Background:The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care. Methods:We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a selfdirected DVD intervention (n = 81), or (3) usual care (n=81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or homebased DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.Results: At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/ Pacific Islander. At month 15, the meanϮSE change in BMI from baseline was Ϫ2.2Ϯ0.3 in the coach-led group vs Ϫ0.9 Ϯ 0.3 in the usual care group (P Ͻ .001) and Ϫ1.6Ϯ0.3 in the self-directed group vs usual care (P=.02). The percentages of participants who achieved the 7% DPPbased weight-loss goal were 37.0% (P=.003) and 35.9% (P=.004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level. Conclusion:Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact.
ObjectivesDichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure.Data sources and extractionWe conducted a PubMed search in October 2008 and retrieved 494 studies.Data synthesisUse restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children.ConclusionsAlthough we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.
had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Background Latino immigrants have high rates of obesity and face barriers to weight loss. Objective Evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. Design Two-year, randomized controlled trial comparing two interventions to each other and to usual care (UC). Participants/setting Eligible participants included Latinos with a Body Mass Index of 30-60 and one or more heart disease risk factors. The 207 participants recruited from 2009-2011 had a mean age of 47 years and were mostly female (77%). At 24 months, 86% of the sample was assessed. Intervention The CM+CHW (n=82) and CM (n=84) interventions were compared to each other and to UC (n=41). Both included an intensive 12 month phase followed by 12 months of maintenance. The CM+CHW group received home visits. Main outcome measures Weight change at 24 months. Statistical Analyses Generalized estimating equations using intent-to-treat. Results At 6 months, mean weight loss in the CM+CHW arm was −2.1 kg (95% CI −2.8, −1.3) or −2% of baseline weight (−1%, −2%) compared to −1.6 kg (−2.4, −0.7; % weight change: −2%, −1%, −3%) in CM and −0.9 kg (−1.8, 0.1; % weight change: −1%, 0%, −2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (p<0.05). At 6 months, men in the CM+CHW arm lost more weight (−4.4 kg, −6.0, −2.7) compared to UC (−0.4 kg, −2.4, 1.5), but by 12 and 24 months differences were not significant. Conclusions Incorporation of CHWs may help promote early weight loss, especially among men, but it did not achieve weight maintenance. Social and environmental influences may need to be addressed to achieve sustained weight loss in Latino immigrant populations.
The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While “top–down” policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a “bottom–up”, resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization’s age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.