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Incidental findings in research with human participants may have implications for a person's present health or future health outcomes. Current guidelines focus on methods for handling and reporting incidental findings from biological test data but incidental findings might also arise from non-biological tests. This article presents three examples in which the results from non-biological test data can be predictive of future disease and should be disclosed to research participants. It is intended to increase awareness and facilitate further discussion about the reporting of incidental findings from non-biological data.

This study examined the relationships between clinical reasoning behaviors and diagnostic efficiency in the context of diagnosing a virtual patient in BioWorld, a technology-rich environment designed for medical students to practice clinical reasoning skills. Eighty-two medical students who correctly solved a patient case with Diabetes Mellitus were included in this study. These students were grouped into efficient and less efficient groups based on the time they spent diagnosing the case using k-means clustering. Students' clinical reasoning behaviors were recorded in log files and further coded as either relevant or irrelevant to the final correct diagnosis. Independent t-tests and sequential pattern mining were then conducted to compare the differences between efficient and less efficient groups. Results revealed that students in the less efficient group collected significantly more irrelevant evidence, ordered more lab tests, and proposed more incorrect hypotheses than efficient students. Moreover, less efficient students demonstrated more disorganized behavioral patterns than efficient students. These findings underscored metacognitive skills in delivering an efficient diagnosis. This study also informs the practice of medical education in terms of the development of expertise, as well as the design of interventions and scaffolding in promoting efficient learning or clinical reasoning.

Adolescents with type 1 diabetes (TID) and their parents depend on school nurses to keep students safe in school. Parent satisfaction with T1D care is impacted by school factors including school nurse presence. The purpose of this study was to determine the relationships among parental satisfaction with diabetes care in school, parental report of diabetes-related safety, adolescent report of school nurse helpfulness, and school nurse presence represented by school nurse to student ratios. The sample consisted of 89 parent-adolescent dyads. Adolescents 10-16 years old with T1D completed a questionnaire that included perceptions of school nurse helpfulness. Parents completed a questionnaire that included perceptions of T1D safety and satisfaction. Diabetes-related safety was positively correlated with parental satisfaction and school nurse helpfulness and inversely correlated with age and school nurse to student ratios. Findings validate the importance of school nurse presence to adolescents with T1D and their parents with implications for school nursing policy, practice, and research.

Background: Few studies have examined 24-hour activity and sleep behaviors and their contribution to type 2 diabetes (T2D) in Latino adolescents and young adults with obesity. Aim: This study included quantitative data on T2D risk and 24-hour activity and sleep behaviors and qualitative data on individual, social, and environmental behavioral determinants. Method: A 7 day, 24-hour, wrist-worn accelerometer protocol assessed moderate-to-vigorous physical activity (PA), sedentary behaviors (SB), sleep, and sleep regularity, in adolescents (N = 38; 12-16 years) and young adults (N = 22; 18-22 years). T2D-related outcomes included adiposity (BMI, BF%, waist circumference), fasting, and 2-hour glucose. A subsample of participants (N = 16 adolescents, N = 15 young adults) completed interviews to identify behavioral determinants. Results: High levels of PA were observed among adolescents (M = 103.8 ± 67.5 minutes/day) and young adults (M = 96.8 ± 78.8 minutes/day) as well as high levels of SB across both age groups ([greater than or equal to] 10 hours/day). Sleep regularity was negatively associated with adiposity (all ps < 0.05) in both age groups as well as fasting and 2-hour glucose in young adults (all ps < 0.05). Social support was associated with PA in both age groups as well as SB in younger youth. Auditory noises, lights, and safety inhibited sleep in both age groups. Conclusion: PA is critical for disease reduction, yet reducing SB and improving sleep are also important targets for reducing T2D risk in Hispanic adolescents and young adults. Future health promotion and disease prevention strategies should leverage qualitative findings regarding behavioral determinants.

Background: Individuals with diabetes and a learning disability have poorer health outcomes than those without a learning disability. In the UK, the health inequalities faced by people with learning disabilities are often the result of barriers they face in accessing timely, appropriate and effective health care. The aim of the study was to review relevant literature to identify the barriers and enablers to optimal diabetes care for adults with learning disabilities. Methods: Systematic review methodology was used to answer the research question: What barriers and enablers to optimal diabetes care exist for adults with learning disabilities? This review is reported according to PRISMA guidelines. Key databases were searched using relevant terms. Included studies were synthesised using thematic analysis and were quality appraised. Findings: This review identified 12 barriers to optimal diabetes care for adults with learning disabilities and 14 enablers to optimal care from 10 diverse publications. "Low level of diabetes knowledge and understanding" and "systems that do not allow reasonable adjustments" were the barriers considered to have the greatest reliability. The enabler identified to have the highest reliability was "person-centred planning and reasonable adjustments." Conclusion: This work highlights key actions that can be undertaken to address inequalities in diabetes care for people with learning disabilities. With additional research in this field, further progress can be made to improve the lives of those adults living with learning disabilities and diabetes.

Background: This meta-analysis aims to: (i) describe the pooled prevalence of diabetes in people with intellectual disabilities, (ii) investigate the association with demographic, clinical and treatment-related factors and (iii) compare the prevalence versus age- and gender-matched general population controls. Methods: PubMed, Embase and CINAHL were searched until 01 May 2021. Random effects meta-analysis and an odds ratio analysis were conducted to compare rates with controls. Results: The trim- and fill-adjusted pooled diabetes prevalence amongst 55,548 individuals with intellectual disabilities (N studies = 33) was 8.5% (95% CI = 7.2%-10.0%). The trim- and fill-adjusted odds for diabetes was 2.46 times higher (95% CI = 1.89-3.21) (n = 42,684) versus controls (n = 4,177,550). Older age (R[superscript 2] = 0.83, p < 0.001), smoking (R[superscript 2] = 0.30, p = 0.009) and co-morbid depression (R[superscript 2] = 0.18, p = 0.04), anxiety (R[superscript 2] = 0.97, p < 0.001), and hypertension (R[superscript 2] = 0.29, p < 0.001) were associated with higher diabetes prevalence rates. Conclusions: Our findings demonstrate that people with intellectual disabilities are at an increased risk of diabetes, and therefore routine screening and multidisciplinary management of diabetes is needed.

