Escrita em alunos com dificuldades de aprendizagem: Efeito Mateus / Writing in students with learning difficulties: Matthew effect

O estudo investigou a linguagem escrita de crianças do 2º e 4º anos com e sem sinais de transtorno específico de aprendizagem. Objetivou comparar as escritas entre dois os grupos de alunos, de modo a verificar se a diferença entre eles seria menor nas séries iniciais e tenderia a aumentar nas séries finais, como previsto teoricamente com base no efeito Mateus. Participaram do estudo 51 professores e 1085 alunos, sendo 49 indicados com sinais compatíveis com o transtorno específico de aprendizagem. O instrumento utilizado para analisar a escrita dos alunos foi o Teste de Desempenho Escolar (TDE-II). A partir das análises realizadas, observou-se que o total de palavras certas no ditado do TDE-II foi maior no 4º ano do que no 2º ano para a amostra total, como esperado, e que a diferença entre os alunos com e sem queixas de dificuldades foi maior no 4º ano do que no 2º ano. Análise de post-hoc revelou que não houve diferença estatisticamente significativa entre os alunos com queixas do 2º ano e do 4º ano, ou seja, a diferença entre eles foi tão pequena que não se mostrou significativa. Tal resultado corrobora o efeito Mateus, sugerindo que crianças com dificuldades ao início da escolarização tendem a apresentar menores ganhos e se distanciar cada vez mais dos colegas com habilidades mais desenvolvidas. Logo, estratégias e intervenções precisam ser desenvolvidas para facilitar o desenvolvimento da linguagem escrita das crianças e promover avanços logo ao início da escolarização.

The study investigated writing of 2nd and 4th grade children with and without signs of the specific learning disorder, and aimed to compare the difference in writing between these two groups of students, to analyze whether the difference between them would be smaller in the early grades and would tend to increase in the final grades, as theoretically predicted by Matthew effect. 51 teachers and 1085 students participated in this study, among which 49 had signs compatible with the specific learning disorder. The instrument used to analyze the students writing was the School Performance Test (TDE-II). It was observed that, in general, the total number of correct words in the TDE-II dictation was greater in the 4th grade, compared to the 2nd grade, as expected, and the difference between students with and without complaints of difficulties was greater among the students in 4th grade than among 2nd grade students. Post-hoc tests showed that there was no statistically significant difference between 2nd grade students with complaints and 4th grade students of with complaints, that is, the difference between them was so small that it was not significant. This result corroborates the "Matthew effect": children with difficulties at the beginning of schooling tend to present lower gains and, increasingly, distance themselves from colleagues with more developed skills. Thus, strategies and interventions must be designed to facilitate children's literacy and promote advances at beginning of schooling.

Adaptação de fórmula de nivelamento de livros infantis para o português brasileiro: resultados preliminares / Adaptación de la fórmula de nivelación infantil al portugués brasileño: resultados preliminares / Adaptation of children's leveling formula for Brazilian Portuguese: preliminary results

Introdução: Práticas para o ensino da leitura no Brasil podem ser representadas pela adaptação e validação de um instrumento de nivelamento de livros infantis já comprovadamente eficaz em outra língua e cultura. Objetivo: O presente estudo visa adaptar a fórmula de Hatcher para nivelar livros infantis para o uso no português brasileiro, disponibilizando-a como instrumento de trabalho aos profissionais de diferentes áreas no que concerne à seleção de livros adequados à idade e à etapa em que se encontram os leitores iniciantes em seus primeiros anos de alfabetização no Brasil. Método: A pesquisa seguirá as seguintes etapas para adaptação da fórmula de nivelamento de livros infantis: (1) tradução da fórmula do idioma de origem para o idioma-alvo, isto é, do Inglês para o português; (2) síntese das versões traduzidas; (3) avaliação da síntese por juízes experts; (4) avaliação da fórmula pelo público-alvo, considerados aqui professores dos anos iniciais do Ensino Fundamental; (5) tradução reversa do instrumento. Resultados: A fórmula traduzida de Nivelamento de Livros Infantis apresentou 72% de coeficiente de validade de conteúdo, em relação à clareza, e 80% de pertinência prática, demonstrando ser um documento útil, de fácil aplicação e adequado aos profissionais da área da saúde e da educação que poderão avaliar e nivelar os livros antes de indicá-los a leitores iniciantes. Espera-se, em estudos posteriores, realizar a aplicabilidade desta fórmula para facilitar o trabalho na seleção de títulos indicados ao público-alvo.

