Community-Based Trial Educational Heat Disorder Program in Local Salons for Older Adults.

We investigated whether a combined program for heat disorder prevention can improve the behaviors and knowledge of heat disorder prevention in older adults participating in salons. This non-randomized parallel-group comparison study includes 59 participants from two salons. The intervention group met on alternate weeks on a salon day to watch an educational DVD and conduct hands-on education (Wet-Bulb Globe Temperature (WBGT) measurements inside and outside the meeting place). The intervention group conducted calls every other week except salon week to prevent action for heat disorder prevention information based on a leaflet and monitored WBGT in their bedrooms daily at bedtime. We assessed changes in recognition of heat disorders and prevention behavior between baseline, one and a half months after intervention, and post-season (approximately two months after baseline), using the Wilcoxon signed rank test. Recognition of heat disorder scores and preventive behavior improved from pre- to post-season in the intervention group. It was suggested that the approach toward older adults participating in salons could improve their recognition and behavior in preventing heat disorders.

[The impact of dental caries prevention program on the anthropometric measurements of preschool children]. / Vliyanie programmy profilaktiki kariesa zubov, provodimoi v doshkol'nykh uchrezhdeniyakh, na rostovesovye pokazateli detei.

THE AIM OF THE STUDY: Was to compare body mass indices (BMI) of children receiving and not receiving dental caries prevention program in preschool institutions at the age of 3-6 years. MATERIAL AND METHODS: The study comprised163 children (76 boys and 87 girls) initially examined at the age of 3 years in nurseries of the Khimki city region. In one of the nurseries 54 children received dental caries prevention and educational program for 3 years. Other 109 children not receiving any special programs served as controls. Data on caries prevalence and intensity as well as weight and height were collected at baseline examination and 3 years after. BMI was calculated by standard formula and WHO criteria for weight deficiency, normal weight, overweight and obesity for children aged 2-5 and 6-17 years were applied. RESULTS: Caries prevalence in 3-years-old was 34.1% with dmft median of 1.4 teeth. After 3 years the prevalence of dental caries reached 72.5% in controls and was almost twice as low in the main group (39.3%). Caries intensity growth was also significantly higher in controls (p<0.0001). There was statistically significant difference on the rate of underweight and normal weight in children receiving and not receiving dental caries preventive program (p<0.05). The rate of normal and low BMI in the main group was 82.6% (vs. 66% in controls) and 7.7% (vs. 22%), correspondingly. The higher the caries intensity the more is the risk for being underweight (11.5% in caries-free children vs 25.7% in having DMFT+dft more than 4, p=0.034). CONCLUSION: Our study showed positive impact of dental caries prevention program on the anthropometric measurements of children aged 3-6 years which increases the significance of this type of programs in pre-school institutions.

Non-participation in a targeted prevention program aimed at lifestyle-related diseases: a questionnaire-based assessment of patient-reported reasons.

BACKGROUND: Having an unhealthy lifestyle is associated with a higher risk of developing lifestyle-related diseases. Current evidence suggests that interventions targeting health-risk behaviors can help people improve their lifestyles and prevent lifestyle-related diseases. However, preventive programs are often challenged by low participation rates. Reasons for non-participation include lack of time and/or interest, and/or no perceived need for lifestyle intervention. This study explores causes for non-participation in a sample of people who chose not to take up a targeted preventive program (TOF pilot2 study). Patient-reported reasons as well as sociodemographic characteristics and lifestyle factors are in focus. METHODS: A total of 4633 patients from four Danish GP clinics received an invitation to take part in the TOF pilot2 study. Patients who chose not to participate in the TOF pilot2 study were asked to fill in a questionnaire concerning reasons for non-participation, lifestyle, BMI and self-rated health. Descriptive analyses were used to summarize the results. RESULTS: A total of 2462 patients (53.1%) chose not to participate in the TOF pilot2 study. Among these, 84 (3.4%) answered the full questionnaire on reasons for not participating, lifestyle, BMI and self-rated health. The most common reasons for non-participation were lack of time, having an already healthy lifestyle, and feeling healthy. Based on their self-reported lifestyle 45 (53.6%) of the non-participants had one or more health-risk behaviors including smoking, unhealthy diet, BMI ≥ 35 and/or sedentary lifestyle and were therefore eligible to receive the targeted intervention at the GP or the MHC in the original TOF pilot2 study. CONCLUSION: When planning future preventive programs it is important to know the main reasons for patients to not participate. This study provides rare insight into why people opt out of health interventions and advances the evidence base in this area. Our results may inform efforts to better involve these patients in preventive health programs. TRIAL REGISTRATION: Trial registration number: NCT02797392 .