Objectives: The aim of this study was to describe the needs of adolescents with type 1 diabetes mellitus for acquiring self-care and psychosocial skills for the progressive self-management of the disease, as a prelude to the development of an educational programme. The parents and health care professionals who supported young people were also asked to provide their insight into adolescents' needs. Methods, design and setting: Qualitative focus group design with a thematic analysis informed by social-cognitive theory. Results: Findings highlight gaps and divergence in the perceived needs of adolescents engaged with in existing structured educational programmes. Suggestions for change to future programmes were identified, including the implementation of educational follow-ups outside of hospital settings and an educational programme open to family and friends to foster support from the adolescents' social circle. The use of digital media is proposed as an on-demand (rather than planned) educational method. Conclusion: This study provides information relevant to the development of new educational programmes for adolescents with type 1 diabetes in the south of France. Future programmes should be structured so as to promote active participation by adolescents from the start of the programme through to its evaluation.

The physiology of respiration is a challenging subject for many medical students. To assist students, we have developed an active learning game that physically places students within a model outlining the respiratory control pathway. Participants were provided with a vodcast describing the physiology of respiratory control and instructed to view this before the activity. Once in the classroom, groups of students sat at tables marked to represent components of the respiratory control pathway (e.g., apneustic center, diaphragm etc.). Tables were connected with green and red ropes indicating excitatory or inhibitory effects, respectively. Students were presented with various scenarios (e.g., diabetic ketoacidosis) and asked to predict and illustrate the scenario's effect on subsequent steps in the respiratory pathway by waving the appropriate connecting rope. The next table would continue the pattern to simulate the collective physiological adaptation of the respiratory pathway. Thirty first-year medical students participated in this study. Following the activity, 25 out of the 30 participants completed an optional survey. The survey aimed to assess the benefits of adding this activity to our first-year medical curriculum to build a foundational understanding of the physiology of respiration. Responses were overwhelmingly favorable, and participants reported that playing the game significantly improved their perceived understanding of the physiology of respiratory control. All but one of the participants recommended using the activity in future classes. Because the small size of the study group may limit generalizability, future larger scale studies are planned.

Over the past forty years, considerable attention and funding has been spent to improve the health status of Kanaka ?Oiwi. While gains have been made, Kanaka 'Oiwi continue to experience an average life span ten years shorter than that of the general population (Wu et al. 2017). This is caused in part by non-communicable diseases such as diabetes, stroke, and cardiovascular diseases that affect Kanaka 'Oiwi at significantly higher rates than the general population (Native Hawaiian Databook 2017). Coupled with mental and behavioral health conditions such as depression, anxiety, and substance abuse, there are multiple health needs that require attention to improve the health of all Native Hawaiians throughout the lifespan. In addition to these physical and mental health factors, there are systemic barriers to achieving health equity. "The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels" (World Health Organization 2017). The purpose of this article is to describe an initiative that addresses intergenerational health disparities as a public health crisis and mobilizes experts throughout Hawai?i in a call to action to implement large scale interventions that will create structural shifts to achieve health equity and social justice. The authors describe the initiative's three-pronged approach involving collaborative leadership, a strong research base and applied health framework as requisite conditions for developing a social justice curriculum as a method of addressing the determinants of Kanaka 'Oiwi health, and realizing mauli ola (Hawaiian deity of health and life).

Purpose: Diabetes mellitus (DM) is a growing problem in the United States and worldwide. Diabetes possesses a significant burden on the healthcare costs. An evidence-based, practical, and economically feasible strategy to tackle the growing burden of DM is imminent. Diabetes self-management education and support (DSMES) is the backbone to improve the care in DM. A research study called a nurse-led inpatient DSMES was designed and implemented in a community hospital on the west coast to improve patient knowledge of DM and medication adherence with DM. Methods: A descriptive, pretest-posttest study was employed to evaluate the effects of a DSMES program on patient knowledge of DM and patient medication adherence in an inpatient setting on the West coast. Convenience sampling was utilized, and the sample included 10 participants. Paired t-test was used to compare the group means before and after the provision of DSMES to the same sample. Results: The study revealed a statistically significant improvement (p = 0.026) in the participants' knowledge of DM after the provision of DSMES while no changes (although not statistically significant, p = 1.00), in the participants' medication adherence. Conclusions: Provision of DSMES by nurses can improve the outcomes of patients with DM in inpatient settings. Recommendations: Implementation of a nurse-led DSMES project has the potential to improve patient knowledge and diabetes self-management skills, which can, in turn, improve treatment adherence and potentially prevent frequent hospitalizations in patients with DM. Further large-scale studies are needed to generate further evidence to support the provision of DSMES by nurses.

Limited health literacy is a barrier to optimal healthcare delivery and outcomes. Current measures requiring patients to self-report limitations are time-consuming and may be considered intrusive by some. This makes widespread classification of patient health literacy challenging. The objective of this study was to develop and validate "literacy profiles" as automated indicators of patients' health literacy to facilitate a non-intrusive, economic and more comprehensive characterization of health literacy among a health care delivery system's membership. To this end, three literacy profiles were generated based on natural language processing (combining computational linguistics and machine learning) using a sample of 283,216 secure messages sent from 6,941 patients to their primary care physicians. All patients were participants in Kaiser Permanente Northern California's DISTANCE Study. Performance of the three literacy profiles were compared against a gold standard of patient self-reported health literacy. Associations were analyzed between each literacy profile and patient demographics, health outcomes and healthcare utilization. T-tests were used for numeric data such as A1C, Charlson comorbidity index and healthcare utilization rates, and chi-square tests for categorical data such as sex, race, poor adherence and severe hypoglycemia. Literacy profiles varied in their test characteristics, with C-statistics ranging from 0.61-0.74. Relations between literacy profiles and health outcomes revealed patterns consistent with previous health literacy research: patients identified via literacy profiles indicative of limited health literacy: (a) were older and more likely of minority status; (b) had poorer medication adherence and glycemic control; and (c) exhibited higher rates of hypoglycemia, comorbidities and healthcare utilization. This represents the first successful attempt to employ natural language processing to estimate health literacy. Literacy profiles can offer an automated and economical way to identify patients with limited health literacy and greater vulnerability to poor health outcomes.

Histotechnology is commonly used in medical research, pathological testing, and pharmaceutical development. We designed a three-week, inquiry-based laboratory module that helps prepare students for biomedical careers by teaching them tissue sampling, processing, and imaging. Rats were treated with streptozotocin (a known diabetogen) while control rats were injected with buffer solution. Rats were sacrificed one week following treatment. Pre- and post-injection weights were compared and blood samples were collected for glucose analysis and insulin determinations using an enzyme-linked immunosorbent assay (ELISA). Pancreatic tissue was collected, preserved in Bouin's fixative, embedded in paraffin, and sectioned using a microtome. Students then performed hematoxylin/phloxine staining. The number of islet beta cells were compared between control and treated rats. Blood glucose measurements demonstrated that treated rats had significantly higher blood glucose levels and lower beta cells numbers, while the ELISA tests indicated that treated rats had lower blood insulin concentrations. Following this module, students presented an individual poster with images and quantitative data analyses that included insulin concentrations, blood glucose levels, and histological images of pancreatic islets, in addition to beta cell quantification. Overall, students gained hands-on experience with hypothesis testing and an understanding of the pathology of diabetes.

Due to the increased risks of neurocognitive impairment when a child is diagnosed with Type 1 diabetes (T1D) at an early age, early identification and assessment are critical. A study by Nadebaum et al. (2012) found that cognition is impaired in a significant number of children at the time of diagnosis, and those who are initially impaired show a reduction in performance on attention and memory tasks in the week after diagnosis. Additionally, IQ scores of children with impaired mental states fell almost a full standard deviation below the unimpaired group (Nadebaum et al., 2012). Neurodevelopmental disorders such as ADHD, specific learning disabilities, and intellectual disability tend to be comorbid with T1D and are usually associated with poor glycemic control and a higher risk for diabetic complications (Liu et al., 2021). These findings emphasize the importance of early intervention and supports. It also can help inform inpatient education for children with T1D and their families, providing them with the tools they need in order for them to be successful.

Objective: Evidence suggests the increased prevalence of diabetes among South Asian (SA) adolescents is due to their genetic risk profile. The South Asian Adolescent Diabetes Awareness Program (SAADAP) is a pilot intervention for SA youth in Canada with a family history of type 2 diabetes mellitus (T2DM). We sought to investigate changes in (1) diabetes knowledge and associated risk factors, (2) risk perception and (3) health behaviours among adolescents participating in SAADAP. Design: One-group pre-test, post-test design informed by a commitment to community-based participatory research (CBPR). Setting: Sixty-eight adolescents aged 13-17 years with a family history of T2DM participated in SAADAP in a clinical-community setting in Canada. Method: Pre-post questionnaires were administered to evaluate diabetes knowledge and associated risk factors, risk perceptions and health behaviours. Analyses were restricted to 49 participants who attended at least four diabetes education sessions. Results: The mean age of adolescents was 14.5 years, and 57.1% self-identified as girls. The difference in knowledge about the definition, symptoms and complications of T2DM from baseline to post-intervention was 3.32 out of 21 (p < 0.001) among SA youth. There was significant increase in learning about diabetes risk factors (p < 0.001) from baseline to post-intervention. Almost 60% of participants exhibited no change in their risk perception after intervention. Approximately two-thirds of the participants self-reported positive changes in health behaviours after completing the programme. Conclusion: SAADAP showed promising outcomes in raising knowledge and improving health behaviours in SA adolescents with a family history of diabetes. Larger controlled trials with longer follow-up are recommended to support and expand on the current findings.

Diabetes management at school demands close collaboration of multiple stakeholders, including students with diabetes and parents, school nurses, teachers/staff, and local health care providers. This scoping review identified and synthesized evidence concerning factors that contributed to the quality and effectiveness of diabetes care implementation in U.S. K-12 schools. Forty-six studies met the eligibility criteria and were included. Five common factors emerged surrounding training and experiences, communications, parent engagement, resource allocations, and school environment. Complex interactions between multiple stakeholders jointly determined the quality of school diabetes care. A conceptual model was established to elucidate the complex interactions between multiple stakeholders and the relevant facilitators and barriers. Future research should improve sample representativeness, contrast school diabetes care practices to the national guidelines, and assess the impact of the social, economic, and political environment at federal, state, local/district levels on school diabetes care implementation.

The COVID-19 pandemic redefined how chemistry laboratories were taught. It also introduced a racial health disparity for Black and Brown people. The General Chemistry I laboratory curriculum at a Historically Black College and University (HBCU) in Baltimore, MD, was redesigned to meet student needs during this challenging time. While surrounded by civil unrest and uncertainty, we wanted to reach our underrepresented students in a way that they felt seen and heard. "The Mystery of Mr. Johnson" series was designed to reinforce the role chemistry can serve in advancing equity in their community. This interconnected series of three experiments (Solutions, Titration, Spectroscopy) developed chemistry laboratory skills which were applied to diabetes, a COVID-19 comorbidity, and health disparity highly prevalent in Baltimore. "The Mystery of Mr. Johnson" series provided opportunities for students to gain exposure to the role of chemistry in addressing a health disparity that impacts their community. The culminating project was a public service announcement to communicate lifestyle changes and the prevalence of diabetes in the black community.

Type 1 diabetes (T1D) is an endocrine and metabolic disorder affecting approximately 1.4 million adults living in the United States. Psychosocial factors have been identified as key barriers to improvements in self-care among T1D adults, including emotional well-being, social support and self-efficacy, and personal motivation. It is posited that nonclinical approaches, such as peer-based outdoor adventure education programs, could assist T1D adults with their individual psychosocial needs. However, very little research exists to support this unique approach to care. The purpose of this study was to explore the meaning that adults living with T1D ascribe to participation in a wilderness backpacking trip. Eighteen participants with T1D completed a 5-day backpacking trip on the Chilkoot Trail in Alaska and British Columbia. Once on the trip, participants were invited to participate in two semi-structured interviews within 48 hours of the trip start and end date. Using a phenomenological approach, three themes were constructed: a) seeking and finding a diabetes community, b) revealing capabilities to yourself and the world, and c) enhancing diabetes management and self-care on the trail and in life. A common thread across the three constructed themes was the sense of belonging to the diabetes community, which was described by the participants as paramount to their positive overall trip experience. This finding extends assertions that peer relationships during OAE programs may play a central role in improving psychosocial functioning for individuals living with T1D. This provides evidence on the power of using outdoor recreation to positively impact the community of individuals with T1D.

Objective: To explore the diabetes knowledge and future disease risk perception of college students. Participants: 697 college students were purposefully recruited at a large state university and completed an online survey. Methods: Diabetes knowledge, future disease risk perception, lifestyle, and demographic factors were assessed. Results: The majority of students (56%) reported a family history of diabetes but perceived their diabetes risk as low/moderate (90%). Logistic regression indicated higher knowledge (OR, 1.07; 95% CI, 1.01-1.13), age (OR, 1.08; 95% CI, 1.00-1.16), bodymassindex (BMI) (OR, 4.90; 95% CI, 2.33-10.30) and family history of diabetes (OR, 4.30; 95% CI, 1.97-9.40) increased perception of future diabetes risk. Those who self-rated their health as good/excellent and read food labels regularly/often had lower perceived future risk of diabetes. Conclusions: Results highlight the importance of educating college students on diabetes risk factors as well as primary/secondary prevention for reducing diabetes incidence in this age group.

During early childhood, economically disadvantaged children can experience challenges that affect their social-emotional, language, and physical health development across the lifespan. Psychologists have tested several interventions to address developmental problems during early childhood, but information about the degree to which economically disadvantaged children are included in such research is limited. The current paper reviews selected interventions in the areas of social-emotional, language, and physical health challenges to examine the degree to which economically disadvantaged children have been included in early childhood intervention research and to identify efficacious interventions for practitioners and researchers. The review suggests that some areas, such as interventions for Type 1 diabetes and child anxiety disorders, warrant additional research with economically disadvantaged children. The authors recommend increased dissemination, collaboration among early childhood professionals, and the replication of effective interventions with young children and their families to increase their access to quality early childhood care.

According to the Centers for Disease Control and Prevention, diabetes prevention represents a critical need for the health education curriculum, given the rise of the disease and its precondition for today's youth. An active understanding of diabetes encourages young people to take control of the nutritional and exercise factors that keep the disease in check. When teachers use experiential activities, or "adventure" education, students perform tasks that illustrate conceptual content and reinforce learning. Research has found that current modalities to be successful but lacking the physicality to meet the recommendations of the American Heart Association and the Society of Health and Physical Educators. Games such as Toll Road Boogie; Tom and Jerry, or Insulin and Sugar; Wacky Receptor; and Tusker Monster, or Fat Cell Tag help children meet the 60 min of physical activity that are required most days of the week. This article offers several examples of how to design and implement games and incentives into lessons that are both enjoyable and illustrative of diabetes prevention-based education for ages 8 to 18.

Background: Diabetes self-management education (DSME) improves disease-specific markers (HbA1c levels and bodyweight) and prevents disease-related complications. Yet, patients do not seem to benefit equally from such education, likely because of differences in approaches to learning. Purpose: We investigated which learning approaches are best addressed by diabetes curricula and suggest improvements in curriculum design. Methods: Two of the most popular German type 2 DSME curricula were studied. We used qualitative content analysis to build a systematic coding frame, extracting and connecting categories of meaning from the material. Criteria for categories were drawn from research on learning preferences in adult Germans. Results: Both curricula mainly address participants preferring educator-guided and application-driven learning. One of the curricula more actively involves its participants with open discussions and personal goal-setting and shows a stronger emphasis on social support strategies. Discussion: Different learning approaches are not met equally in the curricula, which might create unique difficulties for participants of DSME. Translation to Health Education Practice: Introducing personal goal-setting and progress monitoring in DSME should benefit participants with passive approaches to learning. Offering additional course material could diversify teaching methods and satisfy theoretically driven people. All DSME programs should emphasize social support strategies.

Background: Following the spread of COVID-19, the Rhode Island Department of Health delivered its first virtual World Diabetes Day (RIWDD) event. Evaluations exploring advantages and disadvantages of delivering public health events virtually are generally lacking. Purpose: The aims of the present paper were to evaluate the reach, feasibility, and effectiveness of delivering RIWDD virtually. Methods: Quantitative methods were used to: (1) estimate and compare the target population to RIWDD's event reach; and (2) evaluate whether diabetes knowledge increased amongst attendees. Qualitative methods assessed event facilitators' perceptions of the strengths, limitations, and challenges of using a virtual format to inform planning and implementation of future RIWDD events. Results: Results revealed segments of RI's population disproportionately affected by diabetes, including men, persons of color, and older adults were underrepresented at the event. The event was not associated with increases in diabetes knowledge; however, attendees possessed high diabetes knowledge overall. Facilitators identified several important factors associated with virtual delivery in the context of COVID-19. Discussion: Considerations for delivering virtual events are discussed. Translation to Health Education Practice: A key takeaway of this evaluation is the critical need for cultural competency as a guiding framework for professional practice when delivering events virtually.

