AAT), called the Pi∗ZZ genotype, causes a liver and lung disease called alpha-1 antitrypsin deficiency. Heterozygosity (the Pi∗MZ genotype) is a risk factor for cirrhosis in individuals with liver disease. Up to 4% of Europeans have the Pi∗MZ genotype; we compared features of adults with and without Pi∗MZ genotype among persons without preexisting liver disease.info:eu-repo/semantics/publishedVersio

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Averting biodiversity collapse in tropical forest protected areas

The rapid disruption of tropical forests probably imperils global biodiversity more than any other contemporary phenomenon¹⁻³. With deforestation advancing quickly, protected areas are increasingly becoming final refuges for threatened species and natural ecosystem processes. However, many protected areas in the tropics are themselves vulnerable to human encroachment and other environmental stresses⁴⁻⁹. As pressures mount, it is vital to know whether existing reserves can sustain their biodiversity. A critical constraint in addressing this question has been that data describing a broad array of biodiversity groups have been unavailable for a sufficiently large and representative sample of reserves. Here we present a uniquely comprehensive data set on changes over the past 20 to 30 years in 31 functional groups of species and 21 potential drivers of environmental change, for 60 protected areas stratified across the world’s major tropical regions. Our analysis reveals great variation in reserve ‘health’: about half of all reserves have been effective or performed passably, but the rest are experiencing an erosion of biodiversity that is often alarmingly widespread taxonomically and functionally. Habitat disruption, hunting and forest-product exploitation were the strongest predictors of declining reserve health. Crucially, environmental changes immediately outside reserves seemed nearly as important as those inside in determining their ecological fate, with changes inside reserves strongly mirroring those occurring around them. These findings suggest that tropical protected areas are often intimately linked ecologically to their surrounding habitats, and that a failure to stem broad-scale loss and degradation of such habitats could sharply increase the likelihood of serious biodiversity declines.Keywords: Ecology, Environmental scienc

Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes

Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants’ needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery