Outcomes and Economic Benefits of Penn State Extension's Dining With Diabetes Program.

INTRODUCTION: Many diabetes education programs address the problem of diabetes, but little attention is given to the economic impact of such programs. Our objective was to assess the effectiveness of a community-based education program in improving diabetes-related lifestyle behaviors and biomarkers and ascertain the economic benefits of the program for adults aged 18 years or older with type 2 diabetes, prediabetes, or no diagnosis of diabetes in Pennsylvania. METHODS: From October 2012 through June 2015, Pennsylvania State University Extension's Dining with Diabetes program collected data on 2,738 adults with type 2 diabetes or prediabetes and adult family members without diabetes. The program consisted of 4 weekly 2-hour classes and a follow-up class conducted 3 months after the fourth 2-hour class. In the initial class and the follow-up class, participants completed a lifestyle questionnaire and their hemoglobin A1c and blood pressure were measured. Economic benefit was calculated as the medical expenditure cost savings resulting from program participation. RESULTS: At 3-month follow-up, a significant number of participants had improved their lifestyle behaviors (diet and physical activity), had reductions in hemoglobin A1c and blood pressure, and improved their diabetes status. The Dining with Diabetes program had a 5-year benefit-cost ratio of 2.49 to 3.35. CONCLUSION: Participants who completed the Dining with Diabetes program had significant improvements in diabetes-related biomarkers and lifestyle behaviors. If the Dining with Diabetes program were extended to half of the 1.3 million people living with diabetes in Pennsylvania and if they had similar improvements, the 1-year benefit to the state would be approximately $195 million, assuming a conservative 15% decrease in direct medical costs.

National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women.

OBJECTIVES: We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. METHODS: In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. RESULTS: Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. CONCLUSIONS: The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.

Adaptation of an evidence-based intervention for Appalachian women: new STEPS (Strength Through Education, Physical fitness and Support) for breast health.

Appalachia is characterized by a high prevalence of individual-level risks for breast cancer, including physical inactivity and postmenopausal obesity. The availability of local, evidence-based programs to improve physical fitness is limited. We adapted an evidence-based intervention, StrongWomen, to improve physical fitness and increase breast cancer knowledge among women 40 years and older in Appalachian Pennsylvania. Utilizing a multi-site, community-based design, we tested the adapted 12-week, supervised program-New STEPS (Strength Through Education, Physical fitness and Support)-among 139 women. The completion rate was 67.6 %. Pre/post scores improved for each of six fitness assessments (P<0.01). We found differences in overall fitness by study site (P<0.001), but no differences by age (P=0.13) or by previous breast cancer diagnosis (P=0.73). New STEPS is an adapted, evidence-based program that can improve physical fitness and breast cancer awareness among women in Appalachian Pennsylvania. New STEPS may help fill a void in local fitness programs for Appalachian women at risk for breast cancer or breast cancer recurrence.

Rural Embedded Assistants for Community Health (REACH) network: first-person accounts in a community-university partnership.

Community research and action projects undertaken by community-university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community-university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community-university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider's perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership's efforts to improve the delivery infrastructure for rural healthcare.

Growth, performance, and carcass characteristics of feedlot Holstein steers fed ractopamine hydrochloride.

Growth-promoting technologies such as implants, ionophores, and ß-agonists improve feedlot performance, efficiency, and carcass characteristics of cattle. The objective of this experiment was to determine the effects of dose and duration of ractopamine hydrochloride (RH) on feedlot performance and carcass characteristics when fed to Holstein steers. A randomized complete block design was used with a 3 × 3 factorial arrangement of treatments with 3 RH doses (0, 300, or 400 mg∙steer-1∙d-1) fed for 3 durations (28, 35, or 42 d). Holstein steers (n = 855; initial body weight [BW] = 448 ± 37 kg) were blocked by BW and randomly allocated to 1 of 9 pens (15 blocks; 9 dose × duration treatment combinations) approximately 72 d before harvest. Weekly pen weights, chute temperament scores, and animal mobility were determined during the RH feeding period. At harvest, carcass data were collected on all steers, and tenderness was measured on steaks from 3 or 4 randomly selected steers from each pen and slice shear force (SSF) was determined on one steak selected from each side of the carcass after aging for 14 or 21 d. For feedlot performance, carcass characteristics, and SSF, no dose × duration interactions were observed (P ≥ 0.11). With increasing RH dose, average daily gain (ADG) and gain-to-feed ratio (G:F) increased linearly (P ≤ 0.01), whereas BW gain increased linearly with RH dose and duration (P ≤ 0.01). Hot carcass weight (P = 0.02) and longissimus muscle (LM) area (P ≤ 0.01) increased linearly with increasing RH dose. The percentage of carcasses in the USDA Yield Grade 2 category increased linearly (P ≤ 0.01) and percentage of carcasses in the USDA Yield Grade 4 category tended (P = 0.08) to decrease linearly as RH dose increased. In the 14-d aged steaks, the percentage of steaks with SSF ≤ 15.3 kg decreased linearly (P ≤ 0.01), whereas the percentage of steaks with ≥20.0 kg SSF increased linearly (P ≤ 0.01) with increasing RH dose. After 21-d aging, there was a tendency (P = 0.06) for a greater percentage of steaks from steers fed RH to have SSF ≥ 20.0 kg (2% of total steaks), but no difference (P ≥ 0.12) in the percentage of steaks with SSF ≤ 19.9 kg. Final chute temperament (P ≥ 0.45) and animal mobility (P ≥ 0.67) scores were not affected by feeding RH. Increasing the dose of RH (300 or 400 mg∙steer-1∙d-1) fed for 28 to 42 d before harvest increased ADG, G:F, hot carcass weight, and LM area when fed to Holstein steers with no negative effects on behavior or mobility. The percentage of steaks classified as not tender improved when steaks were aged for 21 d from steers treated with RH.

