Community engagement in kidney research: Guatemalan experience.

BACKGROUND: Community engagement is essential for effective research when addressing issues important to both the community and researchers. Despite its effectiveness, there is limited published evidence concerning the evaluation of community engagement in research projects, especially in the area of nephrology. METHODS: We developed a community engagement program in Guatemala to address the role of hydration in chronic kidney disease of unknown origin, using five key engagement principles: 1. Local relevance and determinants of health. 2. Acknowledgment of the community. 3. Dissemination of findings and knowledge gained to all partners. 4. Usage of community partners' input. 5. Involvement of a cyclical and iterative process in the pursuit of goals. The effectiveness of community engagement was measured by a structured questionnaire on a 5-point likert scale. This measure determined how well and how often the research team adhered to the five engagement principles. We assessed internal consistency for each set of the engagement items through Omega coefficient. RESULTS: Sixty-two community leaders completed the questionnaire. Seventy-five percent were female, with a mean age of 37 years. All 5 engagement principles scored highly on the 5-point likert scale. Every item set corresponding to an engagement principles evaluation had a Omega coefficient > 0.80, indicating a firm internal consistency for all question groups on both qualitative and quantitative scales. CONCLUSION: Engagement of the community in the kidney research provides sustainability of the efforts and facilitates the achievements of the goals. Community leaders and researchers became a team and develop a relationship in which commitment and empowerment facilitated the participation in all aspects of the research process. This initiative could be a useful tool for researchers, especially in low-middle income countries, to start research in a community, achieve objectives in a viable form, and open opportunities to further studies.

Evaluating the YMCA Move for Health Program in Individuals With Osteoarthritis and Assessing Maintenance During the COVID-19 Pandemic.

Osteoarthritis is the most common condition to co-occur with other chronic health conditions and a broad exercise program on management of chronic conditions may be suitable for this group. This study evaluated the 12-week YMCA Move for Health exercise program among adults with osteoarthritis or with/at risk of chronic health conditions using a mixed-methods study design based on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Participants (n = 66) completed the exercise program at the YMCAs in Cambridge, Kitchener, and Waterloo. Assessments included physical function, health-related quality of life, symptoms of arthritis, and physical activity levels and were conducted at baseline (B), postprogram (PP), and 3-month postprogram. Due to interruption by COVID-19, a subgroup of participants completed the 3-month postprogram assessments after the onset of the pandemic. At PP, participants with OA showed significant improvements in level of disability (B = 0.63 ± 0.45 and PP = 0.55 ± 0.47; p = .049), pain (B = 4.3 ± 2.5 and PP = 3.6 ± 2.4; p = .026), fatigue (B = 3.9 ± 3.1 and PP = 2.8 ± 2.6; p = .003), and several domains related to health-related quality of life. Despite interruption by the COVID-19 pandemic and poor maintenance of physical activity levels, nearly all improvements related to level of disability, symptoms of arthritis, and health-related quality of life observed at PP were maintained 3-months postprogram. The Move for Health program proved to be a feasible and effective community program for people with osteoarthritis. Additional supports may be needed to maintain physical activity levels after the program.

Understanding breast cancer survivors' financial burden and distress after financial assistance.

PURPOSE: Little is known about how breast cancer may impact survivors' financial well-being. This study aims to investigate the financial status, burden, and opinions of breast cancer survivors who received short-term financial assistance, emotional support, and resource navigation from a community organization during treatment. METHODS: Clients previously served by the community organization were mailed a 16-question survey (n = 751) to elicit their perspective on financial status and burden before, during, and after diagnosis and treatment along with general demographic and opinion items. RESULTS: 136 surveys (18.1%) were returned yielding 118 (15.7%) suitable for analyses. Clients' average age was 54.3 years. Most were female (99.2%), Caucasian (66.1%), and diagnosed with Stage 1 or 2 breast cancer (58.5%). Clients reported significantly worse (p < 0.001) financial status after being diagnosed compared to before diagnosis. Financial distress was highest during cancer treatment (mean = 3.92, SD = 0.85), lowest prior to treatment (mean = 2.48, SD = 1.05), and remained high after treatment (mean = 3.59, SD = 1.05). Those with higher distress after treatment were significantly (p = 0.01) more likely to report lower social support during treatment. CONCLUSIONS: Breast cancer survivors reported worsening financial status and distress after being diagnosed and during treatment despite receiving short-term financial assistance, emotional support, and resource navigation. Survivors' financial distress after treatment remained higher than before treatment. However, most felt receiving financial assistance improved their quality of life and made them feel more in control of financial decision-making. Breast cancer survivors who feel they have low social support during treatment may feel higher financial distress posttreatment.

