scholarly journals The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

2020 ◽  
Author(s):  
Andrea M. Kriska ◽  
Bonny Rockette-Wagner ◽  
Sharon L. Edelstein ◽  
George A. Bray ◽  
Linda M. Delahanty ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Diabetes Prevention ◽  
Cox Proportional Hazards ◽  
Lessons Learned ◽  
Diabetes Incidence ◽  
Care Providers ◽  
Cross Sectional ◽  
Entire Cohort ◽  
The Impact

<b>Objective:</b> Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. <p><b>Research Design and Methods:</b> Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. </p> <p><b>Results:</b> There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models.</p> <p><b>Conclusions:</b> PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.</p>

scholarly journals The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

2020 ◽  
Author(s):  
Andrea M. Kriska ◽  
Bonny Rockette-Wagner ◽  
Sharon L. Edelstein ◽  
George A. Bray ◽  
Linda M. Delahanty ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Diabetes Prevention ◽  
Cox Proportional Hazards ◽  
Lessons Learned ◽  
Diabetes Incidence ◽  
Care Providers ◽  
Cross Sectional ◽  
Entire Cohort ◽  
The Impact

<b>Objective:</b> Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. <p><b>Research Design and Methods:</b> Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. </p> <p><b>Results:</b> There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models.</p> <p><b>Conclusions:</b> PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.</p>

scholarly journals Cannabis and breastfeeding

2020 ◽  
Vol 25 (Supplement_1) ◽  
pp. S26-S28 ◽  
Author(s):  
Lisa Graves
Keyword(s):  
Health Care Providers ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Care Providers ◽  
High Quality ◽  
High Quality Evidence ◽  
Small Sample Sizes ◽  
The Impact ◽  
Quality Evidence

Abstract Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.

scholarly journals Person-Centered Maternity Care During Childbirth and Associated Factors at Selected Public Hospitals in Addis Ababa, Ethiopia, 2021: A Cross-Sectional Study

2021 ◽  
Author(s):  
Azezew Ambachew Tarekegne ◽  
Berhanu Wordofa Giru ◽  
Bazie Mekonnen
Keyword(s):  
Health Care Providers ◽  
Maternity Care ◽  
Associated Factors ◽  
Addis Ababa ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background: Person-centered maternity care is respectful and responsive care to individual women’s preferences, needs, and values and ensuring that their values guide all clinical decisions during childbirth. It is recognized as a key dimension of the quality of maternity care that increases client satisfaction and institutional delivery. However, little research has been conducted about person-centered maternity care in Ethiopia. Objective: The aim of this study was to assess the status of person-centered maternity care and associated factors among mothers who gave birth at selected public hospitals in Addis Ababa city, Addis Ababa, Ethiopia, 2021.Method: A facility-based cross-sectional study was conducted at selected public hospitals in Addis Ababa city. A semi-structured questionnaire was used to collect data from post-natal mothers selected by systematic random sampling. The data was coded and entered using Epi-data version 4.6 and analyzed using SPSS version 25. Bivariate and multivariable linear regression analysis was used to identify factors associated with person-centered maternity care. The strength of association between independent and dependent variables was reported by using unstandardized β at 95% CI and p-value < 0.05 were considered statistically significant.Results: In this study 384 mothers were participated with a response rate of 99.2%. The overall prevalence of person-centered maternity care was 65.8%. Respondents who had no ANC follow-up (β= -5.39, 95% CI: -10.52, -0.26), <4 ANC follow up (β= -3.99, 95% CI: -6.63, -1.36), night time delivery (β= -3.95, 95% CI: -5.91, -1.98) and complications during delivery (β= -3.18, 95% CI: -6.01, -0.35) were factors significantly associated with person-centered maternity care.Conclusion and Recommendations: The finding of this study showed that the proportion of person-centered maternity care among mothers who gave birth in public hospitals of Addis Ababa was high as compared to previous studies. The factors affecting person-centered maternity care are manageable to interventions. Therefore, Health care providers need to provide person-centered maternity care for all mothers.

scholarly journals Linking Incidents in Long-Term Care Facilities to Worker Activities

2017 ◽  
Vol 65 (10) ◽  
pp. 457-466
Author(s):  
Rose McCloskey ◽  
Cindy Donovan ◽  
Alicia Donovan
Keyword(s):  
Health Care Providers ◽  
Long Term Care ◽  
Occupational Injury ◽  
Worker Safety ◽  
Care Providers ◽  
Cross Sectional ◽  
Term Care ◽  
Care Facilities ◽  
The Impact

