This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
Knowledge to action: changing the dynamic between patients and providers - en...Paul Gallant
This presentation provides tips, examples and extensive resources on taking action for better patient and health provider engagement. As part of my invited keynote presentation for Choosing Wisely Alberta/Alberta Medical Association. I hope you find the presentation deck useful. Brief video clips & words of wisdom from my friend and colleague, Annette McKinnon are included in the presentation to accompany the slides.
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This invited presentation was part of the 2020 6th Annual Interior Region Eating Disorder (Virtual) Forum, September 2020. The presentation addresses recent research, community and clinical experiences of men with eating disorders to deepen our understanding to improve caring. Stories, stats, questions, video clips and polls were included to seek input from those participating.
For example: Do males comprise 33-40% of those we are caring for? If NO, WHY NOT?
You may find use for some of these in future presentations or team discussions.
Tips to Improve Caring include:
*Team based interest/working groups to plan better for
males; include cross site/jurisdiction knowledge
exchange/peer support for clinicians/mentorship
*Include male former patients/MWED in planning/advising
*Include males in research AND disseminate this research to honor their contribution
rather than “the number of males were insufficient to report on”
*Include retrospective reviews on past males for quality improvement
*Review non-published findings on males in your own research
*Demonstrate that you’re informed/comfortable working with MWED
*Know the literature/resources & limits of both for males with eating disorders
*Use your creativity & planning to consider all-male therapeutic groups including online therapeutic or support groups?
*Schedule male appointments back to back/same time. Males see they are not the only male in treatment/care
*Seize the moment to engage the person who is seeking support (hope, optimism and repeat check-in)
A take away team or self-reflection exercise asks:
What are we doing in our own practice or setting to__
-Demonstrate a “male friendly” welcoming environment for
boys/men with Eating Disorders?
-Better understand… boys/men with Eating Disorders?
-Better support/treat/demonstrate caring … boys/men with
Eating Disorders?
Better Healthcare Through Community and Stakeholder Engagement, 2015 Webinar ...Paul Gallant
"An enjoyable presentation, well-delivered with excellent insight into community and stakeholder engagement strategies. Terry Dyni - July 23, 2015" on the webinar version. This version is my complete slide deck from a live webinar presentation requested by the Conference Board of Canada. April, 2015. Thanks for your interest in Better Healthcare Through Community and Stakeholder Engagement.
Compliments of Paul W. Gallant, CHE, GALLANT HEALTHWORKS & Associates (GHWA), Vancouver, BC, Canada. PS See the last slide for contact details or to arrange customized training/facilitation or advice on your organizational needs.
Health innovation for all conference sustaining and transforming our health s...Paul Gallant
IHI Open School UBC Chapter, Health Innovation for All Conference. Sustaining and Transforming Our Health System(s)
Presentation by: Paul W. Gallant, Gallant HealthWorks
Session Summary:
This interactive workshop encourages participants to contribute their knowledge, views and experiences as health system(s) stakeholders to discuss questions based on the concepts and trends presented.
Knowledge to action: changing the dynamic between patients and providers - en...Paul Gallant
This presentation provides tips, examples and extensive resources on taking action for better patient and health provider engagement. As part of my invited keynote presentation for Choosing Wisely Alberta/Alberta Medical Association. I hope you find the presentation deck useful. Brief video clips & words of wisdom from my friend and colleague, Annette McKinnon are included in the presentation to accompany the slides.
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This invited presentation was part of the 2020 6th Annual Interior Region Eating Disorder (Virtual) Forum, September 2020. The presentation addresses recent research, community and clinical experiences of men with eating disorders to deepen our understanding to improve caring. Stories, stats, questions, video clips and polls were included to seek input from those participating.
For example: Do males comprise 33-40% of those we are caring for? If NO, WHY NOT?
You may find use for some of these in future presentations or team discussions.
Tips to Improve Caring include:
*Team based interest/working groups to plan better for
males; include cross site/jurisdiction knowledge
exchange/peer support for clinicians/mentorship
*Include male former patients/MWED in planning/advising
*Include males in research AND disseminate this research to honor their contribution
rather than “the number of males were insufficient to report on”
*Include retrospective reviews on past males for quality improvement
*Review non-published findings on males in your own research
*Demonstrate that you’re informed/comfortable working with MWED
*Know the literature/resources & limits of both for males with eating disorders
*Use your creativity & planning to consider all-male therapeutic groups including online therapeutic or support groups?
*Schedule male appointments back to back/same time. Males see they are not the only male in treatment/care
*Seize the moment to engage the person who is seeking support (hope, optimism and repeat check-in)
A take away team or self-reflection exercise asks:
What are we doing in our own practice or setting to__
-Demonstrate a “male friendly” welcoming environment for
boys/men with Eating Disorders?
-Better understand… boys/men with Eating Disorders?
-Better support/treat/demonstrate caring … boys/men with
Eating Disorders?
Better Healthcare Through Community and Stakeholder Engagement, 2015 Webinar ...Paul Gallant
"An enjoyable presentation, well-delivered with excellent insight into community and stakeholder engagement strategies. Terry Dyni - July 23, 2015" on the webinar version. This version is my complete slide deck from a live webinar presentation requested by the Conference Board of Canada. April, 2015. Thanks for your interest in Better Healthcare Through Community and Stakeholder Engagement.
Compliments of Paul W. Gallant, CHE, GALLANT HEALTHWORKS & Associates (GHWA), Vancouver, BC, Canada. PS See the last slide for contact details or to arrange customized training/facilitation or advice on your organizational needs.
Health innovation for all conference sustaining and transforming our health s...Paul Gallant
IHI Open School UBC Chapter, Health Innovation for All Conference. Sustaining and Transforming Our Health System(s)
Presentation by: Paul W. Gallant, Gallant HealthWorks
Session Summary:
This interactive workshop encourages participants to contribute their knowledge, views and experiences as health system(s) stakeholders to discuss questions based on the concepts and trends presented.
Hi52Hlth: Using Mobile Technology to Access Healthcare for TeensYTH
Hi52Hlth is a mobile application (app) created to engage adolescents and young adults in the search for resources in the Houston area. The app allows the user to search for locations of clinics and community organizations with directions, articles and videos on HIV/AIDS, ability to ask questions directly to health avatars ("Tiff" and "Ty"), PEP (Post-Exposure Prophylaxis) and PrEP (Pre-Exposure Prophylaxis) information, and a frequently asked questions section.
These slides provide an overview of the major elements required for effectively addressing addiction and risky use of addictive substances within the primary care setting. For more information, including a supplement guide with slide-by-slide background information, case studies and references please visit http://www.casacolumbia.org/health-care-providers/addiction-resources-tools
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
These slides accompany the didactic lectures Dr. Stephen Grcevich presented to child and adolescent psychiatry fellows at Akron Children's Hospital in September 2020. Topics covered include:
Session One: Epidemiology, presentation throughout childhood/adolescence, clinical course, risk factors, etiology
Session Two: Evaluation – diagnostic criteria, differential diagnosis, comorbidity, use of rating scales
Session Three: Pharmacotherapy and other medical treatments
Session Four: Non-pharmacologic treatments
Presentation by Hunter Institute of Mental Health Senior Project Officer Liz Kemp for Hunter Youth Mentor Collaborative network and learning meeting, May 2016.
Symposium presentation by Ellen Newman, Hunter Institute of Mental Health, for the Society for Mental Health Research Conference 2016.
For more information visit www.responseability.org
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
Hi52Hlth: Using Mobile Technology to Access Healthcare for TeensYTH
Hi52Hlth is a mobile application (app) created to engage adolescents and young adults in the search for resources in the Houston area. The app allows the user to search for locations of clinics and community organizations with directions, articles and videos on HIV/AIDS, ability to ask questions directly to health avatars ("Tiff" and "Ty"), PEP (Post-Exposure Prophylaxis) and PrEP (Pre-Exposure Prophylaxis) information, and a frequently asked questions section.
These slides provide an overview of the major elements required for effectively addressing addiction and risky use of addictive substances within the primary care setting. For more information, including a supplement guide with slide-by-slide background information, case studies and references please visit http://www.casacolumbia.org/health-care-providers/addiction-resources-tools
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
These slides accompany the didactic lectures Dr. Stephen Grcevich presented to child and adolescent psychiatry fellows at Akron Children's Hospital in September 2020. Topics covered include:
Session One: Epidemiology, presentation throughout childhood/adolescence, clinical course, risk factors, etiology
Session Two: Evaluation – diagnostic criteria, differential diagnosis, comorbidity, use of rating scales
Session Three: Pharmacotherapy and other medical treatments
Session Four: Non-pharmacologic treatments
Presentation by Hunter Institute of Mental Health Senior Project Officer Liz Kemp for Hunter Youth Mentor Collaborative network and learning meeting, May 2016.
