Parenthood and Glee: An online study to examine differences between viewers and non-viewers of television shows featuring a character with a developmental disability.

We present findings from our study, which examined whether ability to identify Down syndrome and autism was linked to participants' willingness to maintain social contact with individuals with the respective conditions. Additionally, we explored whether viewers and non-viewers of Parenthood and Glee, television shows featuring a character with autism and Down syndrome respectively, differed in their awareness, beliefs regarding causes and interventions, and desire to maintain social proximity with individuals with these conditions. Participants completed an online survey, which included vignettes based on Max, the character with autism from Parenthood and Becky, the character with Down syndrome from Glee as well as the adapted Intellectual Disabilities Literacy Scale. Based on 300 responses, key differences were noted in the hypothesized direction on the assessed variables (symptom recognition, causal beliefs, and treatment beliefs) between Parenthood and Glee viewers and non-viewers. Findings are discussed in the context of practical implications and methodological limitations.

Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters.

BACKGROUND: Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control. METHOD: Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators. RESULTS: Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (ß = - 3.00, p = 0.02; ß = - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect = - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters. CONCLUSION: These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

A carefully planned resistance training program improves strength, fitness and depressive symptoms for a woman with type 2 diabetes.

Summary: Depression in type 2 diabetes (T2D) is estimated at 50% vs 18% among US adults, and markers of inflammation, which are tightly linked to hyperglycemia, are 5- to 50-fold higher in adults with T2D. Although lifestyle modifications are recommended for managing diabetes, resistance training (RT) is not commonly considered. This case report examined the practicality of implementing a structured RT protocol in a highly sedentary woman with T2D and depressive symptomology and assessed changes in strength, fitness, depression, and inflammation. The 59-year-old participant (body mass index: 38.1 kg/m2) was diagnosed in 2015. She had hypertension and bronchial asthma, was highly sedentary, and was clinically depressed based on validated measures: The Center for Epidemiological Studies Depression (CES-D) questionnaire and the Profile of Mood States (POMS) questionnaire. She had quit smoking 6 months earlier. The estimated 1RM guided the exercise prescription that used progressive overload to improve strength and promote the accretion of lean body mass. All exercise sessions (~45 minutes duration; 3× weekly) were supervised by trained personnel. After 8 weeks, total strength improved 135%. Heart rate was reduced by 14%, and depression symptomology fell into normal ranges. Although RT improved strength, fitness, and depressive symptomology, RT did not improve HbA1c, HOMA-IR, or inflammation emphasizing the need for a comprehensive treatment strategy. Simple assessments can be performed to determine the fitness and mental health of individuals with T2D, and incorporating an exercise prescription to standard care to address these key health determinants will empower patients to actively engage in their health care. Learning points: A progressive, individualized resistance training program is feasible and improves muscular strength, fitness level, and mental health in a high-risk individual with type 2 diabetes and multiple comorbidities. Flexibility with resistance training prescription to adapt to patient's needs and abilities contributes to exercise adherence and successful outcomes Physical activity assessment and exercise prescription should be a part of standard care for patients with diabetes.

Drowning is fast, silent, and preventable: a Texas example of research in action.

Drowning is a major public health issue internationally. In August 2022, a report was released by members of the Central Texas Drowning Prevention Action Team that provided data on drowning fatalities in Texas between 2006 and 2020 and offered recommendations for drowning prevention actions. The information in the Texas drowning report is an important contribution to the field of injury prevention. The aim of this editorial is to allow the information in the report to be available to a wider audience and potentially used as a model for other states.

Encouraging Mental Health Care in Family Medicine Residents.

Introduction: Residency training is associated with stress and burnout that can contribute to poor mental health. However, residents are less likely to utilize mental health services due to perceived barriers such as lack of time and concerns about confidentiality, among others.1 There is a need to promote help-seeking behavior and improve access to mental health services during residency training. Methods: In order to decrease barriers to seeking mental health care and promote well-being among residents, the University of California Irvine Family Medicine Residency Program (UCI FMRP) implemented a program that included confidential, regular, mental health check-ins between residents and a psychiatrist. We gathered data on help-seeking behavior from an internally conducted electronic survey of 29 residents regarding perceived barriers to seeking mental health care in June, 2020. Results: The internal survey results from 24 respondents out of 29 residents demonstrated that the program supported help-seeking behavior among the residents, with 33% of the residents requesting additional sessions with the psychiatrist and another 13% seeking external mental health resources. Conclusion: Providing additional, confidential, on-site support may be one method of decreasing stigma, increasing access to care, and normalizing conversations around mental health in residency.

Attributes of effective community preceptors for pre-clerkship medical students.