Influence of beta-agonists (ractopamine HCl and zilpaterol HCl) on fecal shedding of Escherichia coli O157:H7 in feedlot cattle.

Ractopamine HCl and zilpaterol HCl, beta-agonists recently approved for use in feedlot cattle to improve performance traits and carcass leanness, were examined for their effects on fecal shedding of Escherichia coli O157:H7 in feedlot cattle. Fecal samples (n = 2,454) were obtained from four experiments (one ractopamine HCl, three zilpaterol HCl) over the course of a 3-year period, either by rectal palpation (ractopamine HCl experiment) or from pen-floor fecal pats. Samples were cultured quantitatively and qualitatively for E. coli O157:H7. No significant treatment differences were detected for fecal prevalence of E. coli O157:H7 in the ractopamine HCl experiment. Zilpaterol HCl feeding had no effect (P > 0.20) on fecal shedding in the first or second experiments, with overall E. coli O157:H7 prevalence relatively low (<7%). In the third zilpaterol HCl experiment, the percentage of fecal samples that were E. coli O157:H7 positive following qualitative culture was higher (P < 0.05) in the zilpaterol HCl treatment (10.3%) than for the control (6.1%). The current research showed minimal effects of beta-agonists on fecal shedding of E. coli O157:H7 and indicated that these compounds (fed immediately prior to slaughter) are not a cause for concern from a food safety standpoint.

Assessing performance of feedlot operations using epidemiology.

The progressive feedlot veterinarian must be well versed not only in individual production animal medicine, but also in population-based medicine. Feedlot health programs must be goal oriented, and evaluation of these goals is accomplished through diligent use of record systems and analytic evaluation of these record systems. Basic feedlot monitoring parameters include health and economic parameters in addition to the use of bench marking parameters between and among feed yards. When these parameters have significant changes, steps should be initiated to begin field investigations. Feedlot epidemiology uses several novel applications such as partial budgeting, risk assessment, and packing plant audits to provide scientifically sound and economically feasible solutions for the feeding industry.

The StrongWomen-Healthy Hearts program in Pennsylvania: RE-AIM analysis.

Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen-Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss -2.0 kg, p < 0.001). Adoption among trained leaders was high (83.3 %), as was fidelity in implementation (average score 9.3 of 10). No leaders maintained the program. To increase impact of the StrongWomen-Healthy Hearts Program, it will be important to lower the costs and modify the recruitment and training strategies to better reach low-income and minority women. Such strategies may also improve program maintenance.

Relationship of in vitro minimum inhibitory concentrations of tilmicosin against Mannheimia haemolytica and Pasteurella multocida and in vivo tilmicosin treatment outcome among calves with signs of bovine respiratory disease.

OBJECTIVE: To determine associations between in vitro minimum inhibitory concentrations (MICs) of tilmicosin against Mannheimia haemolytica and Pasteurella multocida and in vivo tilmicosin treatment outcome among calves with clinical signs of bovine respiratory disease (BRD). DESIGN: Observational, retrospective, cohort study. ANIMALS: 976 feeder calves with clinical signs of BRD enrolled in 16 randomized clinical trials. PROCEDURES: Records of clinical trials from October 26, 1996, to November 15, 2004, were searched to identify calves with BRD from which a single isolate of M haemolytica or P multocida was identified via culture of deep nasal swab samples prior to treatment with tilmicosin (10 mg/kg [4.5 mg/lb], SC) and for which MICs of tilmicosin against the isolate were determined. The MICs of tilmicosin against recovered isolates and response to tilmicosin treatment were evaluated. RESULTS: Tilmicosin resistance among M haemolytica and P multocida isolates was uncommon (6/745 [0.8%] and 16/231 [6.9%], respectively). Treatment outcome, defined as success or failure after tilmicosin treatment, did not vary with the MIC of tilmicosin against recovered isolates. The proportion of treatment failures attributed to M haemolytica isolates categorized as resistant (MIC of tilmicosin, ≥ 32 µg/mL) or not susceptible (MIC of tilmicosin, ≥ 16 µg/mL), was 0.2% and 0.5%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Recovery of tilmicosin-resistant M haemolytica or P multocida isolates was rare, and no association was detected between MIC of tilmicosin and treatment response.