Introduction: Practices for the teaching of reading in Brazil can be represented by the adaptation and validation of a children's book leveling instrument already proven to be effective in another language and culture. Objective: The present study aims to adapt Hatcher's formula to level children's books for use in Brazilian Portuguese, making it available as a working tool to professionals in different areas with regard to the selection of books suitable for the age and stage in which readers are beginning their first years of literacy in Brazil. Method: The research will follow the following steps to adapt the leveling formula for children's books: (1) translation of the formula from the source language to the target language, that is, from English to Portuguese; (2) synthesis of the translated versions; (3) evaluation of the synthesis by expert judges; (4) evaluation of the formula by the target audience, considered here teachers from the early years of elementary school; (5) reverse translation of the instrument. Results: The translated formula for Children's Book Leveling presented 72% of content validity coefficient, in relation to clarity, and 80% of practical relevance, proving to be a useful document, easy to apply and suitable for health professionals and of education that will be able to evaluate and level the books before recommending them to beginning readers. It is expected, in later studies, to apply this formula to facilitate the work in selecting titles indicated to the target audience.

Introducción: Prácticas para la enseñanza de la lectura en Brasil puede ser representada por la adaptación y validación de un instrumento de nivelación de libros infantiles que ya ha demostrado su eficacia en otra lengua y cultura. Objetivo: Este estudio objetiva adaptar la fórmula de Hatcher para nivelar libros infantiles para uso en portugués, poniéndola a disposición como herramienta de trabajo para profesionales de diferentes áreas en lo que se refiere a la selección de libros adecuados a la edad y etapa en la que los lectores están comenzando sus primeros años de alfabetización en Brasil. Método: La investigación seguirá los siguientes pasos para adaptar la fórmula de nivelación para libros infantiles: (1) traducción de la fórmula del idioma de origen al idioma de destino, es decir, del inglés al portugués; (2) síntesis de las versiones traducidas; (3) evaluación de la síntesis por jueces expertos; (4) evaluación de la fórmula por parte del público objetivo, aquí considerados docentes de los primeros años de la enseñanza básica; (5) traducción inversa del instrumento. Resultados: Esta fórmula traducida presentó 72% de coeficiente de validez de contenido, en relación con la claridad, y 80% de pertinencia práctica, demostrando ser un documento útil, de fácil aplicación y adecuado para los profesionales de la salud y de la educación que serán capaz de evaluar y nivelar los libros antes de recomendarlos a lectores principiantes. Se espera, en estudios posteriores, aplicar esta fórmula para facilitar el trabajo en la selección de títulos al público indicado.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood.

OBJECTIVE: To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DESIGN: A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. PARTICIPANTS: The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. INTERVENTION: A training session for primary care workers based on the Brazilian National Guidelines for Children. MAIN OUTCOME MEASURE: Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. ANALYSIS: The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. RESULTS: Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age. CONCLUSIONS AND IMPLICATIONS: Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

The general movement checklist: A guide to the assessment of general movements during preterm and term age

Abstract Objectives To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. Methods Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). Results The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p < 0.001). The checklist score also differentiated between poor-repertoire (median = 13) and cramped-synchronized general movements (median = 7; p = 0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa = 0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa = 0.56-0.93); (iii) the checklist was good to excellent (ICC = 0.77-0.96). Conclusion The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

Understanding key worker experiences at an Australian Early Childhood Intervention Service.

The delivery of family-centred practice (FCP) within Early Childhood Intervention Services (ECISs) for young children with a disability or development delay conceptualises that children's learning environments, parenting, family and community supports intersect to have the greatest impact on the developing child. The transdisciplinary key worker model is considered a best-practice approach within ECISs whereby staff work collaboratively across disciplinary boundaries to plan and implement services for children and their families. Research suggests families who have a key worker have better relationships with services, fewer unmet needs, better morale, more information about services, higher parental satisfaction and more parental involvement than those not receiving this service. Using a phenomenological qualitative design this study sought to understand transdisciplinary key workers' perspectives regarding the strengths and challenges to undertaking their role in providing services to children and families accessing an ECIS at a major disability service organisation, in light of the changing policy reform during the roll out of the National Disability Insurance Scheme in Australia. Purposive sampling was used to recruit key workers (n = 13) to participate in semi-structured interviews during 2015. Data were analysed using an inductive, thematic approach. Results revealed four main themes that impact on the effectiveness of key workers' service provision. These are broadly categorised as (a) Engagement with the workplace, (b) Engagement with clients, (c) Professional capacity and (d) Staff Wellbeing. The findings aligned with previous studies identifying sources of support and stress for disability services staff. They also provided new insights into key workers' lack of confidence in addressing parental mental health issues, despite operating under a family-centred approach. These findings informed the development of an intervention trial and evaluation to improve support for parent and staff wellbeing within a Victorian Disability Service with the aim of building their capacity to support children with a disability.

The general movement checklist: A guide to the assessment of general movements during preterm and term age.

OBJECTIVES: To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. METHODS: Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). RESULTS: The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56-0.93); (iii) the checklist was good to excellent (ICC=0.77-0.96). CONCLUSION: The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder.

AIMS: Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies. METHODS: A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input. RESULTS: Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies. CONCLUSIONS: Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis / Efeitos da intervenção precoce com foco na família no desenvolvimento de criançasnascidas prematuras e/ou em risco social: metanálise

Abstract Objective To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. Source of data Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. Data synthesis Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD = 0.48, 95% CI: 0.34-0.61) and motor (SMD = 0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. Conclusion Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Resumo Objetivo Verificar se a intervenção precoce com foco na família melhora o desenvolvimento cognitivo, motor e a linguagem de crianças nascidas prematuras e/ou em risco social nos primeiros três anos de vida. Fontes de dados Metanálise de ensaios clínicos publicados entre 2008 a 2018, nas bases de dados CINAHL, Medline - Pubmed, Medline - BVS, Lilacs - BVS, IBECS - BVS, PEDro e Cochrane/Reviews. Foram incluídos estudos experimentais de intervenção precoce com foco na família cujo público-alvo eram prematuros e/ou crianças em risco social com avaliação do desenvolvimento cognitivo e/ou motor e/ou linguagem até os três anos. Os artigos foram pontuados pela Escala PEDro. Síntese dos dados Do total de 3378 artigos, 12 estudos foram incluídos. A intervenção precoce com foco na família contribuiu para o desenvolvimento dos domínios cognição (DMP = 0,48; 95%IC: 0,34-0,61) e motor (DMP = 0,76; 95% IC: 0,55-0,96) de prematuros. Na cognição, a melhora do desempenho foi observada aos 12, 24 e 36 meses, enquanto no domínio motor, o efeito foi observado apenas aos 12 meses nos prematuros. Não houve benefício da intervenção nos desfechos cognitivo, motor e linguagem de crianças com fator de risco social associado ao biológico. Conclusão Intervenção com foco na família tem efeito positivo sobre a cognição de crianças prematuras. O efeito no desenvolvimento motor foi menor, possivelmente devido à ênfase das intervenções na interação família-criança. O efeito das intervenções sobre o desenvolvimento de crianças em risco social e no domínio da linguagem foram inconclusivos, devido à escassez de estudos na área.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis.

OBJECTIVE: To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. SOURCE OF DATA: Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. DATA SYNTHESIS: Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD=0.48, 95% CI: 0.34-0.61) and motor (SMD=0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. CONCLUSION: Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Birth characteristics of children who used early intervention and special education services in New York City.

BACKGROUND: Early intervention (EI) and special education (SE) are beneficial for children with developmental disabilities and/or delays and their families, yet there are disparities in service use. We sought to identify the birth characteristics that predict EI/SE service use patterns. METHODS: We conducted a retrospective cohort study using linked administrative data from five sources for all children born in 1998 to New York City resident mothers. Multinomial regression was used to identify birth characteristics that predicted predominant patterns of service use. RESULTS: Children with service use patterns characterized by late or limited/no EI use were more likely to be first-born children and have Black or Latina mothers. Children born with a gestational age ≤31 weeks were more likely to enter services early. Early term gestational age was associated with patterns of service use common to children with pervasive developmental delay, and maternal obesity was associated with the initiation of speech therapy at the time of entry into school. CONCLUSIONS: Maternal racial disparities existed for patterns of EI/SE service use. Specific birth characteristics, such as parity and gestational age, may be useful to better identify children who are at risk for suboptimal EI use.

Asociación entre programa de intervención educativa integral y control metabólico de usuarios diabéticos tipo 2 insulino requirentes de Centro de Salud Familiar Cardenal Raúl Silva Henríquez, período 2015-2016 Chile / The effect of an educational intervention on the metabolic control of diabetic patients

Background: Diabetic patients have a poor adherence to lifestyle changes and a low compliance with medications. Aim: To study the effect of an educational intervention on the metabolic control of patients with diabetes mellitus. Patients and Methods: We studied insulin requiring diabetic patients attended at a primary health care clinic, who were randomly divided in two groups. One group participated in four modules of an educative intervention, carried out in four occasions. The other group did not participate in the educational sessions. Clinical, anthropometric and laboratory variables of the participants were obtained from their medical records, at three and six months after the intervention. Results: We recruited 22 men aged 64 ± 14 years and 48 women aged 63 ± 10 years. Thirty-six of these received the educational intervention. Eighty four percent were overweight or obese. The proportion of compensated patients, defined as those having a glycosylated hemoglobin between 7 and 9%, increased significantly after the educational intervention (χ2 = 7.9 p < 0.01, odds ratio: 0.2). Conclusions: A educational intervention in patients with insulin requiring diabetes mellitus improved the metabolic control of their disease.

Effects of a visit prior to hospital admission on anxiety, depression and satisfaction of patients in an intensive care unit.

OBJECTIVES: To assess the effects of a vists prior to hospital admission on anxiety, depression and satisfaction of patients admitted electively to an intensive care unit (ICU). DESIGN: A randomised clinical trial [NCT03605407]. SETTING: A sample of 38 patients was recruited who were to be electively admiited to ICU divided into experimental (n = 19 patients receiving one visit prior to hospital ICU admission for surgery) and control (n = 19 patients not receiving a visit prior to hospital ICU admission for surgery) groups. MAIN OUTCOME MEASUREMENTS: Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) were self-reported by patients before ICU admission, at 3-days and 90-days after ICU discharge. Critical Care Family Needs Inventory (CCFNI) and Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) were used to measure the users' satisfaction before ICU admission and 3-days after ICU discharge. RESULTS: There were statistically significant differences between experimental and control groups for FS-ICU, but not for HADS, IES-R and CCFNI. Indeed, control group patients were more satisfied with regard to emotional support, ease of getting information, control feeling, concerns and questions expression ability and overall score for decision-making satisfaction. CONCLUSIONS: The visit prior to hospital admission did not seem to modify anxiety or depression, but may impair satisfaction of ICU patients.

Hospital-Based Korean Diabetes Prevention Study: A Prospective, Multi-Center, Randomized, Open-Label Controlled Study.

BACKGROUND: The prevalence of diabetes mellitus (DM) continues to increase, and the disease burden is the highest of any medical condition in Korea. However, large-scale clinical studies have not yet conducted to establish the basis for diabetes prevention in Korea. METHODS: The hospital-based Korean Diabetes Prevention Study (H-KDPS) is a prospective, multi-center, randomized, open-label controlled study conducted at university hospitals for the purpose of gathering data to help in efforts to prevent type 2 DM. Ten university hospitals are participating, and 744 subjects will be recruited. The subjects are randomly assigned to the standard care group, lifestyle modification group, or metformin group, and their clinical course will be observed for 36 months. RESULTS: All intervention methodologies were developed, validated, and approved by Korean Diabetes Association (KDA) multi-disciplinary team members. The standard control group will engage in individual education based on the current KDA guidelines, and the lifestyle modification group will participate in a professionally guided healthcare intervention aiming for ≥5% weight loss. The metformin group will begin dosing at 250 mg/day, increasing to a maximum of 1,000 mg/day. The primary endpoint of this study is the cumulative incidence of DM during the 3 years after randomization. CONCLUSION: The H-KDPS study is the first large-scale clinical study to establish evidence-based interventions for the prevention of type 2 DM in Koreans. The evidence gathered by this study will be useful for enhancing the health of Koreans and improving the stability of the Korean healthcare system (Trial registration: CRIS KCT0002260, NCT02981121).

Public Awareness of Low-Risk Alcohol Use Guidelines.

Objective. To evaluate the effectiveness of a population-based, public education campaign designed to increase awareness of the Canadian Low-Risk Alcohol Drinking Guidelines (LRDG). Method. A province-wide mass media campaign was introduced. To measure campaign effectiveness, we completed a cross-sectional study using pre- and postcampaign surveys. Measurements included awareness of the LRDG, specific knowledge of the LRDG, and beliefs toward drinking and behavior change. Results. Postsurvey respondents were more likely to be aware of the LRDG (19.2% vs. 25.8%). However, increased awareness was largely driven by females being significantly more aware of the guidelines after the campaign (odds ratio = 1.74; 95% confidence interval = [1.38, 2.19]). Men were not found to be more aware postcampaign. The results did not show a significant increase in specific knowledge of the LRDG or change in beliefs toward drinking and behavior change after the campaign. Independent of the survey cycle, males and those aged 19 to 25 years were less likely to be aware of the LRDG, select the correct drink limit or less, and believe that consuming alcohol in excess has short- and long-term health consequences when compared to females and those aged 56 to 70 years. Conclusions. A provincial public health education campaign was effective at increasing awareness of the LRDG, though uptake was lowest among those at highest risk for heavy drinking.

Hospital-Based Korean Diabetes Prevention Study: A Prospective, Multi-Center, Randomized, Open-Label Controlled Study

BACKGROUND: The prevalence of diabetes mellitus (DM) continues to increase, and the disease burden is the highest of any medical condition in Korea. However, large-scale clinical studies have not yet conducted to establish the basis for diabetes prevention in Korea. METHODS: The hospital-based Korean Diabetes Prevention Study (H-KDPS) is a prospective, multi-center, randomized, open-label controlled study conducted at university hospitals for the purpose of gathering data to help in efforts to prevent type 2 DM. Ten university hospitals are participating, and 744 subjects will be recruited. The subjects are randomly assigned to the standard care group, lifestyle modification group, or metformin group, and their clinical course will be observed for 36 months. RESULTS: All intervention methodologies were developed, validated, and approved by Korean Diabetes Association (KDA) multi-disciplinary team members. The standard control group will engage in individual education based on the current KDA guidelines, and the lifestyle modification group will participate in a professionally guided healthcare intervention aiming for ≥5% weight loss. The metformin group will begin dosing at 250 mg/day, increasing to a maximum of 1,000 mg/day. The primary endpoint of this study is the cumulative incidence of DM during the 3 years after randomization. CONCLUSION: The H-KDPS study is the first large-scale clinical study to establish evidence-based interventions for the prevention of type 2 DM in Koreans. The evidence gathered by this study will be useful for enhancing the health of Koreans and improving the stability of the Korean healthcare system (Trial registration: CRIS KCT0002260, NCT02981121).