This article reports on a study examining staff activities being performed when incidents were reported to have occurred. The risk for injury among health care providers who engage in patient handling activities is widely acknowledged. For those working in long-term care, the risk of occupational injury is particularly high. Although injuries and injury prevention have been widely studied, the work has generally focused on incident rates and the impact of specific assistive devices on worker safety. The purpose of this study was to examine reported staff incidents in relation to staff activities. A multicenter cross-sectional exploratory study used retrospective data from reported staff incidents (2010, 2011, and 2012) and prospective data from 360 hours of staff observations in five long-term care facilities during 2013. Descriptive statistics were used to analyze data. A total of 898 staff incidents were reviewed from the facilities. Incidents were most likely to occur in resident rooms. Resident aides were more likely to be engaged in high-risk activities than other care providers. Times when staff incidents were reported to have occurred were not associated with periods of high staff-to-resident contact. Safe handling during low and moderate risk activities should be promoted. Education on what constitutes a reportable incident and strategies to ensure compliance with reporting policies and procedures may be needed to ensure accuracy and completeness of incident data.

Adding a Parent to the Brain Tumor Team: Evaluating a Peer Support Intervention for Parents of Children With Brain Tumors

2018 ◽  
Vol 35 (3) ◽  
pp. 218-228 ◽  
Author(s):  
Mary Baron Nelson ◽  
Kathy Riley ◽  
Kimberly Arellano
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Focus Groups ◽  
Health Care Providers ◽  
Intervention Group ◽  
Pediatric Brain Tumor ◽  
Family Impact ◽  
Care Providers ◽  
Cross Sectional ◽  
The Impact

Childhood brain tumors often present profound challenges to patients and families. To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support services to parents of children with brain tumors from a Veteran Parent (VP). This mixed-methods, cross-sectional study was designed to evaluate the effectiveness of the intervention using validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not. Two-tailed t tests assessed significant differences in scores on the PedsQL Family Impact module and Connor–Davidson Resilience Scale (CD-RISC-25). Additional qualitative data gleaned from focus groups with stakeholders (health care providers and parents) were analyzed using key constructs of social support theory with Atlas.ti. Although there were no significant differences in overall scores on the PedsQL Family Impact module or CD-RISC-25 between groups, parents in the intervention group scored better on items related to handling difficult decisions and painful feelings. Overarching themes emerged from focus groups around participants’ experiences with the program and included informational and emotional support, peer parent relatedness, changed outlook, and empowerment. Results reveal the impact of peer parent support and need for emotional and instrumental support.

scholarly journals ANALISIS IMPLEMENTASI PROGRAM JAMINAN KESEHATAN NASIONAL BERDASARKAN ANGGOTA KEPESERTAAN BPJS (STUDI DI PUSKESMAS WIYUNG, KOTA SURABAYA TAHUN 2017)

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Satriya Wijaya
Keyword(s):  
Health Insurance ◽  
Health Center ◽  
Health Care Providers ◽  
Secondary Data ◽  
Care Providers ◽  
Cross Sectional ◽  
Stake Holder ◽  
The Government ◽  
Document Review ◽  
The Impact

