Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic

Background

Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation.

Methods

Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data.

Results

The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs.

Conclusion

CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.

Community Programming for Companion Dog Retention: A Survey of Animal Welfare Organizations

Animal sheltering organizations in the United States offer programs to support dog ownership, yet little is known about what has been implemented across the U.S. In order to systematically examine factors sheltering organizations believe contribute to canine relinquishment and identify what programs they employ to address relinquishment in their communities, we conducted a cross-sectional online survey of U.S. animal sheltering organizations. In total, 111 participants from organizations serving dogs completed the organizational survey. Organizations believed a lack of access to affordable veterinary and behavioral services as well as affordable pet-friendly housing were common reasons for dog relinquishment. Most organizations offered at least one program to address relinquishment such as behavior helplines, pet food banks, and veterinary care. Reasons for discontinuing a program or not being able offer a program that was desired included lack of staff and other resources. Given limited resources, animal welfare organizations should strategically develop programs for their individual communities and actively work to partner with the veterinary and the canine behavior profession to provide necessary medical and behavioral resources.

Examination of Ecological Systems Contexts Within a Latino-Based Community Sport Youth Development Initiative

Youth Development Programs (YDPs) can serve as effective mechanisms to alleviate social and psychological adversities while enhancing and developing resilience among youth. Recently, more YDPs have incorporated sport within Sport for Development (SFD) models to achieve these goals. Due to the growing Latino population in the US and the wide achievement gap between Latinos and other demographic populations, there is a need to explore programs that may support individual development as well as long-term change with regard to social inequality. There is also a need to better understand the ecological contexts within SFD programs and how these contexts may support underserved youth. Specifically, using an ecological systems perspective, this study seeks to explore the implementation of a sport program by a YDP in order to examine the ecological processes that may support or inhibit the efficacy of sport programs working with underserved youth. Juntos is a YDP that primarily serves Latinx youth and families by assisting youth with graduating high school and pursuing higher education opportunities. Juntos incorporates two annual soccer tournaments (i.e., Kicking it with Juntos and Copa Unidos). A qualitative case study approach was implemented in two counties in North Carolina. Interviews were conducted with tournament participants, county coordinators and planning committee members. Findings found three key themes related to three ecological levels 1. At the Microsystem level, sport was implemented to engage youth and connect to non-sport program outcomes, but divergent perceptions of goals among stakeholders potentially inhibited intentional implementation. At the Mesosystem level, sport provided a mechanism to engage in collaborative relationships and encouraged parental participation. At the Macrosystem level, sport celebrated Latino culture and attempted to address social barriers facing Latinx youth, but some aspects of culture may have created barriers to access for girls. Findings suggested that while the programs emphasized mesosystem engagement, more integration across exosystem and macrosystem levels may be needed for sustainable outcomes.

Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas

Pediatric asthma morbidity is often linked to challenges including poor housing quality, inability to access proper medical care, lack of medications, and poor adherence to medical regimens. Such factors also propagate known disparities, by race and income, in asthma-related outcomes. Multimodal home visits have an established evidence base in support of their use to improve such outcomes. The Collaboration to Lessen Environmental Asthma Risks (CLEAR) is a partnership between the Cincinnati Children's Hospital Medical Center and the local health department which carries out home visits to provide healthy homes education and write orders for remediation should code violations and environmental asthma triggers be identified. To assess the strengths and weaknesses of the program, we obtained qualitative feedback from health professionals and mothers of children recently hospitalized with asthma using key informant interviews. Health professionals viewed the program as a positive support system for families and highlighted the potential benefit of education on home asthma triggers and connecting families with services for home improvements. Mothers report working to correct asthma triggers in the home based on the education they received during the course of their child's recent illness. Some mothers indicated mistrust of the health department staff completing home visits, indicating a further need for research to identify the sources of this mistrust. Overall, the interviews provided insights into successful areas of the program and areas for program improvement.

