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Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers. [ABSTRACT FROM AUTHOR]

Background: Evidence-based public health gives public health practitioners the tools they need to make choices based on the best and most current evidence. An evidence-based public health training course developed in 1997 by the Prevention Research Center in St. Louis has been taught by a transdisciplinary team multiple times with positive results. In order to scale up evidence-based practices, a train-the-trainer initiative was launched in 2010.Methods: This study examines the outcomes achieved among participants of courses led by trained state-level faculty. Participants from trainee-led courses in four states (Indiana, Colorado, Nebraska, and Kansas) over three years were asked to complete an online survey. Attempts were made to contact 317 past participants. One-hundred forty-four (50.9 %) reachable participants were included in analysis. Outcomes measured include frequency of use of materials, resources, and other skills or tools from the course; reasons for not using the materials and resources; and benefits from attending the course. Survey responses were tabulated and compared using Chi-square tests.Results: Among the most commonly reported benefits, 88 % of respondents agreed that they acquired knowledge about a new subject, 85 % saw applications for the knowledge to their work, and 78 % agreed the course also improved abilities to make scientifically informed decisions at work. The most commonly reported reasons for not using course content as much as intended included not having enough time to implement evidence-based approaches (42 %); other staff/peers lack training (34 %); and not enough funding for continued training (34 %). The study findings suggest that utilization of course materials and teachings remains relatively high across practitioner groups, whether they were taught by the original trainers or by state-based trainers.Conclusions: The findings of this study suggest that train-the-trainer is an effective method for broadly disseminating evidence-based public health principles. Train-the-trainer is less costly than the traditional method and allows for courses to be tailored to local issues, thus making it a viable approach to dissemination and scale up of new public health practices. [ABSTRACT FROM AUTHOR]

There is a growing and increasingly compelling body of evidence that self-management interventions for persons with type 2 diabetes can be both effective and cost-effective from a societal perspective. Yet, the evidence is elusive that these interventions can produce a positive business case for a sponsoring provider organization in the short term. The lack of a business case limits the enthusiasm for provider organizations to implement these proven quality-enhancing interventions more widely. This article provides a case example of a self-management intervention in a community general hospital targeting an underserved population who have significant barriers to receiving regular health care. The 3-component program sought to improve meaningful access to care, increase health literacy related to type 2 diabetes, and partner with the enrollees to make long-term lifestyle changes. The intervention not only resulted in significant improvements in HbA1c levels (-0.77%) but saved the hospital an average of $551 per active patient per year, primarily by reducing hospital visits. With only 255 actively enrolled patients, the hospital can recover fully its total direct annual personnel and operating costs for the program. Because the program serves patients who would have been seen at other hospitals, it also enhanced care quality and reduced costs for the broader community in which the program is embedded. ( Population Health Management 2012;15:230-235) [ABSTRACT FROM AUTHOR]

The article examines the tools developed by the Diabetes Initiative of the Robert Wood Johnson Foundation to assess the partnership characteristics between health care clinics and community organizations when they provide assistance to chronic disease care and management. It states that tools to assess partnership development in the short, intermediate and long-term outcomes have not yet been developed. It was concluded that the tool developed was brief and user-friendly.

The article discusses a study that aims to estimate the cost-effectiveness of diabetes self-management programs in community primary care settings. According to a Markov simulation model, the intervention reduces long-term complications that lead to an increase in remaining life-years and quality-adjusted life-years (QALYs). The study notes that from a health systems perspective, type 2 diabetes self-management programs are considered cost-effective when the cost savings due to reductions in long-term complications are identified.

This article discusses the development and validation of an instrument that was developed to measure individuals' reported access to resources and support for self-management (RSSM) from providers and from nonclinical, social and community sources. The study used cross-sectional analyses of the second wave of a survey of participants in the Robert Wood Johnson Foundation Diabetes Initiative. It concluded that the ecological orientation and link of RSSM to the broad framework of chronic care suggest broader application.

Addressing complex challenges such as diabetes calls for a comprehensive approach in which health care organizations and communities work together for change. This article describes approaches and lessons learned from eight clinic-community demonstration projects funded through the Diabetes Initiative of the Robert Wood Johnson Foundation. [ABSTRACT FROM AUTHOR]

The article features the Diabetes Initiative of the Robert Wood Johnson Foundation. The purpose of the foundation is to demonstrate feasible and sustainable approaches in promoting diabetes self-management. It includes 14 demonstration projects in primary care settings and in community clinical partnerships. The initiative has identified key resources and supports for self-management.

Depression is a common comorbidity in diabetic patients and poses challenges for health care providers, patients, and health care systems. This article describes the implementation of unique models of care geared toward treating patients with both illnesses in a coordinated manner in primary care and community settings serving disadvantaged and ethnic minority populations. Nine community sites used the PHQ-9, a short version of the Patient Health Questionnaire, as a screening tool for depression in all diabetic patients enrolled in the Robert Wood Johnson Foundation Diabetes Initiative. The interventions and protocols developed independently at each Diabetes Initiative site are described. The authors then report aggregate screening data across the nine sites, describe models of treatment developed by the projects, and highlight key emergent themes. The proportion of diabetic patients in this population with moderate to severe depression ranged from 30 to 70%. The interventions and treatment protocols that emerged included enhancements of primary care, integrated mental health services, group therapy, and approaches emphasizing cultural traditions and mind-body focus. Patients with diabetes from underserved and ethnic minority populations have high rates of comorbid depression, and this may affect their ability to self-manage diabetes. Addressing depression is an essential part of diabetes care and can be accomplished in a coordinated manner in real-world settings. [ABSTRACT FROM AUTHOR]