Abstrak Pelaksanaan JKN di Indonesia menghadapi berbagai tantangan, dari sisi pemberi layanan kesehatan, pengelola jaminan kesehatan, masyarakat sebagai pengguna, serta pemerintah sebagai regulator program. Berbagai studi telah dilakukan untuk menelaah dampak JKN pada pelayanan kesehatan di Indonesia, namun pemanfaatan hasil studi tersebut untuk menyempurnakan kebijakan masih terbatas. Jenis penelitian ini adalah penelitian deskriptif eksploratif, yang menggunakan metode deskriptif kualitatif serta penelaahan dokumen. Desain penelitian adalah cross-sectional dengan pendekatan retrospektif. Sampel penelitian ini adalah seluruh stakeholder kunci yang berada di wilayah kerja Puskesmas Wiyung yang terkait erat dengan pelaksanaan JKN. Analisa dan pengumpulan data dilakukan untuk memvalidasi: informasi dari institusi responden, indepth interview dengan stake holder kebijakan dan pelaksana program, kemudian cek silang oleh enumerator lapangan ke beberapa responden untuk temuan yang memerlukan, dan refleksi tim dalam bentuk pertemuan validasi data. Informasi yang diperoleh dari hasil indepth interview stake holder kebijakan dan pelaksana program, informasi cek silang dari enumerator lapangan maupun data sekunder akan diintegrasikan dengan informasi kualitatif yang terkumpul. Hasil analisis menunjukkan tidak semua pengunjung Puskesmas Wiyung telah menjadi peserta BPJS. Sistem administrasi dianggap rumit untuk dipahami dengan mudah oleh masyarakat.  Perlu sosialisasi kepada masyarakat tentang kepesertaan BPJS dan penguatan koordinasi dengan pihak BPJS apabila ada masalah anggota kepesertaan pasien BPJS.   Kata kunci: implementasi JKN, program JKN, kepesertaan BPJS Abstract   Implementation of National Health Insurance (JKN) in Indonesia faces various challenges, from the side of health care providers, health insurance managers, the community as users, and the government as the program regulator. Various studies have been conducted to examine the impact of JKN on health services in Indonesia, but the use of the results of these studies to improve policies is still limited. This type of research is explorative descriptive research, which uses qualitative descriptive methods and document review. The study design was cross-sectional with a retrospective approach. The sample of this study is all key stakeholders in the Wiyung Health Center working area which are closely related to JKN implementation. Analysis and data collection were carried out to validate: information from the respondent's institution, in-depth interviews with policy stakeholders and program implementers, then cross-check by field enumerators to several respondents for findings that needed, and team reflection in the form of data validation meetings. Information obtained from the results of an in-depth interview of policy stakeholders and program implementers, cross check information from field enumerators and secondary data will be integrated with qualitative information collected. The results of the analysis showed that not all visitors to the Wiyung Health Center had become BPJS participants. The administrative system is considered complicated to be easily understood by the community. Need to disseminate information to the public about BPJS membership and strengthening coordination with BPJS if there are problems with membership of BPJS patients.  Keywords: implementation of JKN, JKN program, BPJS membership

scholarly journals THE CORRELATION BETWEEN KNOWLEDGE OF MARRIAGEABLE AGE, EDUCATION, MATCHMAKING AND CHILD MARRIAGE IN FEMALES IN BANJARNEGARA INDONESIA

2018 ◽  
Vol 4 (5) ◽  
pp. 502-509
Author(s):  
Reni Sumanti ◽  
Sri Handayani ◽  
Dhesi Ari Astuti
Keyword(s):  
Health Care Providers ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Dominant Factor ◽  
Child Marriage ◽  
Care Providers ◽  
Chi Square ◽  
Cross Sectional ◽  
High Knowledge ◽  
The Impact

Background: Teenage marriage is still found in developing countries, including Indonesia. The percentage of teenage marriage in females in Indonesia is 11.5%. Various factors related to teenage marriage are education, knowledge, economy, and culture. Impacts caused by teenage marriages include pregnancy in adolescence which results in increased maternal and infant deaths, dropouts, and poor quality of the family. The prevalence of teenage marriage in Banjarnegara in 2016 was 23%, higher than the national prevalence.Objective: This study aims to determine the correlation between factors related to knowledge of marriageable age, education, matchmaking and child marriage in females in Banjarnegara Indonesia.Methods: This was a correlational cross sectional study. There were 96 respondents selected using proportionated stratified random sampling Chi square and logistic regression were used for data analysis.Results: Findings show that there were statistically significant correlations between knowledge of marriageable age, education and child marriage. There was no signifciant relationship between matchmaking and child marriage, Respondents with low knowledge were 0.5 times more likely to have child marriage compared with those with high knowledge (p = 0.001, 95% CI = 0.320-0.782).Conclusion: Knowledge of marriageable age is cosidered as the dominant factor affecting child marriage in Banjarnegara Indonesia. It is suggested that health care providers should continuously promote about the impact of child marriage to increase the knowledge of marriageable age.

scholarly journals Pediatric HIV Disclosure in Northern India: Evaluation of Its Prevalence, Perceptions amongst Caregivers, and Its Impact on CLHIV

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Rajesh Meena ◽  
Alok Hemal ◽  
Shilpa Khanna Arora
Keyword(s):  
Health Care Providers ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Hiv Disclosure ◽  
Pediatric Hiv ◽  
Smooth Transition ◽  
Standards Of Care ◽  
Care Providers ◽  
Cross Sectional ◽  
The Impact