Commentary: Getting kids what they need, where they are, when they need it: home-based services in a continuum of care - a commentary on Boege et al. (2021)

In this edition of CAMH, Boege and colleague's 4-year follow-up study supports intensive home-based treatment as a viable alternative to inpatient hospitalization. Youth receiving home-based multimodal treatment fared just as well as those who remained hospitalized longer, with higher parental satisfaction. This study contributes to a sparse evidence base regarding longitudinal outcomes of psychiatric inpatient and intensive outpatient treatments for children and adolescents. Although mental illness is prevalent and increasing among youth, existing systems of care are often inadequate to provide flexible, effective, interdisciplinary team-based treatments, and supports for children and their families. Innovative approaches to providing evidence-based care and tracking outcomes are needed to strengthen the continuum of care.

Building youth leadership skills and community awareness: Engagement of rural youth with a community-based leadership program

AIMS

Community leadership programs have the potential to positively impact many aspects of young people's development, as well as the community. This study, therefore, aims to understand the experiences of the young people, particularly rural youth, involved with the Western Bulldogs Youth Leadership Project (WBYLP), a 7-month program for Year-9 and Year-10 students, and if the developmental assets are a good framework to inform future program development.

METHOD

A transformative mixed-methods design was used and included surveys with 96 participants at two time points, and semistructured interviews with eight participants.

RESULTS

Quantitatively leadership significantly increased, particularly due to increases in the domains of understanding self and decision-making skills. Social competencies increased, though total developmental assets did not. Interviews identified four primary themes: Perspective taking, self-efficacy, community awareness, and decreased isolation.

CONCLUSIONS

These results indicate that participants developed both individual skills relating to leadership and social skills. The participants also developed their awareness of the issues in their community.

"Keep Moving": Experiences of People With Parkinson's and Their Care Partners in a Dance Class

The purpose of this study was to examine the experiences of people with Parkinson's (PwP) and their care partners (CPs) who participated in a Parkinson's-focused community dance class in a northeastern state of the United States. In this qualitative inquiry, participants included five PwP and their respective CPs (n = 5). Three major, recurrent, and interrelated themes emerged from the data. These themes were (a) keep moving, (b) compassion in action, and (c) acceptance and freedom in dance. These themes captured personal and environmental factors that influenced the participation of PwP and their CPs in a dance class and how they perceived that dance influenced their quality of life. The themes described the obstacles, motives, and perceived outcomes of participating in dance. The findings emphasize the need for future dance interventions and programs that consider the CPs' role in promoting participation for PwP in dance classes.

The influence of disclosure of an autism diagnosis on peer engagement and interactions for a child with autism in summer camps: a case study

PURPOSE

Little research has evaluated how disclosure of an autism diagnosis influences peer engagement and understanding of children with autism in community recreation programs. This study describes outcomes of disclosing an autism diagnosis for a child with autism participating in mainstream, community summer camps.

METHODS

This case study includes a 9-year-old boy diagnosed with autism who participated in two camps, one in which he disclosed and one in which he did not disclose. Quantitative data on peer engagement states and reciprocal interactions were coded through structured behavioral observation of video recorded on the first, second, and last day of each program. Qualitative interviews about perceived outcomes of disclosure were completed with the child with autism, camp leaders, and peers in the disclosure camp.

RESULTS

Peer engagement and reciprocal interactions improved following the disclosure protocol and continued to improve on the final day of the camp, which was not observed in the non-disclosure camp. A key qualitative theme revealed that changed behavioral attribution was the main contributor to improved inclusion following disclosure.

CONCLUSIONS

This study provides preliminary data to support that disclosure may be a simple intervention to improve peer engagement and understanding of children with autism in community programs.IMPLICATIONS FOR REHABILITATIONChildren with Autism Spectrum Disorder are at high risk of experiencing social exclusion, especially in community programs.A disclosure protocol (disclosure + explanation for behaviors) could be a simple intervention to facilitate peer acceptance and inclusion of children with autism, however this intervention has not been evaluated in a real life context.This study provides preliminary evidence to support the use of a simple disclosure protocol for families who want to disclose, within short-term community programs.