Objective: Impaired sleep is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (T2DM), but is poorly understood in young adults. This cross-sectional study examined sleep characteristics, risk factors for T2DM, and IR in college students. Participants: Thirty-two college students (18--25 years) with either short sleep or poor quality sleep were assessed. Methods: Participants completed self-report measures of sleep and T2DM risk factors. One week of objective sleep was measured with wrist actigraphy. IR was calculated from fasting serum glucose and insulin concentrations. Results: The sample slept on average 6.6 hours/night, and over half had IR. Of those with IR, 44.4% had normal body mass index (BMI), 72% had normal fasting glucose concentrations, and all but one had T2DM risk test score indicating they were not at risk. Conclusions: IR was found in over half of participants; however, many typical T2DM risk factors were not present in those with IR.

Background: Diabetes education and treatment is a public health priority. Student-delivered strategies have the potential to offer low-cost, high-quality healthcare services to underserved patients while giving students practice experience. However, the effectiveness of these interventions is unknown. Purpose: To document study characteristics and the effectiveness of student-delivered interventions on diabetes health outcomes. Methods: Databases searched included Medline, CINAHL Plus, and others. Appropriate keywords/ subject headings were used to identify studies meeting inclusion criteria. Two reviewers independently extracted data which were compared, and conflicts resolved by discussion. Results: Seven studies met inclusion criteria. Six had statistically significant improvement in outcomes including HbA1c, a long-term glycemic control indicator (n = 4), blood pressure (n = 3), physical activity (n = 1), and exercise stage of change (n = 1). Studies involved medical (n = 3), pharmacy (n = 2), nursing (n = 1), and exercise science (n = 1) students. Studies with improved outcomes tended to have more patient contact. Discussion: This review provides evidence that student-led diabetes interventions may be effective at improving outcomes, although studies reviewed are limited by lack of comparison groups and representative samples. Translation to Health Education Practice: Student-delivered diabetes interventions may improve outcomes, especially with adequate patient contact time. Studies of theory- and evidence-based student-led diabetes interventions involving health education/promotion students are warranted.

Objective: This study examined diabetes knowledge, health fatalism (the belief that health outcomes are outside one's control), and their interaction, as predictors of Type 2 Diabetes preventive behavior. Participants: Ethnically diverse college students (N = 345) without prior diagnosis of diabetes. Methods: Cross-sectional design using validated self-report measures. Results: Respondents answered approximately half of the diabetes knowledge items correctly. Physical activity and sedentary behavior were not predicted by diabetes knowledge, fatalism, or their interaction. Higher diabetes knowledge was associated with a healthier diet among individuals with low fatalism. Greater fatalism was associated with a poorer diet among individuals with moderate or high diabetes knowledge. Conclusions: Diabetes knowledge was moderate in this college student sample. Greater knowledge was linked with a healthier diet among those with sense of personal control over their health. College health educators may consider emphasizing modifiability of health behaviors in conjunction with Type 2 diabetes education efforts.

Digital education is intertwined with matters of global economics, geopolitics, as well as ongoing changes in what counts as knowledge, skills and learning. We have witnessed throughout the COVID-19 pandemic how technology has been embraced within education from online classes to innovative mobile learning approaches and evaluating humanoid robots in education is the next step. Driven by a need to keep pace with the evolving techno- and socio-economic requirements, schools and society are increasingly adopting artificial intelligence (AI) and robots in their daily activity. This paper presents a feasibility case study in digital health education where a humanoid robot was chosen to teach based on its form and function. With an imperative to establish a strong and sustainable learning space, the aim of this paper is to present results and learn about the future of digital health education from humanoid robots being deployed in digital health learning spaces. The paper concludes by highlighting key design challenges in unbundling educational approaches in the context of humanoid robots. It is intended that the outcomes of this paper will extend beyond the COVID-19 pandemic by contributing to the humanoid robot technology discussion that will push towards more futuristic artificial intelligence in and for education.

Background: Chronic care management (CCM) and community health worker (CHW) interventions hold promise for managing complex chronic conditions such as diabetes and related comorbidities. This qualitative study examines facilitators and barriers to the implementation of an expanded CCM intervention that explicitly incorporated program staff, clinic staff, CHWs, and partnerships with community-based organizations to enhance diabetes management among Mexican-origin adults. Method: Grounded theory was used to analyze interviews conducted in 2018 with 24 members of the CCM team, including program staff, clinic staff, and community-based program partner staff. Results: Three themes emerged that characterize perceived facilitators and barriers to CCM implementation, based on analysis of interviews: (1) understanding roles and responsibilities across organizations, (2) building relationships across organizations, and (3) coordinating delivery of the model among different organizations. First, structured meetings and colocated workspaces enhanced understanding of CCM roles for each team member and across organizations. Barriers to understanding CCM roles were more common during the early stages of CCM implementation and amongst staff who did not participate in regular meetings. Second, regular meetings facilitated development of relationships across organizations to enhance implementation of the CCM model. In contrast, limited relationship building among some CCM team members served as a barrier to implementation. Third, CHWs and case review meetings fostered communication and coordination across the CCM model. Conclusions: Results suggest the importance of understanding roles and building relationships among multidisciplinary teams to ensure effective communication and coordination of care.

The current study aimed to examine the effectiveness of multimedia messaging service (MMS) education on exercise benefits and barriers in patients with type 2 diabetes. A quasi-experimental, pretest-post-test design recruited 98 patients with type 2 diabetes. The intervention group received MMS education to improve perceived exercise benefits and decrease exercise barriers over two months, and the control group received routine care. All patients completed a survey at three time points (baseline, 4 and 8 weeks post-intervention). The results showed that there was an improvement in both perceived life enhancement and physical performance domains in the intervention group. The exercise context barriers decreased after the first follow-up but increased during the second follow-up in the intervention group. Cohen's d values indicated a medium effect size in life enhancement (0.502) and physical performance (0.525) subscales. A small effect size was found in psychological outlook (0.196) and exercise context (0.132) subscales. However, there was no significant effect of the intervention in time expenditure (-0.244) and physical exertion (-0.119) subscales. In conclusion, theoretically based MMS health education targeting perceived exercise benefits and barriers was feasible and cost-effective in changing patients with diabetes' perceptions and intended behaviors about regular physical activity.