Sustainability of a rural volunteer program (Nav-CARE): a case study.

INTRODUCTION: Nav-CARE (Navigation: Connecting, Accessing, Resourcing and Engaging) is an evidence-based program that was implemented over 1 year in a rural community in western Canada. Nav-CARE uses volunteers who are trained in navigation to facilitate access to resources and provide social support to older persons living in the community with serious illness such as cancer, congestive heart failure and chronic obstructive pulmonary disease. Following implementation in which Nav-CARE was found to be feasible, acceptable and have positive outcomes, Nav-CARE was integrated into the local community-based hospice society program. Two years after a successful implementation, it continued to be sustainable in this same rural community. The purpose of this study was to explore the key factors that facilitated the sustainability of Nav-CARE in a rural hospice society. METHODS: A qualitative single case study design was used with data from several sources collected at different times: (a) pre-implementation, (b) Nav-CARE program implementation (1-year time period), (c) immediately after implementation and (d) 6 months to 2 years after implementation). Data included individual interviews with community stakeholders (n=9), the study volunteer coordinator (n=1), hospice society coordinator (n=1) and Nav-CARE volunteers (n=9). It also included meeting notes of volunteer debriefing sessions and meetings with stakeholders planning for sustainability of Nav-CARE that were held during the 1-year implementation. Data were organized using the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) framework (a well known implementation framework). Data were analyzed using Yin's qualitative case study approach. RESULTS: The findings from this case study suggested that key factors in facilitating sustainability of a rural community intervention (Nav-CARE) were the organizational context (inner context) and facilitation (facilitator and facilitation processes). Additionally, the inner context included the fit of Nav-CARE with the organization's priorities, the absorptive capacity of the organization, and organizational structure and mechanisms to integrate Nav-CARE into current programs. The hospice society was well established and supported by the rural community. The role of the facilitator and the planned facilitation processes (training of volunteer navigators, ongoing support and planning events) were key factors in the sustainability of the Nav-CARE program. The findings found that the formal role of the facilitator in the implementation and sustainability of Nav-CARE in this rural community required skills and knowledge, as well as ongoing mentorship. As well, the facilitation process for Nav-CARE included formal sustainability planning meetings involving stakeholders. CONCLUSION: Using the i-PARIHS framework and a case study approach, key factors for facilitating sustainability were identified. The role of the facilitator, the facilitation processes and the characteristics of the organizational context were important for the sustainability of Nav-CARE. Future research is needed to understand how to assess and enhance an organization's sustainability capacity and the impact of additional facilitator training and mentoring. This study provides a foundation for future research and adds to the discussion of the issue of sustainability of evidence-based interventions in rural community settings.

Girls on the Run: Impact of a Physical Activity Youth Development Program on Psychosocial and Behavioral Outcomes.

PURPOSE: Girls on the Run is an after-school physical activity-based positive youth development program designed to enhance girls' social, psychological, and physical development. We evaluated the effectiveness of the program by employing a longitudinal design and mixed methods. METHODS: Girls (N = 203; aged 8-11 y) completed survey measures of positive youth development constructs (competence, confidence, connection, character, and caring), physical activity, and sedentary behavior prior to, at the end of, and 3 months after the season. Subsamples of girls, coaches, caregivers, and school personnel participated in focus groups. Coaches completed information about their team's community impact project and number of girls who completed the season-ending 5k. RESULTS: The full sample improved in confidence and connection, whereas girls who started below the preseason average showed the greatest gains from preseason to postseason on all measures, and scores were maintained or continued to improve at follow-up. All stakeholders in focus groups corroborated evidence of season-long improvement in social and emotional behaviors and health outcomes. Involvement in the community impact project contributed to girls' growth in character and empathy skills. CONCLUSION: Findings provide empirical evidence that Girls on the Run is effective in promoting positive youth development, including season-long and lasting change in competence, confidence, connection, character, caring, and physical activity, especially among girls who exhibited lower preseason scores than their peers.