Developing and testing a readiness tool for interpersonal violence prevention partnerships with community-based projects

Community-based projects that serve vulnerable families have the opportunity to identify and respond to interpersonal violence (IPV). We developed a readiness assessment tool to support selection of projects to participate in an initiative that involved implementing a community-based IPV intervention for mothers. The overarching aim of the current study was to describe the development of this tool and examine the reliability of coding, validity, and utility of the tool. After developing and refining the tool, 41 community-based projects completed the tool. Responses were coded and scored; scores were used to select projects for the initiative. Preliminary validation for the tool included (a) expert opinion, (b) uptake/implementation of the intervention, and (c) feedback and responses from service providers in terms of the usefulness and importance of the tool. This tool can be used by both researchers and service providers to assess community project readiness and capacity to provide trauma-informed services for vulnerable families.

South West Food Community: how government and community initiatives are supporting systemic change towards enhanced food security

OBJECTIVE

Food security refers to adequate physical, social and economic access to food and is regarded as a complex, 'wicked' issue. This research aimed to understand the perspectives of initiative leaders (stakeholders), regarding their project relating to food security and its possession of characteristics associated with system change to enhance food security.

METHODS

Stakeholders (n=51) participated in semi-structured interviews that evaluated initiatives (n=52) against 36 desirable characteristics for system change. Transcripts were analysed using QSR NVivo and Wicked Lab's Tool for Systemic Change.

RESULTS

Community-based initiatives often harnessed the passion of local communities to enhance food security through awareness-raising activities and partnerships. Few initiatives created conflict to disrupt the current way of working. The largest 'window of opportunity' included better connection between government and community groups.

CONCLUSIONS

This novel contribution provided in-depth understanding of individual initiatives and patterns of working among the food security system in the South West region of Western Australia. Implications for public health: Recommendations to better foster connection between the government and community initiatives include: ensuring government worker responsibilities include task and indicator-related measures; and strengthening understanding of food security among community groups of staff and elected member roles within local government and the ways local government could be supported to harness community knowledge.

The six-minute walk test as a fall risk screening tool in community programs for persons with stroke: a cross-sectional analysis

Background and Purpose: Persons with stroke have increased risk for recurrent stroke. Group exercise programs like cardiac rehabilitation might reduce this risk. These programs commonly use the six-minute walk test to measure aerobic capacity. However, failure to assess fall risk may compromise safety for persons with stroke. The study aim was to determine the association between the six-minute walk test and fall risk in persons with stroke.Methods: Cross-sectional analysis measured the association between the six-minute walk test and fall risk in 66 persons with stroke with a mean age of 66 years (SD 12) and median stroke chronicity of 60.9 months (range 6.0-272.1). The six-minute walk test was evaluated using logistic regression. The best fit model was used in Receiver Operating Characteristic analysis. Likelihood ratios and post-test probabilities were calculated.Results: Lower six-minute walk test distance was associated with increased fall risk in logistic regression (p = .002). The area under the curve for the univariate six-minute walk test model (best fit) was 0.701 (p = .006). The cutoff for increased fall risk was six-minute walk test <331.65 m. The post-test probability of fall risk increased to 74.3% from a pre-test probability of 59.1%.Discussion: The moderate association between fall risk and six-minute walk test suggests that in addition to assessing capacity, the six-minute walk test provides insight into fall risk/balance confidence.Conclusion: Using the six-minute walk test cutoff to screen fall risk in community exercise programs may enhance safety for persons with stroke without additional testing required.

Qualitative Evaluation of a Community-Based Physical Activity and Yoga Program for Men Living With Prostate Cancer: Survivor Perspectives

Purpose

Physical activity (PA) programs for prostate cancer survivors have positive effects on many aspects of health-related quality of life. Translating this research into sustainable community-based settings is necessary to ensure access to programs for survivors. This study examines patient perspectives in the community-based TrueNTH Lifestyle Management (TrueNTH LM) program in Calgary, Canada.

Methods

Eleven men from programs at civic wellness centers participated in 2 small semistructured focus groups (n = 5 and 6) at the University of Calgary. Motivation for program initiation and adherence, benefits and barriers to participation, and individual satisfaction and feedback on program improvement were discussed. Audio recordings were transcribed and analyzed using thematic methodology guided by a pragmatic philosophy on the patient experience in the program.

Results

Themes identified included perceived benefits of participating (physical, psychological, and social), facilitators for involvement in the PA program (program design, initial free access, tailored to prostate cancer specific needs, psychosocial environment), and opportunities for improvement and sustainability (exercise as a part of standard care, cost structure, home-based options).