The effect of a multimodal dementia prevention program involving community-dwelling elderly.

BACKGROUND: With the rapid increase in the average age of society, the number of people with dementia has increased in Japan. Thus, the need to prevent dementia is greater, and prevention programs have been implemented throughout Japan. This study aims to evaluate both the short-term and the long-term effects of a dementia prevention program on physical and cognitive function in community-dwelling elderly. METHODS: Cognitive and physical assessments were carried out at baseline for a sample including 57 elderly participants. The participants underwent an intensive training program lasting for 2 h per week for 10 days. After the last period of training, the assessment performed was reapplied. The outcome measures used to establish effectiveness were a Mini-Mental State Examination, Five Cognitive Tests, a Cognitive Function Instrument, a Timed Up & Go Test, a grip strength evaluation, a Geriatric Depression Scale, an EQ-5D and a Physical Activity Scale for the Elderly. Participants were then divided randomly into two groups: a booster group and a non-booster group. The booster group received booster training every 3 months after the intensive training period, whereas the non-booster group did not. Both groups were monitored every 6 months for approximately two and a half years after baseline assessment. RESULTS: The Mini-Mental State Examination, the subtests of the Five Cognitive Tests (attention, memory, language and reasoning) and the Timed Up & Go Test revealed a significant improvement after intensive training. For most of the outcome measures, the booster training showed no additional significant improvements. CONCLUSIONS: In this study, intensive training had a short-term positive effect. Although the effect of the booster training was not clear, the functions of the elderly participants were found to be maintained during a follow-up assessment. The study findings recommend conducting intensive training for the community-dwelling elderly without follow-up training.

School-based oral health education increases caries inequalities.

OBJECTIVE: To evaluate the effect of one and half years of an oral health promotion program in primary schools. DESIGN: A cluster-randomized controlled trial. PARTICIPANTS: 740 students aged 9-12 years (48% female) recruited from the fifth grade of 18 different primary schools in West Pomerania, Germany. METHODS: General and oral health education was provided to the teachers in the intervention schools, which they conveyed to their students. No additional measures were conducted in the control schools. Medical and dental school examinations, as well as questionnaires for the students and their parents were conducted at baseline and follow-up. Data were analysed using Poisson regression models. RESULTS: A significant incident rate ratio between caries increment was found, with a 35% higher risk in the control group. However, parents' socioeconomic characteristics modified the effect of the program on their children, as high socio-economic status in the intervention group was associated with 94% reduction in the incidence risk ratio (p ⟨ 0.001). CONCLUSIONS: The program was effective in improving dental health among students with higher socio-economic status. No preventive effect could be found in low socio-economic status groups.

Long-term effect of intensive prevention on dental health of primary school children by socioeconomic status.

OBJECTIVES: Children in a German region took part in regular toothbrushing with fluoride gel during their time in primary school after having received a preventive program in kindergarten. The study aimed at determining the dental health of the students as a function of prevention in kindergarten and at school while taking into account their socioeconomic status and other confounders. MATERIALS AND METHODS: The subjects were in six groups: groups 1 and 2, intensive prevention in kindergarten with and without fluoride gel at school; groups 3 and 4, basic prevention in kindergarten with and without fluoride gel at school; groups 5 and 6, no organized prevention in kindergarten with and without fluoride gel at school. Two dental examinations were performed for assessing caries experience and calculating caries increment from second grade (7-year-olds) to fourth grade (9-year-olds). A standardized questionnaire was used to record independent variables. To compare caries scores and preventive measures of various subgroups, non-parametric tests and a binary logistic regression analysis were performed. RESULTS: A significant difference was found in the mean decayed, missing, and filled tooth/teeth (DMFT) depending on socioeconomic status (no prevention in kindergarten, fluoride gel at school in children with low SES: DMFT = 0.47 vs. DMFT = 0.18 in children with high SES; p = 0.023). Class-specific differences were no longer visible among children who had taken part in an intensive preventive program combining daily supervised toothbrushing in kindergarten and application of fluoride gel in school. CONCLUSIONS: Early prevention, focusing on professionally supported training of toothbrushing in kindergarten and at school, has a positive effect on dental health and is able to reduce class-specific differences in caries distribution. CLINICAL RELEVANCE: Early training of toothbrushing and fissure sealing of first permanent molars are the most important factors for the dental health of primary school children.