Symposium presentation by Ellen Newman, Hunter Institute of Mental Health, for the Society for Mental Health Research Conference 2016.
For more information visit www.responseability.org
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
"Putting Dietary Guidelines for Americans to Work! Multifactorial Approaches ...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 2.2: Information and education for healthy food behaviours"
A Conversation with the Dean of the Tufts School of Human Nutrition. 9-17-15 Recording here: https://www.dropbox.com/s/8qly017hyhct6ut/Darius%20Tufts%20Nutrition%20Talk.m4a?dl=0
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
1. Balanced Living with Diabetes:
A Community-based Lifestyle Intervention
Program for Improved Blood Glucose
Control
Eleanor Schlenker, PhD, RD
Carlin Rafie, PhD, RD
Melissa Chase, PhD
Kathy Hosig, PhD, MPH, RD
Associate Professor
Director, Center for Public Health Practice and Research
Population Health Sciences
Virginia Tech
2. Outline
Background
Challenges for health behavior change
Strategies for health behavior change
Balanced Living with Diabetes
– Program description
– Program history
– Program tailoring and outcomes in Virginia
Elements of success
Next Steps
– Expand VCE reach to Hispanic population (promotora)
– BLD dissemination to rural Virginia
3. Diabetes Prevalence and Risk
US adults > 20 years (2010-2012)
– Overall US population: 9.6%
– Non-Hispanic blacks: 13.2%
– Hispanics: 12.8%
Rural communities
– 17% higher risk for diabetes
– Higher prevalence of diabetes risk factors
poverty, obesity, tobacco use, low health literacy
– Less likely to engage in recommended diabetes self-care
except quarterly A1c
– Less likely to have health insurance
– Live farther from healthcare facilities
4. 7th leading cause of death in US in 2010
– Likely underreported
Health Complications
– Heart disease and stroke
– Blindness
– Kidney failure
– Lower-limb amputation
Burden of Diabetes
5. Chronic disease and diabetes
– 1.7 times higher risk for cardiovascular disease
– 71% have hypertension
– 65% have high LDL cholesterol
– 29% have diabetic retinopathy
– 60% of non-traumatic lower-limb amputations occur in
people with diagnosed diabetes
– Diabetes listed as primary cause for 44% of new kidney
failure cases
Burden of Diabetes
6. Burden of Diabetes
2013
Per-capita healthcare costs without diabetes = $4,305
Per-capita healthcare costs with diabetes = $14,000
Out-of-pocket costs 2.5x higher with diabetes
8. American Diabetes Association recommendation:
– A1c < 7.0%
Prevent complications
Reduce medical costs
For each 1% decrease in mean A1c:
– 21% decrease in risk of death related to diabetes
– 14% decrease in risk for myocardial infarction
– 37% decrease in risk for microvascular complications
Preventing Diabetes Complications
12. Challenge: Underserved
Services not available
Services not accessible
Target population may not take advantage of
available services
Unique characteristics for each target
population
14. Health Behavior Theory
Is basic information (knowledge) important for
health behavior change?
– Is it enough?
Why do interventions that focus on providing
information (i.e. “education”) often fail to produce
change in behavior?
15. Rationale for Theory-based
Interventions
Health behavior interventions that are fully
grounded in theory appear to be more effective
in producing change in health behavior – why?
– Fidelity to theory components
– Processes involved in maintaining fidelity to theory
17. Community-based Participatory
Research (CBPR)
Involvement of communities in designing,
implementing and evaluating community
interventions, with an emphasis on sustainability
Community members and researchers partner to
combine knowledge and action for social change to
improve community health and often reduce health
disparities.
18. Community-based Participatory
Research (CBPR)
Academic/research and community partners join to
develop models and approaches to building
communication, trust and capacity
CBPR equitably involves all partners in the research
process and recognizes the unique strengths that
each brings.