Objectives: The purpose of this study was to assess the experience and satisfaction of teachers and parents of children with and without diabetes, with the Kids and Diabetes in School (KiDS) intervention. Project KiDS aimed to foster a safe and supportive school environment to encourage the management of type 1 diabetes and prevention of type 2 diabetes. Design: This qualitative evaluation involved semi-structured, face-to-face, in-depth interviews with a purposive sample of 35 respondents, including teachers and parents of children with and without diabetes attending the selected schools at 1 and 3months post-intervention implementation. In total, n = 5 schools (3 government and 2 private) were selected out of 15 schools in which the KiDS project was implemented. Methods: In total, 65 interviews were conducted in two rounds. The sample comprised teachers (n = 20 in round 1; n = 18 in round 2), parents of children with diabetes (n = 3 in both the rounds) and parents of children without diabetes (n = 15 in round 1; n = 6 in round 2) attending five schools. Data were analysed using the thematic framework method. Results: Teachers reported gaining new knowledge as a result of the KiDS intervention. They felt more confident in assisting children with diabetes. Suggestions to strengthen the KiDS resource pack were the inclusion of case studies and audio-visual aids. Parents of children with diabetes reported that the project reinforced information and improved diabetes management skills. Their suggestions for strengthening KiDS materials included the provision of additional technical information. The parents of children without diabetes reported that the resource pack aided a better understanding of diabetes and clarified myths and misconceptions. Suggestions for strengthening the pack included the regular reinforcement of information on diabetes among children. Conclusion: Findings support the upscaling of KiDS work elsewhere in India through the engagement of multiple stakeholders to promote the management and prevention of diabetes in school.

Worksite wellness programs continue to demonstrate a high return on investment by controlling and reducing employer shares of health care expenditures. Health risk assessments (HRA) are commonly used to establish priorities. This crosssectional study utilized an online HRA grounded by constructs from the Health Belief Model and the Theory of Planned Behavior. An online anonymous survey was disseminated to employees at an urban academic-medical institution, n=816 responses were obtained for a 12% response rate. The majority of respondents were female. Seventy-one percent (71%) of employees believed they were at-risk for pre-diabetes/diabetes, 49% perceived they were at risk for high blood pressure, and 43% indicated they were at risk for depression. Less than 10% reported their health status as being excellent. One in five respondents were unable to see a primary care provider (PCP) due to challenges in their life and 14% did not have a PCP. The average employee exercises 3-4 times per week and consumes on average 12.41 servings of fruits and vegetables per week. Self-efficacy was associated with intention (r(702) = 0.45, p = <0.001). The results indicate insufficient achievement of health behaviors and the need for evidence based programs that encourage self-efficacy, accountability, and positive perceived norms.

We performed this study to better understand communities' health priorities and willingness to participate in research in order to reduce health disparities. To include communities whose members often experience health disparities and may lack opportunities to participate in research, student interns from multiple disciplines administered the Sentinel Network's 33-item survey in nontraditional locations. The survey was completed by 3,151 respondents. The five most frequently identified health concerns were diabetes, cancer, hypertension, heart problems, and weight. Concerns varied by race/ethnicity. In general, respondents across all races/ethnicities--especially Pacific Islanders--expressed willingness to participate in research. The study demonstrates the effectiveness of this method for identifying health priorities and willingness to participate in research. The results illustrate minority communities' willingness to participate in research if provided the opportunity. Insights gained from this study are informing current and planned community-engaged research to reduce health disparities among minority communities.

The field of pure nature cure, health and holistic education are very important for human well being. To achieve the real health and happiness, education is the key. The genesis of this online course on Basics of Nature Cure lies in overcoming of some ailments which the author of this article suffered such as diabetes, ankylosing spondylitis, chronic rhinitis etc. These all done just by modifying the lifestyle and the philosophy. This article describes the course and its delivery process using Social Media and other technology platforms.

This specially themed ""Getting of Wisdom," Learning in Later Life" Edition of the "Australian Journal of Adult Learning" ("AJAL") is not so much concerned with the issue of ageing itself, but more about quality of life regardless of age. It is about taking, but also giving back as best as possible at any age. This special issue is a result of the one week "The Getting of Wisdom Exchange", a collaboration between around 100 adult education practitioners and researchers from ten countries from Australia, New Zealand, Asia and Europe. In this issue, papers are presented from Sweden, Ireland, Aotearoa/New Zealand, Australia, Slovenia, Poland, Germany, Portugal and the United Kingdom. Papers cover different topics and open questions about various issues in older people's learning.

Type 2 Diabetes is both an incurable illness and a hidden disability that has reached epidemic proportions on a global scale. It has obviously spawned a huge clinical literature, but no scholarly accounts of learning to live with the illness on a daily basis from a feminist perspective. As an older woman, I have made use of a somewhat controversial autoethnographical approach to explore how far I consider myself empowered to live with, and manage this condition for the rest of my life. Self-management is an idea that is central to both the United Kingdom (UK) National Health Service (NHS) philosophy of supporting patient choice and within a feminist perspective on health care. Learning to identify, access and use the necessary resources to manage my condition suggests that there are regional differences within the UK as to how much practical care diabetes patients are offered or can access. The paternalistic nature of the health care team/patient relationship appears to militate against the concept of patient empowerment.

Background: People with developmental disabilities experience worse health than typically developing peers. This health differential is often described in terms of health disparities, which refers to differences caused or exacerbated by social or access issues. Objective: the goal of this study was to compare the weight status and health conditions of adults with Down syndrome to comparison groups of adults with developmental disabilities and adults with no disability. Methods: Information about health risks and health conditions was collected for 291 adults with Down syndrome living in Ohio through an online survey. We compared this data on adults with Down syndrome to state-level data from adults without disabilities (2012 BRFSS) and Ohio data on a random sample of adults with developmental disabilities other than Down syndrome (2012-2013 National Core Indicators). Results: Adults with Down syndrome were 3 times more likely to be overweight or obese than adults without disabilities. Surprisingly, despite having a body mass index in the overweight or obese range, 70% of adults with Down syndrome reported having eating habits that were good to excellent and less than 6% of the Down syndrome sample reported having co-occurring diabetes or hypertension. Discussion: Despite high rates of overweight and obesity, few adults with Down syndrome reported having the chronic health conditions associated with excess weight. Further research is needed to understand the health risks of overweight in adults with Down syndrome and the availability of health promotion programs for this population.