Effect of supervised brushing with fluoride gel during primary school, taking into account the group prevention schedule in kindergarten.

OBJECTIVES: In one region of Germany, a group of children took part in regular fluoride gel applications during primary school following intensified prevention in kindergarten. This observational study aimed to ascertain whether the dental health of primary school children can be improved by introducing a group prevention program based on applications of fluoride gel. MATERIALS AND METHODS: The subjects were distributed among six groups with varying preventive measures in kindergarten and at school. The basis for determining caries experience and calculating the caries increment consisted of dental findings gathered in the second and fourth grade. RESULTS: While second graders without professionally supported daily toothbrushing in kindergarten exhibited an average d3-6mft of 2.17, in those who had enjoyed intensive dental prevention, the corresponding value was 19% lower (d3-6mft = 1.74). The caries increment was significantly lower mainly among children who had received the maximum of group prevention (intensive prevention in kindergarten and gel program at school). CONCLUSIONS: The results show that intensified preventive programs in kindergartens and schools, based mainly on supervised toothbrushing, have a positive effect on the dental health of primary school children. CLINICAL RELEVANCE: Such programs are efficient in reducing caries experience especially in socially deprived areas.

First-trimester predictive models for adverse pregnancy outcomes-a base for implementation of strategies to prevent cardiovascular disease development.

Introduction: This study aimed to establish efficient, cost-effective, and early predictive models for adverse pregnancy outcomes based on the combinations of a minimum number of miRNA biomarkers, whose altered expression was observed in specific pregnancy-related complications and selected maternal clinical characteristics. Methods: This retrospective study included singleton pregnancies with gestational hypertension (GH, n = 83), preeclampsia (PE, n = 66), HELLP syndrome (n = 14), fetal growth restriction (FGR, n = 82), small for gestational age (SGA, n = 37), gestational diabetes mellitus (GDM, n = 121), preterm birth in the absence of other complications (n = 106), late miscarriage (n = 34), stillbirth (n = 24), and 80 normal term pregnancies. MiRNA gene expression profiling was performed on the whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time reverse transcription polymerase chain reaction (RT-PCR). Results: Most pregnancies with adverse outcomes were identified using the proposed approach (the combinations of selected miRNAs and appropriate maternal clinical characteristics) (GH, 69.88%; PE, 83.33%; HELLP, 92.86%; FGR, 73.17%; SGA, 81.08%; GDM on therapy, 89.47%; and late miscarriage, 84.85%). In the case of stillbirth, no addition of maternal clinical characteristics to the predictive model was necessary because a high detection rate was achieved by a combination of miRNA biomarkers only [91.67% cases at 10.0% false positive rate (FPR)]. Conclusion: The proposed models based on the combinations of selected cardiovascular disease-associated miRNAs and maternal clinical variables have a high predictive potential for identifying women at increased risk of adverse pregnancy outcomes; this can be incorporated into routine first-trimester screening programs. Preventive programs can be initiated based on these models to lower cardiovascular risk and prevent the development of metabolic/cardiovascular/cerebrovascular diseases because timely implementation of beneficial lifestyle strategies may reverse the dysregulation of miRNAs maintaining and controlling the cardiovascular system.

Design and Evaluation of a Collective Preventive Program for Musical Performance Anxiety (ConfiDance).

Musical performance anxiety (MPA) is considered a subtype of social phobia and affects musicians who must face musical exposure in public, potentially severely affecting their emotional stability and significantly impairing the quality of their performance. This research has utilized previous scientific knowledge on the issue and a qualitative approach to musicians' needs through focus groups in order to design a collective preventive program for MPA that could be implemented within the training curriculum of professional musicians. To evaluate the adequacy of the preventive program 'ConfiDance', a pilot test was conducted with a sample of 17 professional musicians in training, all post-graduate students in classical music performance. For the pilot test, a quasi-experimental model with a repeated measures methodology (pre-post and one-year follow-up after application) was carried out. The results indicate a significant decrease in MPA after the program implementation, with a notable improvement in effect one year post-application, demonstrating an even greater positive impact over time. These data should be interpreted cautiously due to sample limitations but represent an opportunity for the future implementation of a program that can prevent and treat MPA in music education centers.