19. Balanced Living with Diabetes
Program Description
Program History
Program Tailoring and Outcomes in Virginia
21. Balanced Living with Diabetes
Adapted from Dining with Diabetes (CBPR)
• Name developed through Project Advisory Board
• Entire curriculum completely revised
o Focus on interaction and application of basic concepts
o Tested and revised 2 times
• Stronger fidelity to Social Cognitive Theory (SCT)
• Refined assessments to include SCT variables
• Recipes tested by Virginia residents and Extension Agents
for taste, ease of preparation
• Additional physical activity content
o Aerobic, strength, stretching
o Physical Activity Readiness Questionnaire
o Goal setting and tracking
o Step log for use with pedometers
22. Balanced Living with Diabetes
Social Cognitive Theory
• Curriculum content to address expectations
• Mastery experiences to increase self-efficacy
• In-class interaction for social support
• Emphasis on self-regulation
– Goal-setting
– Tracking
23. Program Operation*
• Weekly 2-hour classes for four weeks
• Reunion class three months after last class
• Assessments at first and 3-month reunion classes:
– A1c, height/weight
– Diabetes self-management, SCT variables
• Encourage diabetes support group for class
members and family
*Considered a research study; protocol approved by VT Institutional Review Board
24. Class Structure
Power Point interactive lecture by qualified local
health professional (CDE/RD)
Physical Activity Discussion
Food demonstration/tasting by local Virginia
Cooperative Extension Educator
Personal goal-setting, sharing, and practice
29. How Can You Avoid Complications?
• Good blood sugar control
30. Lifestyle to Control Type 2 Diabetes
Choose healthy foods
Be active
Stay at a healthy weight
31. How Can Balanced Living with Diabetes
Help You?
• Manage your diabetes
• Choose healthy foods
• Be more active
• Lower your blood sugar
• Prevent complications from diabetes
32. Balanced Living with Diabetes
• Making Food Choices
– Using the Plate Method
– Learn foods to focus on
• Being Active
– Walking or other moderate physical activity
– Strength and stretching exercises
• Practicing What you Learn
– Setting goals
– Making plans
– Keeping track
37. Can I safely become more active?
Physical
Activity
Readiness
Questionnaire
Fill it out now!
38. Balanced Living with Diabetes
Fitness
• Ways to be more active.
• Tools to help you stick to it.
• PAR-Q and your doctor
Use the PAR-Q and talk to your doctor before becoming much more active!
39. Tools for an Active Life
• Pedometer
• add 250 steps/day each week
Use the PAR-Q and talk to your doctor before becoming much more active!
40. Staying More Active
• 150 minutes a week
• exercise like walking
• slow enough to talk, but not sing!
• build to 30 minutes at least 5 days a week
Use the PAR-Q and talk to your doctor before becoming much more active!
44. Practice:
Finding Carbohydrate with Food Labels
• Use labels at your table or handouts
• Find:
Serving size
Carbohydrate
Dietary fiber
Sugar
• Compare labels for the same types of food
Yogurt
Oat cereal
Vegetables
Wheat cereal
45. Do You Have Some Tips for Us?
• Do you have ideas that you have used
at home to make your recipes
healthier?
• Please share with us!
46. More Practice with Recipes
• Look at the recipes in the handouts
• Discuss with your group how to change
these recipes to make them healthier
47. Practice!
• Use the food labels at your table
– Oils
– Shortening, Butter and Margarine
– Spreads
– Milk
– Ranch Dressing
• Talk to the people at your table about
healthy choices using these labels
48. Practice!
• Use the food labels at your table
– Vegetable Soup
– Chicken Noodle Soup
• Talk to the people at your table
about healthy choices using these
labels
49. Practice!
• Use the menus in your handouts or that
you brought
• Talk to the people at your table about
healthy choices using these menus
• Use the Plate Method!
– Write your choices on the blank
plate
54. Setting Goals & Keeping Track
• Set goals
– foods to focus on
– use Plate Method
– wear step counter
• Keep track
– foods
– Plate Method
– Steps/Walks
55. Let’s Set Goals for this Week!
• Where are you
now?
– Plate method?
– Regular meals?
• Where do you want
to go this week?
– Build slowly
• Use your diary!
56. Keep Track
• write down
goals
• notice how you
get enough
steps on days
you walk!
Use the PAR-Q and talk to your doctor before becoming much more active!
57. Let’s Review!
• Starting Point
– Plate method?
– Regular meals?
– Counting steps?
– Adding mins of
walking?
• Build slowly
• Use your diary!