A prospective non-randomized feasibility study of an online membership-based fitness program for promoting physical activity in people with mobility impairments.

BACKGROUND: People with mobility limitations have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes. These conditions often result from poor access to home and community-based health promotion/wellness programs. The aim of this project was to determine the feasibility of delivering an online community membership-based fitness program for individuals with mobility impairments. METHODS: For this prospective single-arm study, participants were recruited from members of a community fitness facility that serves people with physical disabilities and chronic health conditions. While all members had access to the online platform, individuals had to opt-in to participate in the research component. Activity options included 16 pre-recorded videos and 9 live exercise classes. During the 8-week program, participants had an opportunity to earn three exercise incentives for reaching certain activity milestones. Enrollment percentage, attendance, and attrition were tracked to assess program feasibility and acceptability. Changes in participant-reported outcomes including self-reported physical activity, psychosocial outcomes, and health-related quality of life (HRQOL) were examined using non-parametric analyses. RESULTS: A total of 146 eligible individuals were screened of which 33 enrolled (22.6%). Two participants withdrew from the study, so a total of 31 were used for analyses. Participants included 29 women and 12 Black people with an average age of 60 (± 15.9) years. Health conditions included stroke, post-polio, arthritis, neuropathy, cerebral palsy, and obesity. Ten participants used an assistive device to get around inside the home. Twenty-six participants (78.8%) completed the online program, and 5 participants earned all 3 participation incentives. The mean number of live Zoom exercise classes attended by the participants was 12.8 (range = 0-43) over 8 weeks; 3 of 31 participants did not attend any classes. On average, participants watched 128 min (range = 0-704 min) of pre-recorded videos; 6 of 31 participants did not view any pre-recorded videos. Self-reported physical activity showed the largest improvement (11.15 units; 95% CI, 3.08, 19.56) with an effect size of 0.51 (Cohen's d). CONCLUSIONS: This pilot study of an online membership-based fitness program for people with mobility impairments demonstrated preliminary effectiveness in increasing physical activity and was found to be feasible and acceptable. Feasibility endpoints do indicate potential to improve retention. These results suggest that online delivery of exercise programs can broaden the reach of specialized community fitness programs and is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05138809. Registered September 2, 2021, ClinicalTrials.gov PRS: Record Summary NCT05138809.

Describing the food choices of Aboriginal children attending an afterschool cultural program from two different knowledge systems: The importance of Country, community, and kinship.

AIMS: This study describes a program co-created with Aboriginal communities to strengthen cultural ties with the children. Food data are reported from two knowledge systems (lenses): Western and Aboriginal relational, focused on Country, community, and kinship. METHODS: A cultural program was undertaken with primary school children of Aboriginal heritage, on Yuin nation, over 10 weeks including culturally appropriate practices (painting, bushtucker, and dance). We report mixed method food outcomes framed by Western (quantitative) 24-h recall and Aboriginal relational methods (qualitative) captured by cultural images, yarning and continuous consultation methods to expose lessons from community and Country, to extend kinship. RESULTS: In total, 111 children (79 providing food data) across three regional communities commenced the program. A storying approach to food data collection and interpretation was preferred. The number of serves of seafood products, such as fish increased, vegetable consumption improved, intakes of dairy improved in quality and energy intakes from discretionary foods decreased across the programs. Qualitative data exposed six themes: Eating with family, competing agendas, food as medicine, applying cultural practices, food choices driven by 'post-invasion tradition' and community events, which deepened our understanding of the food data. Teaching the importance of the ocean and water saw participants engage with family in practices such as fishing to improve overall awareness of culture through food. CONCLUSION: The kinship system in a cultural context supported positive shifts towards accessible food choices driven by messages from Country. While the changes cannot be isolated to the program, cultural immersion drove change and strength-based reporting.

Community Activities in Primary Care: A Literature Review.

Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.

Academic learning time in physical education (ALT-PE) during an adapted tennis program for children with autism spectrum disorders.