Conclusions

These findings provide valuable insight into patient perspectives on effective characteristics of prostate cancer and exercise programs. TrueNTH LM has implemented findings, and ensuring needs (benefits and barriers) are addressed for prostate cancer survivors when entering community-based PA programs.

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study

INTRODUCTION

Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts.

OBJECTIVES

The purposes of this study are to describe the intensity of community programs and policies (CPPs) to address childhood obesity in 130 US communities and to examine the extent to which observed CPPs targeted multiple behaviours and employed a comprehensive array of strategies.

METHODS

To document CPPs occurring over a 10-year period, key informants were interviewed using a semi-structured interview protocol. Staff coded CPPs for key characteristics related to intensity, including reach, duration and strategy. Three types of CPP scores were calculated for intensity of CPPs, targeting of CPPs towards multiple behaviours and strategies used.

RESULTS

Nine thousand six hundred eighty-one CPPs were identified. On average, communities had 74 different CPPs in place (standard deviation 30), with variation in documented CPPs (range 25-295). Most communities experienced a steady, modest increase in intensity scores over 10 years. CPP targeting scores suggested that communities expanded the focus of their efforts over time to include more behaviours and strategies.

CONCLUSIONS

Findings of this large-scale study indicate that great variation exists across communities in the intensity and focus of community interventions being implemented to address childhood obesity.

Review: The impact of pediatric mental health care provided outpatient, primary care, community and school settings on emergency department use - a systematic review

BACKGROUND

Increases in emergency department (ED) visits for pediatric mental health care point to a need to understand the impact of mental health services in relation to emergency-based care. This systematic review examined the impact of mental health services delivered in outpatient, primary care, community and/or school settings on ED use and costs for ED-based mental health care.

METHOD

Two electronic databases and gray literature were searched. Eligible studies consisted of randomized/controlled clinical trials or cohort studies examining the effects of mental health services on ED use and costs for this care. Two reviewers independently screened the studies for relevance and study quality. Relative risks (RR), risk differences (RD), or mean differences (MD) were calculated for each study's primary outcome with 95% confidence intervals (CI). Meta-analysis was deferred due to substantial heterogeneity.

RESULTS

Six studies were included. Overall risk of bias in the studies ranged from low, unclear, to high. The majority of programs had no effect on ED visits for mental health care. A school-based program was found to reduce the risk of ED visits for any reason during use (RD, -8.0%; 95% CI: -15.2%, -0.9%); however, these visits were not specific to mental health. Three studies examined costs. A wrap-around clinical management program was associated with higher average ED costs per patient per month ($20.07 US dollars) compared to usual outpatient care; other studies reported no cost differences.

CONCLUSIONS

At this time, there is limited evidence to suggest outpatient, primary care, community and/or school-based mental health services impact ED use and costs for mental health care. Additional studies are needed.

Effects of the community-based Wellspring Cancer Exercise Program on functional and psychosocial outcomes in cancer survivors

PURPOSE

In this study, we examined the effects of a 30-week community-based exercise program on cancer-related fatigue, quality of life, and other health-related outcomes in a sample of adults with mixed cancer diagnoses.

METHODS

This prospective cohort study looked at outcomes for participants involved in the Wellspring Cancer Exercise Program in southern Ontario. The program consisted of an initial phase of two supervised sessions weekly for 10 weeks and a transition phase of one supervised session weekly for the subsequent 20 weeks. Outcomes were measured at baseline and every 10 weeks throughout the intervention, as well as at 16 weeks after program completion.

RESULTS

During a period of 13 months, 229 of the 355 cancer survivors who enrolled in the exercise program consented to participate in the study. Participants attended 71% of the supervised exercise sessions in the initial phase and 49% in the transition phase. From baseline to the end of the initial phase, significant improvements in cancer-related fatigue, 6-minute walk test, social well-being, systolic blood pressure, balance, and physical activity volume were observed. During the transition phase, health-related quality of life and emotional well-being improved significantly.