Efeito de visitas domiciliares na manutenção das atividades de vida diária de adultos em pós-operatório / Efecto de las visitas domiciliarias en el mantenimiento de las actividades de la vida diaria de los adultos en el postoperatorio / Effect of home visits in the maintenance of daily life activities of adults in postoperative period

Objetivo avaliar os efeitos da implantação de um programa de visitas domiciliares (VD) a pessoas adultas no domínio Atividades de Vida Diária (AVD). Método estudo quasi-experimental, com usuários de um centro hospitalar do Norte de Portugal, aos quais se aplicou a escala Hip Disability and Osteoarthritis Outcome Score LK2.0. O tratamento de dados foi realizado pelo SPSS. Resultados a maioria dos participantes era do sexo masculino (61,4%) e pertencia à faixa etária dos 65 anos ou mais (65,9%). Não se verificou um efeito significativo na interação do programa de VD, sobre o compósito multivariado (AVD Observação1 e AVD Observação2) MANOVA: p=0,164, mas a média da pontuação do domínio AVD nos dois grupos, em comparação, aumentou da Observação1 para a Observação2, sendo o aumento mais pronunciado no Grupo Experimental. Conclusão o programa de VD não teve efeito significativo na melhora do domínio AVD, mas contribuiu ligeiramente para a autonomia do usuário.

Objetivo evaluar los efectos de implementar un programa de visitas domiciliarias (VD) para adultos en el dominio de actividades de la vida diaria (AVD). Método estudio cuasiexperimental con usuarios de un hospital en el norte de Portugal, con la aplicación de la escala Hip Disability and Osteoarthritis Outcome Score LK2.0. El procesamiento de datos se realizó a través de SPSS. Resultados la mayoría de los participantes eran hombres (61,4%) y tenían 65 años o más (65,9%). No hubo un efecto significativo sobre la interacción del programa VD en el compuesto multivariado (AVD Observation1 y AVD Observation2) MANOVA: p=0.164, pero el puntaje promedio del dominio AVD en ambos grupos aumentó de Observation1 a Observation2, siendo el aumento más pronunciado en el Grupo Experimental. Conclusión el programa de VD no tuvo un efecto significativo en la mejora del dominio AVD, pero contribuyó ligeramente a la autonomía del usuario.

Objective to evaluate the effects of implementing a home visiting (HV) program for adults in the Daily Life Activities (DLA) domain. Method quasi-experimental study with users of a hospital center in north Portugal, with the application of the Hip Disability and Osteoarthritis Outcome Score LK2.0 scale. Data processing was performed through SPSS. Results most participants were male (61.4%) and were 65 years old or older (65.9%). There was no significant effect on HV program interaction, on multivariate composite (DLA Observation1 and DLA Observation2) MANOVA: p=0.164, but average DLA domain score in both groups increased from Observation1 to Observation2, with the most pronounced increase in the Experimental Group. Conclusion the HV program had no significant effect on improving the DLA domain, but slightly contributed to the user's autonomy.

Educational intervention to reduce treatment of asymptomatic bacteriuria in long-term care.

OBJECTIVE: To determine if an educational intervention can decrease the inappropriate antibiotic treatment of long-term care (LTC) residents with asymptomatic bacteriuria (ASB). DESIGN: Prospective chart audit between May and July 2017. SETTING: Seven LTC facilities in Regina, Saskatchewan, Canada. PARTICIPANTS: Chart audits were performed on all LTC residents over 18 years of age with a positive urine culture. Educational sessions and tools were available to all clinical staff at participating LTC facilities. INTERVENTION: Fifteen-minute educational sessions were provided to LTC facility staff outlining the harms of unnecessary antibiotic use, antibiotic resistance and the diagnostic criteria of a urinary tract infection (UTI). Educational sessions were complimented with posters and pocket cards that summarised UTI diagnostic criteria. MAIN OUTCOME MEASURE: The primary outcome measure was the number of residents who received inappropriate antibiotic treatment for ASB. Secondary outcome measures included the appropriateness of urine culture tests, number of tests and cost associated with inappropriate treatments. RESULTS: In the preintervention period, 172 urine culture and sensitivity (UC&S) tests were performed, 62 (36.0%) were positive and 50/62 (80.6%) residents had ASB based on chart review. In the postintervention period, 151 UC&S tests were performed, 50 (33.1%) were positive and 35/50 (70.0%) residents had ASB. There was a statistically significant decrease in the number of residents treated with antibiotics for ASB, from 45/50 (90%) preintervention to 22/35 (62.9%) postintervention (χ2=9.087, p=0.003). CONCLUSIONS: An educational intervention was associated with a statistically significant decrease in inappropriate antibiotic treatment of LTC residents with ASB.