Adolescents with Type 1 diabetes (T1D) experience unique self-management challenges, which can lead to poor glycemic control and sequelae. School nurses may impact student self-efficacy behaviors for T1D management in adolescents. The purpose of this study was to determine the relationships among school nurse staffing patterns, measured by school nurse to student ratios, self-efficacy, and glycemic control in adolescents with T1D. The sample consisted of 89 parent-adolescent dyads. Adolescents aged 10-16 years old with T1D completed the Self-Efficacy for Diabetes Self-Management (SEDM) Scale. Parents completed a demographic questionnaire. Higher school nurse to student ratios correlated with better glycemic control and older age. Higher SEDM scores correlated with older age, and females scored significantly higher. Findings contribute new knowledge to the paucity of literature on school nursing and adolescents with T1D, with implications for nursing practice, education, research, and policy.

Type I diabetes (T1D) is one of the most common childhood diseases and Type 2 diabetes (T2D) is increasing at alarming rates. Given that children spend a great percentage of their time in school, this setting is a critical environment for models of care that lead to better management of this and other health conditions. The School Nurses Managing Diabetes Care ECHO was offered to Colorado school nurses to build their capacity in providing evidence-based management of T1D. The purpose of this effort was to (1) determine whether or not the model could be used as a tool of collaboration and dissemination for school nurses across Colorado and (2) assess the effectiveness of the "School Nurses Managing Diabetes Care" ECHO learning series. Post-series survey results demonstrated a 25% increase in self-efficacy ratings, moving learners from "average among my peers" toward "competent." Additionally, all respondents planned to make one or more practice changes to improve care for students with T1D. Expanding the use of the ECHO model to implement intensive management of children and youth with T1D is critically important as rates of this and other chronic conditions continue to increase.

The purpose of this cross-sectional, descriptive, pilot study was to examine the correlations in sleep between caregivers (=18 years) and young (6-12 years) children with type 1 diabetes. Sleep was measured in both parent and child over 7 days using actigraphy and a sleep diary. Parents completed questionnaires on sleep, stress, depressive symptoms, and demographics. Children completed pediatric anxiety and fatigue questionnaires, and A1C (Hemoglobin A1c) was documented at clinic. Descriptive statistics and Pearson correlations were used to analyze data. Parents (N = 18, mean age: 39.3 ± 5.4 years, 100% Caucasian, 83% mothers) and children (N = 18, mean age: 9.6 ± 2.4 years, diagnosed for mean 3.0 ± 2.4 years, 66% female, mean A1C: 7.5 ± 0.8%) were recruited. Strong to moderate correlations were found for several measures including sleep measures based on actigraphy: mean sleep duration (hours; 7.6 ± 0.7 for parents and 8.8 ± 0.8 for children; r = 0.638, p = 0.004), mean sleep efficiency (r = 0.823, p < 0.001), and mean daily wake after sleep onset (minutes; r = 0.530, p = 0.024).

It is important for medical students to understand the relationship between nutrition, obesity, and diabetes to educate their patients in the future. However, medical training does not always include nutritional education. An experiential learning project was incorporated into the medical school curriculum as an effort to implement nutrition in the physiology course. First-year medical students (n=140) received lectures on the regulation of blood glucose levels and their relationship to carbohydrates with different glycemic indexes (GI), obesity, and diabetes. Lectures were followed by a laboratory exercise where students calculated their body mass index (BMI), percentage body fat, and percentage muscle using a Bioelectrical Impedance Commercial Scale. While 63% of students had normal BMI, 31% were overweight or obese and 5% were underweight. A subgroup of 54 students tested different types of breakfasts with varying GI and provided blood samples at 0, 30, 60, 90, and 120 min. Their glucose responses were plotted based on the breakfast GI. Pre- and posttests were conducted to assess the teaching intervention where the Wilcoxon signed ranks test indicated that posttest ranks were significantly higher than pretest ranks (Z =-6.6, P<0.001), suggesting the intervention was beneficial to students.

Background: Acceptance and adjustment to lifelong noncommunicable diseases (NCDs) pose a great challenge for individuals living with these conditions. Diabetes is one of the most prevalent NCDs, with type 1 diabetes usually diagnosed during childhood. Self-leadership is linked to internal and external factors that may motivate individuals with NCDs to play an active role as changemakers in their community or society. The Young Leaders in Diabetes (YLD) training, created to equip young people with skills that would benefit the population to which they belong, uses the Empowerment Ladder as a framework to identify their position relative to three leadership stages (self, community and society). Objective: To describe the stages and the 'climbing' process of the Empowerment Ladder and assess its suitability as a framework for use in a leadership training context. Method: From among 29 youth leaders who participated, 15 were selected (5 men and 10 women) and had their community engagement and activity analysed before and after training. Individuals were positioned on the Empowerment Ladder according to their past and current roles and activities. The difference between pre- and post-training test grades (delta scores) was calculated. Results: Post-training scores were significantly higher than pre-training scores (8.9 ± 0.54 vs 7.6 ± 1.08, p = 0.00084). Most individuals moved to a higher step on the Empowerment Ladder; however, three individuals, with delta scores lower than the median (0.1, 0.15 and 0.85) remained at their pre-YLD training level. Only one individual moved from Stage 1 (self) to Stage 3 (society). Another individual occupied two different steps at Stages 1 and 2 simultaneously because, although they demonstrated community leadership, they had not yet accepted their own health condition. Conclusion: The Empowerment Ladder proved a useful tool for identifying stages from self to broader levels of leadership in individuals living with type 1 diabetes. These initial findings need to be validated with a larger population, which includes other NCD groups.