As the prevalence of autism spectrum disorder (ASD) increases, there is a growing need to develop physical activity interventions that address the behavioral challenges experienced by individuals with ASD. Physical education teachers have employed behavioral supports that add more structure and adapt the environment for individuals with ASD, which are associated with increased engagement for individuals with ASD during PE. The purpose of this study was to quantify motor engaged behaviors (i.e. motor appropriate (MA)), motor inappropriate (MI), motor supported (MS) during skill practice in 18 individuals with ASD (ages 7-19 years) participating in an adapted tennis program (ACEing Autism) using the Academic Learning Time in Physical Education (ALT-PE) instrument. Overall, the supports provided during the program may have enabled participants with ASD to spend more time in MA and MS than MI. Indeed, the participants spent over 50% of their time in MA during the program.

Knowledge interface co-design of a diabetes and metabolic syndrome initiative with and for Aboriginal people living on Ngarrindjeri country.

Objectives: This research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community. Study design: A study protocol on qualitative research. Methods: The study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10-15 Aboriginal participants, through an Aboriginal conversational technique called 'yarning' (60-90 min) in phase 1. Elders and senior community representatives (n = 20-30) will participate in four co-design workshops (2-4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847). Results: This work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics. Conclusions: The findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.

Using CFIR framework for understanding barriers and facilitators to implementation of community tuberculosis program in Burkina Faso.

Introduction: In 2020, there were nearly 9.9 million new Tuberculosis cases and 1.3 million deaths, with about 95% occurring in developing nations. Burkina Faso implemented a community Tuberculosis program, involving Civil Society Organizations, to increase screening and improve treatment outcomes. Therefore, this study aims to identify the factors influencing the implementation of community interventions involving these organizations in the fight against TB in Burkina Faso. Method: This qualitative study conducted semi-structured key informant interviews with a purposive sample of health providers from the ministry of health and community health workers. We used framework (the consolidated framework for implementation research was used method to identify barriers and facilitators to implementation of community tuberculosis program in Burkina Faso. Results: A total of 23 interviews were conducted. The results of this research shed light on several key factors that either contributed to or hindered the program's success. Among the facilitating factors, we identified close collaboration between national and international stakeholders, as well as remarkable program flexibility to adapt to local conditions. Furthermore, continuous training and support for community health workers proved crucial for the program's implementation. However, significant challenges were also unveiled. These challenges encompassed insufficient financial resources, difficulties related to the recruitment and management of civil society associations, and issues regarding program ownership at the peripheral level. Additionally, irregular payments to community health workers had a detrimental impact on their motivation and commitment. Conclusions: Our study conducted a comprehensive examination of the obstacles and facilitators encountered in the implementation of a community-based tuberculosis control program in Burkina Faso. The results of this research shed light on several key factors that either contributed to or hindered the success implementation of program. Measures should be taken to mobilize national resources, strengthen the capacities of associations, and promote local ownership of the program. Special attention should also be given to improving financial management and resolving issues related to the recruitment and compensation of community health workers. For such community-based tuberculosis programs to succeed in Burkina Faso and in similar context it is essential to address these obstacles and facilitators.

Creation of online maps for voluntary out-of-home firearm storage: Experiences and opportunities.

Online maps showing locations for voluntary, temporary firearm storage are a novel approach in suicide and injury prevention. A study team from two states with maps (Colorado and Washington) interviewed leaders from six additional states with maps and six without. Key considerations for map creation were: trust and partnerships; legal issues; funding; and map maintenance. Addressing these considerations - through stronger networks, liability protection, or sustainable programming - may enhance dissemination and use of out-of-home firearm storage options.

Community Strategy for Hepatitis B, C, and D Screening and Linkage to Care in Mongolians Living in Spain.

Mongolia has one of the highest viral hepatitis infection (B, C, and D) rates in the world. The aims of this study were to increase awareness of this disease and promote viral hepatitis screening in the Mongolian community living in Spain. Through a native community worker, Mongolian adults were invited to a community program consisting of an educational activity, an epidemiological questionnaire, and rapid point-of-care testing for hepatitis B and C. In those testing positive, blood extraction was performed to determine serological and virological parameters. In total, 280 Mongolians were invited to the program and 222 (79%) attended the event: 139 were women (63%), mean age was 42 years, and 78 (35%) had viral hepatitis risk factors. Testing found 13 (5.8%) anti-HCV-positive individuals, 1 with detectable HCV RNA (0.5%), 8 HBsAg-positive (3.6%), and 7 with detectable HBV DNA (3.1%). One additional individual had HBV/HCV co-infection with detectable HBV DNA and HCV RNA. Two subjects had hepatitis B/D co-infection (0.9%). The knowledge questionnaire showed a 1.64/8-point (20.5%) increase in correct answers after the educational activity. In summary, a viral hepatitis community program was feasible and widely accepted. It increased awareness of this condition in the Mongolian community in Spain and led to linkage to care in 22 participants, 50% of whom were unaware of their infection.