58. Program History
Virginia Department of Health (Diabetes Prevention and
Control Program) funding:
– Dining with Diabetes by Virginia Cooperative Extension (VCE) with
local healthcare professionals, local health departments
13 counties in Southwest and Central Virginia (2006-2009)
Obici Healthcare Foundation grant:
– VCE partnered with Virginia Diabetes Council
6 counties in Obici service area (2011)
National Institutes of Health grant:
– Program adapted to Balanced Living with Diabetes
– Partnering with Baptist General Convention of Virginia
27 churches in 9 Virginia locations (2010-2015)
Hispanic Balanced Living with Diabetes (unfunded)
– VCE partnered with Catholic churches
5 churches in Southwest/Southside Virginia (2014-2015)
60. Dining with Diabetes Pilot (2006-2009)
N = 146 participants (8 locations analyzed)
o 80% female
o 66% > 60 years old (mean age = 66.4 ± 10.3 years)
o 53% reported income of lower than $30,000
o Race/ethnicity representative of geographic region
o 77% Caucasian
o 7% African American
o 3% Asian
o < 1% Hispanic
61. Dining with Diabetes Pilot (2006-2009)
A1c baseline to 3-month follow up:
Overall
o 7.36 ± 1.60 vs 7.27 ± 1.47 (paired t-test, p = 0.310)
> 7% A1c at baseline (n = 45)
o 8.50 ± 1.58 to 8.00 ± 1.54 (paired t-test, p < 0.001)
62.
63. Dining with Diabetes Pilot (2006-2009)
• Self-reported behaviors baseline to 3-month
follow up:
• 5 times more likely to use a plan to control
carbohydrate at least 3 days/week
o 38% vs. 74% (OR = 4.64, 95% CI = 2.50 – 8.61; t = 5.36, p < .01)
• ↑ 30 minutes physical activity at least 3
days/week
o 73% vs 82% (OR = 1.68; 95% CI=0.84¨C3.37; t=1.49, p=.07)
64. Obici Foundation Project (2011)
(used revised BLD)
39% lowered A1c
51% maintained appropriate A1c levels
65% increased days/week using a meal planning
method
73% increased days/week with 30 minutes of
walking or similar activity
65. RCT with BLD Targeting Medically
Underserved African Americans
5-year project funded by National Institutes of
Health (National Institute for Nursing Research)
3 churches in each of 10 Virginia communities
(n=30)
– Churches randomly assigned to treatment condition
BLD
BLD plus technical assistance for monthly support
group meetings
12-month delayed intervention
66. BLD with Medically Underserved
African Americans
Location
• African American Baptist Churches
• Medically underserved areas of Virginia
Partners
• Baptist General Convention
• Statewide association of black churches
• Health ministry infrastructure
• Virginia Cooperative Extension
• Virginia Department of Health
67. BLD with Medically Underserved
African Americans
Formative work (CBPR)
• Director of church health ministry involved
from beginning (proposal stage)
• Recipe testing at member churches
• Pilot/feasibility programs at 2 member
churches
68. BLD with Medically Underserved
African Americans
Community Advisory Board
• Key stakeholders
• Members of target population
• Members of partner agencies
• Administrative and staff
• Designed consent documents/process
• Chose recipes for testing
• Designed/approved marketing/recruiting
materials
• Continued involvement and formative evaluation
• Dissemination
• Sustainability
70. BLD with Medically Underserved
African Americans
• 264 participants completed 12-month assessments
• 5 locations, 14 churches
• Demographics
• 77% female; 23% male
• 96% African American
• Retention rate
• 82% at 3 months
• 80% at 6 months
• 77% at 12 months
71. BLD with Medically Underserved African Americans
Change in A1c by Treatment Condition for Participants with Baseline A1c ≥ 7.0
(n = 106)
Treatment
Condition
Baseline
A1c
(mean ± sd)
3-month
A1c
(mean ± sd)
6-month
A1c
(mean ± sd)
12-month
A1c
(mean ± sd)
Control waiting 8.5 ± 1.5 8.1 ± 1.4 8.0 ± 1.0 7.8 ± 1.6
Standard
program
8.8 ± 1.7 8.3 ± 1.3 8.1 ± 1.4 8.3 ± 1.8
Program +
support groups
8.7 ± 1.7 8.2 ± 1.1 8.3 ± 1.2 8.2 ± 1.3
72. Identifying and Exploring Capacity & Readiness
of Faith-Based Organizations Implementing
Lifestyle-Related Chronic Disease Health
Programs
Preliminary Research
– Explore capacity and readiness factors that influence
partner experience implementing a collaborative
lifestyle-related faith-based health program (BLD)
Formative and Culminating Research
– Develop and pilot a tool to assess organizational
capacity and readiness of faith-based organizations to
implement lifestyle-related health programs
73. Results
50% did not have policies to promote physical
activity
68% did not have policies related to healthy
food/beverage options at church functions
Most common policy = “No Smoking”
74. Results
57% had health and wellness mission statement