BACKGROUND: Attributes of effective precepting of pre-clerkship medical students in community settings are not adequately described. As part of preceptor needs assessment, we conducted site visits over three consecutive years. We also measured the preceptorships' educational quality, using students' post-rotation data, to identify priority areas for faculty development, corroborate site visit findings, and assess functions of the site visit. METHODS: Three university faculty directly observed teaching encounters in 83 community preceptors' offices during a 12-18-week second year (pre-clerkship) medical student rotation. Data were collected on practice demographics, teaching content, and educational quality, using multiple measures. Narrative responses to interview questions were coded for prevalent themes. Student post-rotation assessments were obtained by anonymous online evaluations. RESULTS: Good precepting attributes and suggestions for improvement were identified from both narrative analysis and student post-rotation evaluations in these key areas: independence in patient assessment, time spent teaching, giving feedback and orientation to the preceptor's practice. Student evaluations of preceptors' effectiveness significantly improved from year 1 to 2 and persisted into year 3. Appropriate faculty development strategies were derived from the combined results. CONCLUSIONS: The site visit by university faculty allows real-time observation and may itself be an effective intervention for improving teaching and learning.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.

BACKGROUND: Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE: Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS: Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS: The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION: Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02741037.

Integrating Undergraduate Patient Partners into Diabetes self-management education: Evaluating a free clinic pilot program for the Underserved.

BACKGROUND: Diabetes self-management education (DSME) improves glycemic control and health outcomes in patients with diabetes. OBJECTIVE: A process evaluation of a two-year pilot intervention examined the feasibility and acceptability of undergraduate volunteers as Patient Partners to foster DSME participation among the underserved.Design setting, and participants. In the setting of a student-run free clinic, 22 patients enrolled in DSME were paired with 16 undergraduate volunteers. During the DSME courses, Patient Partners assisted patients during classes, called patients weekly, and accompanied patients to clinic appointments.Key process evaluation results. Average attendance at DSME classes was 79.4% and 94.7% for patients and Patient Partners, respectively. Sixty-three percent of phone calls were successful and Patient Partners attended 50% of appointments with their patients. Focus groups demonstrated resounding acceptability of the Patient Partner role. CONCLUSIONS: Volunteer undergraduate Patient Partners are a beneficial adjunct to DSME delivery in the resource-constrained environment of a student-run free clinic.

An international physician education program to support the recent introduction of family medicine in Egypt.

BACKGROUND AND OBJECTIVES: There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI). METHODS: Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation. RESULTS: Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before. CONCLUSIONS: Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.

OBJECTIVE: This study sought to evaluate the feasibility of a pilot, dyad-based lifestyle intervention, the Unidas por la Vida program, for improving weight loss and dietary intake among high-risk Mexican American mothers who have Type 2 diabetes and their overweight/obese adult daughters. METHOD: Mother-daughter dyads (N = 89) were recruited from two federally qualified health centers and randomly assigned to either the Unidas intervention or to the control condition. The 16-week Unidas intervention consisted of the following: (a) four group meetings, (b) eight home visits, and (c) booster telephone calls by a lifestyle community coach. The control condition consisted of educational materials mailed to participants' homes. Participants completed surveys at T1 (baseline) and T2 (16 weeks) that assessed various demographic, social network involvement, and dietary variables. RESULTS: Unidas participants lost significantly more weight at T2 (p < .003) compared with the control participants. Furthermore, intervention participants also were more likely to be eating foods with lower glycemic load (p < .001) and less saturated fat (p = .004) at T2. Unidas participants also reported a significant increase in health-related social support and social control (persuasion control only) and a decrease in undermining. CONCLUSIONS: The Unidas program promoted weight loss and improved dietary intake, as well as changes in diet-related involvement of participants' social networks. The results from this study demonstrate that interventions that draw upon multiple people who share a health-risk have the potential to foster significant changes in lifestyle behaviors and in social network members' health-related involvement. Future research that builds on these findings is needed to elucidate the specific dyadic and social network processes that may drive health behavior change.

Unidas por la Vida (United for Life): implementing a culturally-tailored, community-based, family-oriented lifestyle intervention.

Unidas por la Vida, a behavioral weight-loss program, was developed for use among low-income, Mexican-American women with diabetes and their overweight/obese adult daughters. The program leverages community resources in a partnership between primary care and community-based organizations. This paper describes the program's implementation, lessons learned, and implications for sustainability.

The relationship between implicit and explicit motives, goal pursuit, and autobiographical memory content during a diary study.

This online diary study investigated how motives interact with goal pursuit to predict daily autobiographical experiences. Participants (N =141) completed measures of implicit and explicit achievement, provided daily memories and reports of their goal pursuit during a three-week diary period. A stronger implicit achievement motive at the onset of the study was associated with more agentic (and fewer communal) autobiographical content. Goal progress was linked with using more agentic words, while goal attainability was related to using more communal words. Interactions between motives and goal pursuit on autobiographical memory suggests a trade-off: Favorable goal pursuit conditions may prompt people not motivated for achievement to shift their focus from agentic to communal themes, while individuals motivated for achievement maintain their priorities.