In the Diabetes Initiative of The Robert Wood Johnson Foundation, an ecological perspective helped identify the following key resources and supports for self-management (RSSM): individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to resources, and continuity of quality clinical care. These RSSM reflect the grounding of diabetes self-management in the context of social and environmental influences. Research supports the value of each of these key resources and supports. Differences among self-management interventions may be seen as complementary, rather than conflicting, ways of providing RSSM. This way of understanding differences among interventions may aid development of varied programs to reach diverse audiences. In contrast to the "5 A's" model of key provider services (Assess, Advise, Agree, Assist, and Arrange), RSSM articulate self-management from the perspective of individuals' needs. Both approaches emphasize identification of goals, teaching of skills, and facilitation and reinforcement of the use of those skills. [ABSTRACT FROM AUTHOR]

Carnosine (β-alanyl-L-histidine) can delay senescence and provoke cellular rejuvenation in cultured human fibroblasts. The mechanisms by which such a simple molecule induces these effects is not known despite carnosine's well documented anti-oxidant and oxygen free-radical scavenging activities. Carbonyl groups are generated on proteins post-synthetically by the action of reactive oxygen species and glycating agents and their accumulation is a major biochemical manifestation of ageing. We suggest that, in addition to the prophylactic actions of carnosine, it may also directly participate in the inactivation/disposal of aged proteins possibly by direct reaction with the carbonyl groups on proteins. The possible fates of these `carnosinylated' proteins including the formation of inert lipofuscin, proteolysis via the proteasome system and exocytosis following interaction with receptors are also discussed. The proposal may point to a hitherto unrecognised mechanism by which cells/organisms normally defend themselves against protein carbonyls. [ABSTRACT FROM AUTHOR]

This article presents information on a study related to media coverage of cardiovascular health issues in conjunction with a community-based intervention in Missouri. The authors analyzed 23 newspapers in six rural counties in southeastern Missouri for the period October 1988 through August 1993. They conducted regression analysis in the form of an interrupted time series analysis and linear regression analysis was performed relating time to the monthly count of papers. The study concluded that the coverage of the cardiovascular diseases (CVD)-related issues increased during the said period and it is also considered that it might have had a beneficial effect on CVD-related knowledge.

The article presents information about books "Documentary: A History of the Non-Fiction Film," edited by Erik Barnouw and "Nonfiction Film, Theory and Criticism," by Richard Barsam. Barnouw sketchs the central lines of development of documentary film in its theory and practices without allowing himself to first be sidetracked from the project by general discussions of what is documentary film cut off from the consideration of particular films. Richard Barsam's book "Nonfiction Film, Theory and Criticism," is an excellent amplification to Barnouw's history. The selection offers a good cross-section of character, dispute and involved concern that is constituent of the documentary film tradition.

The article discusses the implementation of Resources and Supports for Self Management (RSSM) and strategies of the transtheoretical model (TTM) to produce diabetes programs. Topics discussed include the education of diabetics to change their health behaviors to control the disease. The article concludes that both programs may work positively to enhance self-management behaviors in patients with diabetes.

The article discusses a project to develop and implement a system of care of people with type 2 diabetes in a free clinic setting. Topics discussed include a program built with the support of the Robert Wood Johnson Foundation, the popular education, and self-management support roles. The article concludes that it is possible the creation of successful systems of care for patients with diabetes in free clinics.

The article discusses the self-management projects of the Diabetes Initiative of the Robert Wood Johnson Foundation, in providing ongoing follow-up and support for diabetes self-management. Topics discussed include facilitation of clinical care, and motivational programs. The article concludes that it is important to promote health services and policy initiatives that encourage self-management programs.

The article discusses the process of collaborative goal setting to improve diabetes self-management programs in primary care. Topics discussed include the notions of the The Big Bad Sugar War, disease registry at the Chronic Disease Electronic Management System, and group medical visits. The article concludes that the support helped patients with diabetes to improve their problem-solving skills.

The article discusses the Move More Diabetes (MMD) program, which is used by Lay Health Educators (LHEs) to promote physical activity and improve diabetes self-management among individuals with type 2 diabetes. The conclusion shows that this low-cost program proved to be a great way to address chronic disease in rural communities.

The article discusses the several components of organizational support for self-management in primary care from the Diabetes Initiative’s Advancing Diabetes Self Management (ADSM) projects. Topics discussed include staff training and education, and integration of self-management into primary care. The article concludes that such components provide significant guidance for integrating diabetes self-management services into primary care settings.

The article discusses the ways in which community health workers (CHW) may contribute in community settings to support diabetes self-management. Topics discussed include individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to resources in daily life, and continuity of quality clinical care. The article concludes that the CHW-patient interaction proved to be positive.

The article discusses a study on the integration of a promotora-led self-management component into a system of care and assess the influence of this program on indicators of metabolic control over time. Topics discussed include the self-management support for people Hispanic population in Texas with diabetes. The article concludes such programs produce a good impact on the clinical care of patients with diabetes.

The article discusses the findings of the projects of the Diabetes Initiative of the Robert Wood Johnson Foundation. Topics discussed include the self-management programs, community resources, and continuity of quality clinical care for diabetics. The article concludes that such programs have shown efficiency on disadvantaged populations.