Don't Follow the Smoke-Listening to the Tobacco Experiences and Attitudes of Urban Aboriginal Adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

Preventing smoking among young Aboriginal people is important for reducing health inequities. Multiple factors were associated with adolescent smoking in the SEARCH baseline survey (2009-12) and discussed in a follow-up qualitative study that aimed to inform prevention programs. Twelve yarning circles were facilitated by Aboriginal research staff at two NSW sites in 2019 with 32 existing SEARCH participants aged 12-28 (17 female, 15 male). Open discussion around tobacco was followed by a card sorting activity, prioritising risk and protective factors and program ideas. The age of initiation varied by generation. Older participants had established smoking in their early adolescence, whereas the current younger teens had little exposure. Some smoking commenced around high school (from Year 7), and social smoking increased at age 18. Mental and physical health, smoke-free spaces and strong connections to family, community and culture promoted non-smoking. The key themes were (1) drawing strength from culture and community; (2) how the smoking environment shapes attitudes and intentions; (3) non-smoking as a sign of good physical, social and emotional wellbeing; and (4) the importance of individual empowerment and engagement for being smoke-free. Programs promoting good mental health and strengthening cultural and community connections were identified as a priority for prevention.

The Design and Impact of a Clinic-Based Community Program on Food Insecurity, Healthy Eating Behaviors, and Mood.

Food insecurity is a national issue that disproportionately impacts Louisiana citizens, contributing to the state's poor health outcomes. We know that the Supplemental Nutrition Assistance Program (SNAP) and food pantries improve access to food, but we have limited data on what interventions improve food insecurity. The Geaux Get Healthy Clinical Program at Our Lady of the Lake (GGHOLOL) is a clinic-based community program that leverages community partnerships and a clinical setting to provide education and access to resources for individuals with food insecurity. This prospective study examines the impact of GGHOLOL on food insecurity as a pre-post survey evaluation over a two-year period. A total of 57 research participants with food insecurity completed the program. Mean food security scores improved at completion of GGHOLOL, and these scores further improved 6 months after enrollment. Furthermore, participants demonstrated sustainable improvements in healthy eating, cooking, and shopping behaviors. Lastly, participants improved their overall depression scores at the completion of the program with sustainable improvement at 6 months. With the improvement in GGHOLOL on food insecurity and nutrition behaviors, GGHOLOL may serve as a model for other programs addressing food insecurity in the future.

Yoga for everyone: a qualitative study of a community yoga class for people with disability.

Background and Objective: People with mobility impairments face increased barriers to physical activity. The study aimed to understand the lived experiences of individuals with disability who are regular participants in the Yoga for Everyone class to inform future research, intervention and community programs.Methods: A phenomenological qualitative approach utilized semi-structured interviews and class observations. Data was analyzed through iterative inductive thematic analysis.Results: Six people of varied mobility limitations participated. Thematic analysis revealed themes on influential environmental and personal factors, a holistic-focused class environment, physical improvements, mental/emotional impact, and a sense of belonging to community.Conclusion: The Yoga for Everyone class fostered multi-faceted outcomes for people with diverse movement impairments. Focusing on community-clinical partnerships, utilizing a class structure with volunteers, and fostering an ongoing inclusive social environment are potential strategies for success in other community programs for those with disability.

Voluntary, temporary out-of-home firearm storage: a survey of law enforcement agencies in two states.