Background. With improving standards of care of children living with HIV (CLHIV), pediatric HIV related mortality rates are declining. New challenges like HIV status disclosure are emerging which need to be addressed to ensure their smooth transition into adulthood. Poor disease disclosure rates are observed in CLHIV globally. Aims. This study was done to assess the prevalence of HIV disclosure in North Indian CLHIV, know the perceptions of caregivers regarding disclosure, and evaluate the impact of disclosure on CLHIV. Methods. It was a questionnaire based cross-sectional study carried out amongst 144 caregivers of CLHIV aged 6-16 years attending the pediatric HIV clinic of a tertiary care teaching hospital. Results. Though the majority (93.8%) caregivers felt that it is important to disclose but only 33% of the children were actually disclosed. Eighty five percent felt that disclosure must be done by one of the family members and correspondingly 73% of the disclosed children were actually disclosed by their parents. Forty seven percent believed that the most appropriate age for disclosure is 10-12 years. The mean age at which disclosure was actually done was 11.06 ± 1.62 years. Comparison of the disclosed and undisclosed CLHIV revealed that the disclosed group had significantly higher age, longer duration of taking ART, and higher proportion of paternal orphans. Age of the CLHIV was the only significant factor for disclosure. Several reasons were cited by the caregivers for nondisclosure. The caregivers observed improved drug adherence in 47.9% of the children following disclosure. Conclusions. There is a need to develop region specific pediatric HIV disclosure guidelines keeping in mind the caregivers’ perceptions. The guidelines must be age appropriate, systematic, and socioculturally acceptable. The most suitable age for disclosure appears to be 10-12 years. Involvement of caregivers and health care providers in the process is a must.

scholarly journals Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya

2021 ◽  
Vol 30 (3) ◽  
pp. 27-42
Author(s):  
Laura Janet Pizer Gueron ◽  
Arobogust Amoyi ◽  
Winnie Chao ◽  
Justine Chepngetich ◽  
Jepkemoi Joanne Kibet ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Group Treatment ◽  
Community Education ◽  
Pelvic Floor Dysfunction ◽  
Interdisciplinary Treatment ◽  
Care Providers ◽  
Biopsychosocial Perspective ◽  
Clinically Significant ◽  
The Impact

Introduction:  In this paper we report provisional field results on the impact of CVT’s (the Center for Victims of Torture) interdisciplinary group treatment on physiotherapy indicators in refugees living in urban and camp settings in Kenya and Jordan. The physiotherapy component of this model includes pain neuroscience education, sleep hygiene, posture and body mechanics instruction and healing of pain and trauma from a biopsychosocial perspective, in a program of ten weekly sessions. This program is supported by a clinical assessment that records a broad set of indicators of participant experience and functioning. In addition, some survivors report having pelvic floor dysfunction and data will be offered about a subset of survivors looking at prevalence of these issues. Methods: Survivors are identified through referral systems, community education and sensitization campaigns, contacts and trainings with other NGOs and health care providers. Prospective survivors are screened into CVT services or referred to other agencies that can better meet their needs. CVT focuses its services on refugees with physical and emotional difficulties that may be effectively treated through its interdisciplinary treatment model and who have survived torture or related human rights violations. Following an informed consent process, survivors participate in a comprehensive individual assessment and then progress to the 10-week program. Wherever possible, follow-up assessments are conducted 2 weeks after the sessions end, and at 3, and 9 months following completion of the 10-week long intervention. Results: On average, participants who completed 3-month follow-up assessments showed statistically and clinically significant improvements on physiotherapy indicators. Discussion: Provisional results are encouraging and suggest that the model is adaptable to the needs of different populations and settings. As nearly all participants receive both counseling and physiotherapy, it is difficult to know which benefits can be attributed to physiotherapy alone. 

scholarly journals Outcomes from the Medication Assisted Treatment Pilot Program for Adults With Opioid Use Disorders in Rural Colorado

2021 ◽  
Author(s):  
Claudia R. Amura ◽  
Tanya R. Sorrell ◽  
Mary Weber ◽  
Andrea Alvarez ◽  
Nancy Beste ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rural Areas ◽  
Addiction Severity Index ◽  
Lessons Learned ◽  
Opioid Overdose ◽  
Pilot Program ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
The Impact

Abstract Background. As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence based treatment 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1,005 patients receiving MOUD from the 3 participating organizations. Here we evaluate the impact of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis on patient centered clinical and functional outcomes. Methods. Under state-funded law, three rural agencies submitted patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index with McNemar-Bowker and t tests were used to measure program impact. Results. Patients in treatment reported using less heroin (13.0 vs. 3.7 days), opioids (3.7 vs. 1.9 days), and alcohol (3.2 vs 0.7 days, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less days of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5 % to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions. This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

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