55% had health and wellness budget
57% had health ministry
– Larger churches more likely to have health ministry
– Churches with health ministry more likely to have at
least one health-related policy that was enforced
75. Results
Most churches had not partnered with
colleges/universities for health programming
Only ~50% had partnered with local/state agencies
Assessment tool is promising
– Self-assessment tool for churches
– Research tool
76. Hispanic BLD
Background
• Growing minority population in US
• Increased risk for type 2 diabetes
• Disproportionate suffering from
complications from diabetes
• ↓ access to care
• Potential for undocumented participants
• Unique influences on access to care
• Majority of Hispanic population is Catholic
77. Hispanic BLD
Location
• Catholic Churches with services in Spanish
• Identified via communication with Richmond diocese
Partners
• Richmond Diocese and 4 regional Catholic churches
• St. Mary’s Catholic Church in Blacksburg (support)
• Virginia Cooperative Extension
• Virginia Department of Health
• VT Center for Public Health Practice and Research
78. Hispanic BLD
Formative work
• Doctoral student from El Salvador worked
with BLD for MPH practicum and then……
• Interpreted BLD materials into Spanish
• Obtained permission from state Catholic
diocese to work with local churches
• Established relationship with local Catholic
churches for formative work
• Identified importance of promotora-navigator
79. Hispanic BLD
Formative work
• Recipe testing at two local churches
• Another local Catholic church helped prepare foods
and provided resources for pilot/feasibility programs
• Health fair/ A1c screening at same churches
• Pilot feasibility programs at the same churches
• Prefer Sundays after mass
83. Formative A1c Screening Results
(2 Catholic Churches)
Of 60 participants screened:
• 100% self-identified as
Hispanic
• 68% were female
• 64% were 40 years old or
younger
• 64% did not have a high
school degree or higher
• 75% did not have medical
insurance
84. Formative A1c Screening Results
(2 Catholic Churches)
• 54% had A1c > 5.7%
• Of these, 72% had
never been told that
they had pre-
diabetes, diabetes or
high blood sugar
86. HBLD Pilot RCT Results
A1c-Baseline A1c- 3 months
HBLD
(n=11)
6.4 ± 0.9 6.4 ± 0.9
HBLDd
(n=10)
6.0 ± 0.5 6.2 ± 0.7
Baseline and 3-month Follow Up A1c for Intervention and Delayed Control Churches*
* No differences for change from baseline to 3-month follow up between churches
(Kruskal Wallis, p > 0.05)
87. Considerations and Lessons Learned
High enthusiasm from churches
Documented need
Opportunity to reach severely underserved
Church dissemination infrastructure weaker
Work more closely with individual churches
Must have approval from State Diocese
Greater flexibility from Extension needed for
timing of classes (Sundays)
Bilingual educator required
Promotora navigator to improve access to care
88. Acknowledgments
J Elisha Burke, DMin (Director, Health Ministry - BGCVA)
Eleanor Schlenker, PhD, RD (Extension Nutrition Specialist - VT)
Eileen Anderson Bill (Research Assistant Professor, Psychology – VT)
Ann Forburger, MEd, CHES (Project Coordinator - VT)
Monica Motley, MPH (almost PhD)
Ivette Valenzuela, MPH (almost PhD)
Deborah Jones, MPH (Extension Specialist, Virginia State University)
Carlin Rafie, PhD, RD (Extension Nutrition Specialist - VT)
Melissa Chase, PhD (Consumer Food Safety Program Manager - VT)
89. Common Elements
Know your target population
CBPR
– Builds trust, empathy, capacity
Go where the people already come together
Work with people who are connected to the
target population
Honor and embrace differences in perspective
90. Next Steps
Explore promotora model for Virginia Cooperative
Extension programs
– MPH practicum/capstone (Karina Chavez)
Impacting Rural Community Health Through
Evidence-based Program Implementation in the
Cooperative Extension Network
– USDA: National Institute of Food and Agriculture (2 yrs)
91. USDA-NIFA Rural BLD
Dissemination
Expand BLD to all qualifying rural counties/cities in
Virginia with a Family and Consumer Sciences
Extension Agent.
Conduct process evaluation to facilitate program
sustainabilty
94. USDA-NIFA Rural BLD
Dissemination
Goal 1: Create capacity to use Master Food
Volunteers to assist with BLD implementation
Goal 2: Create sustained capacity for
implementation of BLD in rural Virginia counties
Goal 3: Produce a BLD curriculum kit to be made
available to other state and local Extension
programs
95. Target Counties and Cities
Brunswick Orange
Dickenson Page
Emporia City Patrick
Greensville Russell
Lee Shenandoah
Louisa Surry
Madison Tazewell
Nottoway Wise