Effectiveness of a cognitive behavioral therapy-integrated, hospital-based program for prediabetes: a matched cohort study.

Intensive lifestyle interventions are effective in preventing T2DM, but evidence is lacking for high cardiometabolic individuals in hospital settings. We evaluated a hospital-based, diabetes prevention program integrating cognitive behavioral therapy (CBT) for individuals with prediabetes. This matched cohort assessed individuals with prediabetes receiving the prevention program, which were matched 1:1 with those receiving standard care. The year-long program included five in-person sessions and several online sessions covering prediabetes self-management, dietary and behavioral interventions. Kaplan-Meier and Cox regression models estimated the 60-month T2DM incidence rate. Of 192 patients, 190 joined the prevention program, while 190 out of 10,260 individuals were in the standard-care group. Both groups had similar baseline characteristics (mean age 58.9 ± 10.2 years, FPG 102.3 ± 8.2 mg/dL, HbA1c 5.9 ± 0.3%, BMI 26.2 kg/m2, metabolic syndrome 75%, and ASCVD 6.3%). After 12 months, the intervention group only showed significant decreases in FPG, HbA1c, and triglyceride levels and weight. At 60 months, the T2DM incidence rate was 1.7 (95% CI 0.9-2.8) in the intervention group and 3.5 (2.4-4.9) in the standard-care group. After adjusting for variables, the intervention group had a 0.46 times lower risk of developing diabetes. Therefore, healthcare providers should actively promote CBT-integrated, hospital-based diabetes prevention programs to halve diabetes progression.

The Effect of Interventions on Preventing Musculoskeletal Injuries Related to Nurses Work: Systematic Review.

BACKGROUND: The 12-month prevalence of musculoskeletal disorders related to work (MDRW) in nurses rests between 71.8% to 84%, so it is urgent to develop preventive intervention programs with the purpose of avoiding negative physical, psychological, socioeconomic, and working aspects. There are several intervention programs aimed at preventing musculoskeletal disorders related to work for nurses, but few have successfully proven results. Despite the evidence pointing to the benefits of multidimensional intervention programs, it is essential to determine which interventions have positive effects on the prevention of this kind of disorder to create an effective intervention plan. AIM: This review intends to identify the different interventions adopted in the prevention of musculoskeletal disorders related to work in nurses and to compare the effectiveness of these interventions, providing the appropriate and scientific basis for building an intervention to prevent musculoskeletal disorders in nurses. METHOD: This Systematic Review was guided by the research question, "What are the effects of musculoskeletal disorders preventive interventions on nursing practice?" and carried out in different databases (MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials, SCOPUS, and Science Direct). Later, the results were submitted to the eligibility criteria, the appraisal quality of the papers, and the data synthesis was performed. RESULTS: 13 articles were identified for analysis. The interventions implemented to control the risk were: training patient-handling devices; ergonomics education; involving the management chain; handling protocol/algorithms; acquiring ergonomics equipment; and no-manual lifting. CONCLUSIONS: The studies associated two or more interventions, the majority of which (11 studies) were training-handling devices and ergonomics education, therefore emerging as the most effective instruments in the prevention of MDRW. The studies did not associate interventions that cover all risk factors (individual, associated with the nature of the work, organizational, and psychological aspects). This systematic review can help with making recommendations for other studies that should associate organizational measures and prevention policies with physical exercise and other measures aimed at individual and psychosocial risk factors.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study.

BACKGROUND: Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. OBJECTIVE: The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. METHODS: A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. RESULTS: Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. CONCLUSIONS: Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

Caries Experience and Increment in Children Attending Kindergartens with an Early Childhood Caries Preventive Program Compared to Basic Prophylaxis Measures-A Retrospective Cohort Study.

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009−2019) of these 3−5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf−t). The data were split by observation period (300−550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300−550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.

Social Intelligence Counseling Intervention to Reduce Bullying Behaviors Among Thai Lower Secondary School Students: A Mixed-method Study.