Objective: This study aimed to develop an animation-supported Mobile Diabetic Foot Care Education (M-DFCE) application for use by individuals with type 2 diabetes and identify its effects on knowledge, self-efficacy and foot care behaviour. Design: Randomised, controlled experimental study. Setting and Method: The study was carried out between October 2016 and September 2017. The sample consisted of 130 individuals with diabetes (65 in the experimental group and 65 in the control group). The experimental group received M-DFCE. Data were collected using the Patient Assessment Form, the Diabetes Foot Knowledge Questionnaire, the Diabetic Foot Care Self-Efficacy Scale and the Foot Self-Care Behaviour Scale. Differences between the groups were examined using Student's "t," Mann-Whitney "U," Wilcoxon Signed Rank and Paired Sample tests. Results: Although there was no difference between the groups at initial evaluation, individuals in the experimental group who received animation-supported M-DFCE had significantly higher knowledge, self-efficacy and foot care behaviour levels than the control group. Conclusion: The animation-supported mobile application developed for foot care education was effective in increasing the individuals' knowledge, self-efficacy and behaviour with respect to foot care.

School nurses are instrumental in delivering health services to children in schools. This study addresses the gap in school nurse health services data, examining patterns in health services and programs provided by school nurses between 2006 and 2016 for students in North Carolina public schools. This study focused on services and programs related to asthma and diabetes, two health conditions that affect millions of children in the United States. Over 1.46 million children attend North Carolina public schools. In 2006, the average school nurse-to-student ratio was 1:1,340. By 2016, the average school nurse-to-student ratio decreased to 1:1,086, a 19% improvement. Over the 10-year study time period, there were statistically significant increases in the rate of occurrence of all health conditions that students received health services for (p < 0.001), asthma (p < 0.001), type I diabetes (p = 0.0003), orders for all health-care procedures (p = 0.01), all school nurse-led health counseling (p = 0.004), and diabetes health counseling (p < 0.01).

Objectives: Military retirement happens early in the lifespan presenting a unique transition that challenges chronic illness. The purpose of this study was to explore the factors that military retirees experience as they transition from active duty to military retirement that they perceive as inhibiting their ability to manage type 2 diabetes (T2DM) or pre-diabetes (preDM) and/or which increase their disease risk. Methods: Twenty veterans diagnosed with T2DM or preDM participated in semi-structured, face-to-face interviews in a private setting at their primary care clinic. Transcripts were analysed using constant comparative method. Participants were aged 44 to 63 (M=56), with 15 diagnosed with T2DM and 5 as preDM. They had been retired from the military 6 to 22 years (M=14years). Results: Participants linked five inter-related challenging factors to their T2DM/preDM diagnosis (when diagnosed post-retirement) and/or to their inability to manage their disease: (1) diet/eating habits, (2) physical activity, (3) weight fluctuation, (4) health care interactions and (5) systematic barriers. Military retirees' experiences were embedded within a 'cultural shift'. They struggled to maintain self-management behaviours once they were no longer on active duty and had more independence as civilians. Discussion: Results provide support for diabetes education during military retirement. Military retirees need help maintaining healthy lifestyle behaviours beyond the structured, health-focused military culture. They could also benefit from patient-provider communication skills training in navigating systematic barriers and attaining the support needed to manage their disease. [Additional funding for this study came from research and development award, 59th MDW/ST 6.3.]

Background: Hispanics/Latinos in the United States experience both a health advantage and disadvantage in developing diabetes. Ethnic identity, a predictor of psychological well-being, has not been widely applied to physical health outcomes. The objective of this study is to apply what is known regarding ethnic identity and psychological health to physical health outcomes (diabetes) and to explore the moderating effect of education as a possible underlying mechanism of the Hispanic Health Advantage/Disadvantage. Specifically, this study examines (a) the association between ethnic identity and diabetes prevalence among adult Hispanics/Latinos and (b) determines whether education modifies this relationship. Method: Data come from the nationally representative adult U.S. household study, National Latino and Asian American Study (NLAAS), collected in 2001 to 2003 (N = 1,746). Multiple logistic regression was conducted to examine the relationship between ethnic identity, education, and their interaction with likelihood of diabetes. Results: Hispanics/Latinos with high ethnic identity have a higher odds of reporting diabetes among those with 13 to 15 years of education (odds ratio: 1.84; 95% confidence interval: 1.16-2.92) and a lower odds among those with 16+ years of education (odds ratio: 0.53; 95% confidence interval: 0.34-0.84). Ethnic identity is associated with diabetes prevalence and the relationship is moderated by educational attainment. Conclusion: Given the growth, diversity, and diabetes disparities among Hispanics/Latinos, our buffering and exacerbating findings exemplify the complexity and fluidity of theory in understanding psychological/behavioral processes. The findings highlight the importance of designing targeted health interventions that take into account the diverse psychosocial and educational experiences of Hispanics/Latinos.

Background: Determination of adequate school nurse staffing is a complex process. School nurse-to-student ratios and the health services school nurses provide to students should be considered. The purpose of this study was to examine the impact of North Carolina school nurse-to-student ratios and school nurse health services on the health and education outcomes (eg, absences, grades, self-management) of students receiving services for asthma and diabetes. Methods: This study of all 115 school districts in North Carolina used the Annual School Health Services Report Survey from 2011 to 2016. Descriptive statistics for health services, programs and outcomes, and generalized linear modeling were used to estimate the association of ratios and health services with asthma and diabetes outcomes. Results: By the 2015-2016 school year, the average ratio decreased to 1:1086 in North Carolina public schools. Annually, 100,187 students received services for asthma, 3832 students received services for type 1 diabetes, and 913 students received services for type 2 diabetes. Lower ratios and nurse health services were associated with improved student outcomes, including decreased absences (p = 0.05), improved grades (p = 0.05), and student self-management of their health condition (p = 0.05). Conclusions: Lower school nurse-to-student ratios and services were associated with improvements in students' health and education outcomes.