Association between alcohol screening and brief intervention during routine check-ups and alcohol consumption among adults living in California.

BACKGROUND: Alcohol consumption accounts for 1 in 10 deaths among U.S. adults and cost upwards of $200 billion each year due to productivity loss. Alcohol Screening and Brief Intervention and Referral to Treatment (aSBIRT) was developed as a treatment approach for use in primary care to identify and reduce substance abuse. Although aSBIRT has proven to be successful, implementation rates remain low. METHODS: Using population level representative data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) conducted in California, this study utilizes logistic regression to analyze the association between self-reported drinking levels and screening and brief intervention practices during routine check-ups. RESULTS: The results demonstrated that the more an individual drank, the lower the odds of receiving aSBIRT during a routine check-up. Men had reduced odds of receiving intervention compared to women (odds ratio [OR], 2.21; confidence interval [CI], 1.68-2.90, p < 0.01) and diabetics had reduced odds of receiving intervention compared to non-diabetics (OR, 0.66; CI, 0.45-0.97, p = 0.3). Finally, those with lower income had reduced odds of intervention compared to those with higher income (OR, 1.84; CI, 1.33-2.56, p < 0.01). Among those who were at risk for alcohol abuse (83%) the intervention was only administered to 39%, and men had reduced odds of receiving intervention. CONCLUSION: Physicians perform alcohol screenings, but do not follow up the screening with intervention. Attention should be focused on delivering intervention to those identified as at risk for alcohol abuse through standard screening tools, specifically to men, diabetics, and lower income groups. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Access to preventive services after the integration of oral health care into early childhood education and medical care.

BACKGROUND: The effect of Early Head Start (EHS) on receipt of preventive oral health services (POHS) from both oral and medical health care providers is not known. METHODS: The authors compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates. RESULTS: Primary caregivers of children enrolled in EHS (n = 479) and Medicaid (n = 699) were interviewed when children were approximately 10 and 36 months of age. An average of 81% of EHS and non-EHS children received POHS from an oral or medical health care provider at follow-up. EHS children had greater odds of receiving an oral health assessment (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.74 to 3.13) and fluoride (OR, 1.53; 95% CI, 1.16 to 2.03) from an oral health care provider than children not enrolled. EHS children had decreased odds (OR, 0.73; 95% CI, 0.54 to 0.99) of receiving fluoride from a medical health care provider. CONCLUSIONS: Both children enrolled in EHS and community control participants had high rates of POHS, but the source of services differed. EHS children had greater odds of receiving POHS from oral health care providers than non-EHS children. EHS and non-EHS children had equal rates for fluoride overall because of the greater percentage of non-EHS children with medical fluoride visits. PRACTICAL IMPLICATIONS: The integration of POHS in early education and Medicaid medical benefits combined with existing dental resources in the community greatly improves access to POHS.

Family caregivers' reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia.

Individuals with dementia in the United States have higher rates of hospitalizations and emergency department visits compared to those without. This descriptive study examined the frequency of hospitalizations and emergency department visits among community-dwelling individuals with dementia, reasons for hospitalizations and emergency department visits, and caregivers' actions to prevent these events. Family caregivers ( n = 63) from education/support groups offered through Alzheimer's Association chapters in western Ohio completed a survey. Twenty-two percent of caregivers reported that their care recipient stayed overnight in the hospital and 30% reported that their care recipient visited the emergency department at least once in the past three months. The most frequent reasons for hospitalization and emergency department visits, such as urinary tract infections and fall-related injuries, were potentially avoidable. Caregivers reported giving medications, seeking healthcare services, and obtaining home care services, as the most frequently used preventive actions. Family caregivers of individuals with dementia should be provided substantive education about preventable hospitalizations and emergency department visits.