CONCLUSIONS

The Wellspring Cancer Exercise Program is associated with clinically meaningful improvements in cancer-related fatigue and functional aerobic capacity. Several other aspects of well-being in cancer survivors also improved for participants in the program. Community-based cancer exercise programs such as the Wellspring Cancer Exercise Program can improve well-being for cancer survivors and can provide an effective option that enhances sustainability and accessibility to exercise services for this population.

Effects of the community-based Wellspring Cancer Exercise Program on functional and psychosocial outcomes in cancer survivors

PURPOSE

In this study, we examined the effects of a 30-week community-based exercise program on cancer-related fatigue, quality of life, and other health-related outcomes in a sample of adults with mixed cancer diagnoses.

METHODS

This prospective cohort study looked at outcomes for participants involved in the Wellspring Cancer Exercise Program in southern Ontario. The program consisted of an initial phase of two supervised sessions weekly for 10 weeks and a transition phase of one supervised session weekly for the subsequent 20 weeks. Outcomes were measured at baseline and every 10 weeks throughout the intervention, as well as at 16 weeks after program completion.

RESULTS

During a period of 13 months, 229 of the 355 cancer survivors who enrolled in the exercise program consented to participate in the study. Participants attended 71% of the supervised exercise sessions in the initial phase and 49% in the transition phase. From baseline to the end of the initial phase, significant improvements in cancer-related fatigue, 6-minute walk test, social well-being, systolic blood pressure, balance, and physical activity volume were observed. During the transition phase, health-related quality of life and emotional well-being improved significantly.

CONCLUSIONS

The Wellspring Cancer Exercise Program is associated with clinically meaningful improvements in cancer-related fatigue and functional aerobic capacity. Several other aspects of well-being in cancer survivors also improved for participants in the program. Community-based cancer exercise programs such as the Wellspring Cancer Exercise Program can improve well-being for cancer survivors and can provide an effective option that enhances sustainability and accessibility to exercise services for this population.

Differences between leisure-time physical activity, health-related quality of life and life satisfaction: Al Ritmo de las Comunidades, a natural experiment from Colombia

Physical inactivity is one of the major public health problems worldwide. Community-based interventions have been pointed out as a promising strategy to increase physical activity (PA) levels and impact population health. Recreovía is a community program with a potential to promote PA. There is growing evidence for two benefits derived from the practice of PA: an increased perception of health-related quality of life (HRQoL) and life satisfaction (LS). The purpose of this study was to assess differences between leisure-time PA and perceptions of both HRQoL and LS, as well as to assess differences between perceptions of both HRQoL and LS for Recreovía and non-Recreovía participants. Data were obtained using the baseline cross-sectional survey of 1533 participants (501 belonged to the intervention group) as part of the natural experiment Al Ritmo de las Comunidades. HRQoL was measured with the European Organization for Research and Treatment of Cancer 30-item questionnaire, LS was measured with Questions on Life Satisfaction Scale, and self-reported minutes of leisure-time PA were measured with the long version of the International Physical Activity Questionnaire. The mean age of participants was 41.7 years (standard deviation (SD) = 16.3). The participants had a good overall HRQoL and LS. The mean minutes of leisure-time PA were 158.1 min (SD = 230.2) a week. Results showed that those participants who reported higher leisure-time PA levels also reported a significantly higher LS (M = 41.9, SD = 35.0) relative to participants with lower levels (M = 37.6, SD = 34.2, t(1532) = -2.36, p < 0.01). There were no statistical differences in the perception of HRQoL and leisure-time PA (t(1532) = -1.03, p = 0.30), although active people had higher scores. Both HRQoL and LS scores were higher in individuals who were participating in Recreovía (p < 0.001). Higher LS scores were found in the group with higher leisure-time PA, while HRQoL showed no differences. Better psychological well-being indices were found in the Recreovía group.