OBJECTIVES: To develop and investigate the effectiveness of an integrative counseling intervention for enhancing social intelligence and reducing bullying behaviors among lower secondary school students in Bangkok, Thailand. METHODS: An interventional mixed-method design was employed in 2 phases. Phase 1 involved the development of a qualitative method-based integrative counseling program from key informants using the eclecticism technique. In phase 2, a randomized controlled trial with a wait-list control was conducted and qualitative research was performed with students who demonstrated bullying behaviors. Demographic data, Social Intelligence Scale (SIS) scores, and Bullying-Behavior Scale (BBS) scores were collected at baseline. Changes in SIS scores and qualitative findings obtained from in-depth interviews were examined after counseling ended, and BBS scores were collected again 1 month later. RESULTS: The developed social intelligence counseling program included eight 1-hour weekly sessions consisting of 3 components: (1) social awareness, (2) social information processing, and (3) social skills. After receiving this intervention, scores for the SIS overall (p<0.001) and all of its components (p<0.05) were significantly enhanced in the experimental group compared to the control group. Moreover, the mean BBS scores in the experimental group significantly decreased 1 month after counseling (p=0.001). With regard to the qualitative research results, the experimental students demonstrated improvements in all components of social intelligence. CONCLUSIONS: The results indicated that a preventive counseling program may enhance social intelligence, decrease bullying behaviors among lower secondary school students, and prevent further incidents of school violence. However, further studies in various population subgroups should also be performed.

An Acoustic-Signal-Based Preventive Program for University Lecturers' Vocal Health.

INTRODUCTION: Professional activities of university lecturers involve continued and sustained use of the voice, leading in many cases to increased risk of developing voice disorders. Risk identification followed by the fast application of preventive or corrective measures is a key issue in this context. OBJECTIVE: Define and implement a preventive program for the vocal health of university lecturers by using acoustic features automatically extracted from voice recordings to identify risk groups and manage preventive or corrective actions MATERIAL AND METHODS: A total of 170 subjects, aged between 18 and 65, were recruited at the San Pedro de Alcántara Hospital and at the University of Extremadura in Cáceres (Spain). They formed three groups-one of 25 people suffering from vocal fold nodules, another of 25 healthy people, and the third of 120 university lecturers. Medical history and voice status assessment was performed, and voice recordings were made following a research protocol. A feature extraction, selection, and classification procedure was applied to the voice recordings to provide the best predictors for discriminating between pathological and healthy voices. The model parameters were then used to determine the lecturers' probability of suffering vocal fold nodules or other pathologies with similar dysphonic speech. These probabilities were used to classify the lecturers into three risk groups-low, medium, and high. These groups were taken as the basis to assign the lecturers to a primary, secondary, or tertiary prevention level. Different preventive or corrective actions were applied for each prevention level. RESULTS: The best set of predictors comprised sample entropy, correlation dimension, pitch period entropy, glottal noise excitation, and sex, achieving an overall accuracy of 92% with a random forest classifier. They all showed statistically significant differences between vocal fold nodules and healthy groups (P < 0.05). Three out of the four best acoustic features were nonlinear, showing the importance of nonlinear dynamics for clinical practice. The model parameters were applied to the predictors of the lecturers so as to assign them to the different risk groups, leading to 60.8% (73 out of 120) of the lecturers in the low-risk group, 29.2% (35 out of 120) in the medium-risk group, and 10% (12 out of 120) in the high-risk group. The prevention levels were assigned on the basis of this classification and the medical history and laryngological evaluation of some specific subjects. A statistically significant association was found between the voice status and the assigned prevention level (P < 0.001), with there being a clear dependence relationship (Cramér's V = 0.630). CONCLUSION: It is feasible to develop and apply a preventive voice program for university lecturers that is aided by features automatically extracted from voice recordings. As the program progresses, it is expected that the information automatically provided for the assignment to prevention levels will become ever more precise. The method proposed can be extended to other voice professionals and other voice disorders.

Multicenter study on caries risk assessment in Japanese adult patients.

OBJECTIVES: This study was conducted to identify significant risk factors for the onset and the accumulation of new caries in adult patients undergoing regular preventive therapy. METHODS: The data of 732 patients from nine Japanese general dental practices were retrospectively analyzed. Classification and regression tree (CART) analysis was applied to develop a caries prediction model using the following patient parameters: age, number of teeth with caries experience (DMFT), levels of mutans streptococci (SM) and lactobacilli (LB), saliva flow rate and buffer capacity, and compliance with a preventive program. Poisson regression analysis was conducted to identify factors affecting caries accumulation within three years. RESULTS: CART analysis identified patients at high risk for primary caries with an odds ratio of 3.08 (95%CI, 1.55-5.79; p=0.0018) according to SM levels and compliance; and those for secondary caries with an odds ratio of 3.69 (95%CI, 2.29-5.91; p<0.0001) according to LB and SM levels. Poisson regression analyses showed that accumulation of primary caries was affected by compliance (p<0.001), SM (p<0.001) and LB (p=0.013). Accumulation of secondary caries was affected by DMFT (p<0.001), SM (p<0.001) and LB (p<0.001). CONCLUSIONS: CART is an important tool in identifying the risk of caries development in individual adult patients. Cariogenic bacteria are important factors for both the onset and accumulation of primary and secondary caries. CLINICAL SIGNIFICANCE: Participation in a regular preventive program limits the onset and the accumulation of primary caries in adult patients.