BACKGROUND: Temporary, voluntary storage of firearms away from the home during times of risk is a recommended strategy for suicide prevention. Law enforcement agencies (LEAs) are often suggested as storage sites, and online maps in Colorado and Washington display LEAs willing to consider storage. Questions remain about the experiences and views of LEAs, including barriers to providing storage. METHODS:  LEAs in Colorado and Washington were invited to complete a survey via mail or online from June to July 2021; invitations were sent by email and mail, with telephone calls to non-responders. Survey data were analyzed using descriptive statistics, with testing between states and other subgroups using Fisher's exact tests. RESULTS: Overall, 168 LEAs in Colorado (n = 91) or Washington (n = 77) participated (40% participation rate). Of those, 53% provided temporary, voluntary storage upon request by community members at the time of the survey. More LEAs said they had ever provided storage when the requester was under a court order (74% overall). Over half (60%) of responding LEAs had received at least one storage request in the prior 12 months. Many (41%) said they had declined to return a firearm after temporary storage due to safety concerns. Most LEAs supported engagement in suicide prevention (89%) and provision of community services (77%), but they simultaneously preferred being a storage option of last resort (73%). Factors negatively influencing storage provision included liability and funding concerns. CONCLUSIONS: In Colorado and Washington, half of LEAs currently offer temporary, voluntary firearm storage upon request. While LEAs support suicide prevention and community engagement, broader provision of storage and participation in online maps may be limited by logistic, liability, and financial concerns. Addressing these barriers may facilitate broader suicide prevention efforts.

Community intervention programs for sex offenders: A systematic review.

Sexual violence is a phenomenon that negatively impacts the victims' physical and psychological health and well-being. Sex offenders tend not to take responsibility for their actions, have difficulties in emotion regulation and impulse control, paraphilias or other disorders, so they are a difficult group to treat. In addition, the available psychological treatment programs tend to have inconsistent and, sometimes, undesirable results. This systematic review aimed to analyse the recidivism rates of sex offenders treated in community settings. According to the PRISMA guidelines, a systematic search in three databases, EBSCOhost, PubMed, and Web of Science, and a manual search was performed. A total of 319 empirical studies using quantitative methodologies were identified, 27 of which were selected for full-text analysis. In the end, 15 studies were included, published between 1996 and 2020. The objectives, intervention approach, instruments used, and the main results and conclusions were extracted from each study. The studies explored different types of sex offenders, such as: violent sex offenders (e.g., rapists), child abusers, and child abusers with pedophilia (and/or other paraphilias). Results showed that most of the programs had a cognitive-behavioral approach (n = 13). Overall, the interventions appear to be effective in reducing recidivism rates, and some of them led to improvements in other outcomes, such as cognitive distortions, accepting responsibility, victim awareness and empathy, emotional regulation, and offense supportive attitudes. Limitations and implications for future studies were discussed.

Providing evidence from practice: Evaluating 4.5 years of implementing diabetes education support program in carbohydrate management.

OBJECTIVE: To evaluate personal and economical outcomes of CarbSmart, a 3-hour person-centered, theory-based program implemented throughout Australia, targeting optimal dietary carbohydrate management. METHODS: More than 500 CarbSmart programs were implemented over 4.5 years. Pre-, post-, (N = 4656) and 3-month follow-up assessments (N = 188) of knowledge, empowerment, confidence, and patient activation were collected from people with diabetes. Participant satisfaction and potential annual cost-savings were calculated. FINDINGS: Repeated measures ANCOVAs showed large improvements pre- to post-program in all outcome variables (d = 0.80-1.68), which were maintained at 3-month follow-up in a sub-sample. Participant satisfaction was high (Net Promoter Score = 72.3). Potential annual cost-savings nation-wide were estimated at US$512million. CONCLUSION: This paper provides evidence that CarbSmart is effective in improving behavioral indicators of self-management outcomes in Australians living with diabetes. PRACTICE IMPLICATIONS: CarbSmart has the potential to prevent diabetes-related complications. However, not engaging people living with diabetes with lower levels of patient activation at baseline was recognized as a future opportunity to improve the impact of our service. Strategies are needed to engage people with lower activation levels to improve outcomes in vulnerable and at-risk populations. FUNDING: The development of CarbSmart was funded by Diabetes WA, the national implementation of CarbSmart by the National Diabetes Services Scheme, an initiative of the Australian Government.

A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach.

BACKGROUND: Respiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications. METHODS: We examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured. RESULTS: There were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program. CONCLUSIONS: Community game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise. TRIAL REGISTRATION: KCT0005980.