Collaborative public-private initiatives targeting multidrug-resistant tuberculosis (MDR-TB) supported by the Lilly MDR-TB Partnership: experiences in 2012-2016

Since 2003, the Lilly Foundation has supported the noncommercial Lilly MDR-TB Partnership, which involves more than 45 local, national, global, and nongovernmental organizations and governments. The aim of the Lilly MDR-TB Partnership is to achieve significant global impact on multidrug-resistant tuberculosis (MDR-TB) by addressing a series of important local health care needs in highly affected countries: China, India, Russia, and South Africa. The main focus of activities during 2012–2016 was on community needs in primary care. Supported projects seek to make meaningful and measurable progress toward global and national TB objectives. The partnership programs share an overall conceptual approach known as “research, report, advocate”, based on the piloting of novel approaches on a small scale, with outcomes assessed at early stages. The results are analyzed and communicated to governments, health-policy experts, and local and national stakeholders, including those in other countries facing similar MDR-TB challenges. For successful, cost-effective initiatives, the analysis is used as support when advocating for the scaling up of initiatives to regional or national levels. This article discusses representative examples of projects supported by the Lilly MDR-TB Partnership in the time period 2012–2016. The examples illustrate the potential for globally informed, locally designed primary-care collaborations to strengthen health care systems and support TB policies and offer observations to inform future health care public–private partnerships.

Walking in the neighbourhood: Performing social citizenship in dementia

The proliferation of community-based activity programs for people with dementia suggests an appetite for new approaches to support quality of life and well-being for this population. Such groups also have potential to promote social citizenship, although this remains poorly understood. This article presents findings from a subset of data from an ethnographic study of a community-based program for people with young onset dementia; it focuses on Paul's Club and the experiences of 12-15 members who are physically healthy, with moderate to moderately severe dementia. Analysis suggests how aspects of social citizenship are constructed and revealed through the Club's everyday practice of walking in the neighbourhood. Three major themes emerged: Keeping the focus off dementia; Creating a place of belonging; and Claiming a place in the community How the group balances consideration of members' vulnerability and agency is discussed, and the article concludes with implications for future practice and research initiatives.

Counter and Complicit Masculine Discourse Among Men's Shed Members

Men’s Sheds is a growing international movement aimed at providing men with places and activities that facilitate social connectedness. Despite Men’s Sheds’ focus on males, little attention has been paid to masculinities within the specific context of these settings. The current study used a gender relations framework to explore the ways in which attendees discussed Men’s Sheds, with particular attention to discussions that were complicit and counter to traditional, hegemonic views of masculinity, and diverse positions in between these binaries. The data consisted of transcripts and field notes from four focus groups comprising mostly older, White, retired male members of a Canadian shed (N = 22). The analysis revealed three overall themes: (1) focus on work, (2) independence, and (3) need for male-focused spaces. These themes and associated subthemes suggest that shed members ascribe to dominant masculine values and ideals, but also support more fluid and flexible views of masculinity. Implications are discussed for how working with an array of masculinities within the Men’s Sheds movement will be helpful with respect to their future growth in Canada and internationally.

Outcomes of Stay Strong, Stay Healthy in community settings

Loss of muscle strength, flexibility, and balance are strong predictors of falls in the elderly.

OBJECTIVES

The goal of this research was to investigate the effectiveness of a 10-week, strength-based exercise program delivered by Extension professionals.

METHODS

Matched pair t tests were used to compare differences in five measures of fitness collected from 808 participants (mean age = 65.4 years) at the start and finish of the exercise program.

RESULTS

Following programming, participants significantly improved strength, flexibility, and balance.

DISCUSSION

Results indicate that an evidence-based program can be translated into a community Extension program that is able to improve the fitness level of seniors.

Association of child maltreatment and psychiatric diagnosis in Brazilian children and adolescents

OBJECTIVES

The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program.

METHODS

In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse.

RESULTS

The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation.

CONCLUSION

All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.

The prevention of type 2 diabetes: an overview

Type 2 diabetes mellitus is one of the major public health threats in the United States today, reaching epidemic rates. Epidemiological evidence suggests a strong link between obesity and the risk of developing diabetes. Increasing evidence demonstrates that lifestyle interventions can significantly delay or possibly prevent the onset of type 2 diabetes in persons with increased risk. Despite these findings, there remain important barriers to the translation of this research to the public health. These include identifying persons with an increased risk for developing the disease and the lack of easily accessible, cost-effective intervention programs. At least one study, however, has effectively implemented an evidenced-based intervention in community settings, suggesting that it may be possible to develop a model for the national scalability of primary prevention in the United States.