Reducing diabetic limb amputations in developing countries.

Among all the diabetes complications, diabetic foot complications are associated with the highest morbidity and mortality. Across the globe, 40-60% of all lower extremity non-traumatic amputations are performed in patients with diabetes. The most important intervention in reducing diabetic limb amputation in developing countries is the education of patients about proper limb care. Cost-effective education should be targeted for both healthcare workers and patients. One of these programs is the Step by Step Foot Project, which was piloted and carried out in Tanzania and India. In this review, the author explores the feasible ways of reducing diabetic limb amputation which can be achieved through a trained diabetes workforce working in an effective system of care that focuses on the education of both the healthcare provider and the patient.

Evaluation of the effectiveness of a school-based cannabis prevention program.

BACKGROUND: The effectiveness of a cannabis prevention program in high school students was assessed. METHODS: A quasi-experimental study was designed to evaluate the effectiveness of an intervention implemented in an intervention group (IG) with 39 schools compared with a control group (CG) of 47 schools not exposed to the intervention. Of 224 secondary schools in Barcelona, 86 were assessed in the 2005-2006 school year through a personal questionnaire administered at baseline and 15 months after the intervention. Participants consisted of 4848 ninth graders (14-15 year-olds), 2803 assigned to the IG and 2043 to the CG, according to the type and size of the school and the socioeconomic status of the school's neighborhood. The intervention consisted of a school-based cannabis prevention program (xkpts.com), with four sessions and 16 activities, implemented over 6-10h, with materials for parents and web-based student involvement. Last-month cannabis use was assessed at baseline and at 15 months' follow-up. Process evaluation indicators were assessed. RESULTS: At 15 months follow-up, 8.2% of boys and 8.3% of girls in the IG became last-month cannabis users versus 11.8% of boys and 11.6% of girls in the CG. These differences were statistically significant (p=0.003), representing a 29% reduction in last-month cannabis users in the IG compared with the CG. The incidence of last-month cannabis use was lowest in classrooms that adhered to the program protocol. CONCLUSIONS: The xkpts.com program was effective in preventing progression to last-month cannabis use. Effectiveness was higher in classrooms that adhered closely to the protocol.

El estado de salud del personal de enfermería a cargo del programa preventivo 5 pasos por tu salud: estudio transversal descriptivo / Health status of nursing staff in charge of the 5 steps for your health program: a cross-sectional descriptive study

El personal de enfermería juega un papel clave en la atención integral de la salud en el primer nivel de atención. Ellos son portavoz de la promoción de los estilos vida saludables en la comunidad. Por otra parte, las enfermedades crónicas como la obesidad son uno de los principales desafíos del siglo XXI. Considerando esta problemática, la Secretaría de Salud ha puesto en marcha un programa preventivo dirigido a la población a través de los centros de primer nivel de atención. En su implementación todo el personal de salud es el responsable de darle difusión, siendo vocero y ejemplo de la misma ante la comunidad. El objetivo de este estudio es conocer el estado de salud del personal de enfermería a cargo del programa preventivo, mediante pruebas antropométricas y clínicas. Se realizó un estudio transversal, descriptivo, con metodología cuantitativa. La población de estudio es una muestra de 46 enfermeras(os) que incluye a todas las jefas de enfermeras y enfermeras encargadas del programa de todos los centros de salud que conforman la Jurisdicción Sanitaria Nezahualcóyotl. En la muestra 30,60 por ciento presenta sobrepeso y 52,17 por ciento algún tipo de obesidad. Del total, 86,93 por ciento son mujeres y de ellas 40,63 por ciento tiene sobrepeso y 57,5 por ciento obesidad, a diferencia de los varones con 14,29 por ciento y 7,14 por ciento respectivamente. En cuanto a la circunferencia de cintura, 91,3 por ciento de la muestra registra riesgo cardiovascular (mujeres 92,50 por ciento, hombres 83,33 por ciento). Además, 52,17 por ciento evidencia alteraciones en los niveles de glucemia (55 por ciento en mujeres y 33,33 por ciento en hombres), 78,26 por ciento presenta hipercolesterolemia y 73,91 por ciento hipertrigliceridemia. El sexo masculino exhibe la mayor prevalencia de hipertrigliceridemia (88,33 por ciento versus 72,50 por ciento), mientras que las mujeres ostentan la mayor prevalencia de hipercolesterolemia (80 por ciento versus 66,67 por ciento)...

Nurses play a key role in comprehensive health care in the primary care level. They devote time to the promotion of healthy life styles in the community. Moreover, chronic diseases, which include obesity, are one of the main challenges of the twenty-first century. In consideration of this problem the Ministry of Health has launched a preventive program that targets the general population through the primary care centers. Implementation considers the involvement of all health care staff responsible for outreach to the communities and for being an example of healthy life styles. The aim of this study is to determine the health status of nurses in charge of the prevention program, using anthropometric and clinical tests. We conducted a cross-sectional, descriptive study using quantitative methods. The study population is a sample of 46 nurses that includes all head nurses and nurses in charge of the program for all health centers that comprise the Sanitary Jurisdiction of Nezahualcóyotl. 86.96 percent are female and 13.04 percent are male. 30.60 percent is obese and 52.17 percent is overweight. The gender analysis shows that 40.63 percent of women are overweight and 57.5 percent obese, while 14.29 percent of men are overweight and 7.14 percent are obese. Regarding waist circumference, 91.30 percent of the study population shows cardiovascular risk (92.50 percent of women 80 cm, and 83.33 percent of men 90 cm). 52.17 percent of the sample has blood glucose levels changes (100 mg / dl), 55 percent of women and 33.33 percent of men. 78.26 percent have hypercholesterolemia and 73.91 percent has hypertriglyceridemia. Men have a higher prevalence of hypertriglyceridemia (88.33 percent versus 72.50 percent), while women have a higher prevalence of hypercholesterolemia (80 percent versus 66.67 percent). In conclusion, the state health care system should pay attention to the health status of the nursing staff that implements the preventive program, as it also is beset...

Avaliação da incidência de cárie em pacientes com síndrome de Down após sua inserção em um programa preventivo / Evaluation of the incidence of dental caries in patients with Down syndrome after their insertion in a preventive program

O objetivo deste trabalho foi verificar a incidência de cárie dentária por meio dos índices CPO-D, CPO-S, ceo-d e ceo-s em indivíduos com síndrome de Down regularmente matriculados em um programa preventivo. Foram examinados 24 indivíduos com síndrome de Down de ambos os sexos, com idade entre um e 48 anos. A prevalência (situação experimental inicial) e a incidência (situação experimental final) de cárie dentária foram verificadas utilizando-se os índices CPO-D, CPO-S, ceo-d e ceo-s iniciais e finais dos participantes. Dos 24 indivíduos examinados, dez (42,0 por cento) eram livres de cárie. A prevalência de cárie dentária mostrou valores de CPO-D= 2,33; CPO-S= 3,60; ceo-d= 1,75 e ceo-s= 2,80; enquanto a incidência de cárie apresentou valores de 2,33; 3,80; 1,10 e 1,90, respectivamente. Os indivíduos com síndrome de Down avaliados neste estudo apresentaram baixos índices de cárie e pequena incidência de novas lesões, enfatizando a importância da manutenção desses pacientes em programas preventivos.

The objective of this work was to verify the incidence of dental caries by means of the CPO-D, CPO-S, ceo-d and ceo-s indexes in patients with Down syndrome regularly enrolled in a preventive program. Twenty four Down syndrome patients of both sexes age range of one to 48 years were examined. The prevalence (initial experimental situation) and incidence (final experimental situation) of dental caries were verified using of the initial and final CPO-D, CPO-S, ceo-d and ceo-s indexes of the participants. From 24 individual examined, 10 (42.0 percent) were free of caries. The prevalence of dental caries showed values of CPO-D= 2.33; CPO-S= 3.60; ceo-d= 1.75 e ceo-s= 2.80; while the incidence of caries showed values of 2.33; 3.80; 1.10 e 1.90, respectively. Down syndrome individuals evaluated in this study presented low level of caries and small incidence of new lesions, emphasizing the importance of the maintenance of these patients at preventive programs.