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BackgroundIn many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. ObjectiveThis study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. MethodsWe conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. ResultsWe conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. ConclusionsThese mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.

BackgroundSubstantial evidence supports the effectiveness of peer educator programs for diabetes management in low- and middle-income countries. However, little is known about peer educators' impact relative to other treatment components such as medication and physician consultation. In Cambodia, the non-governmental organization MoPoTsyo organizes four services for people with diabetes: self-management training through peer educator visits, lab tests, physician consultations, and low-cost medicines. Our aims were to 1) quantify MoPoTsyo participant utilization of each program service and 2) define the relationship between each program service and glycemic control.MethodsWe conducted a retrospective cohort study among 4,210 MoPoTsyo participants, using data collected by MoPoTsyo from 2006-2016. Independent variables assessed were medication adherence, number of peer educator visits, number of physician consultations, and number of lab tests. A multiple logistic regression model was used to evaluate the association between these disease management services and glycemic control-fasting plasma glucose ≤130 mg/dl or post-prandial glucose ≤180 mg/dl-based on most recent glucose level. The model was adjusted for baseline demographic and disease characteristics.FindingsParticipants with 12 or more peer educator visits per year had a 35% higher odds of glycemic control relative to participants with 4 or fewer visits (odds ratio 1.35, 95% CI: 1.08-1.69; p = 0.009), after adjustment for utilization of other treatment components (medication adherence, number of physician visits, number of lab tests), follow-up time, and demographic and disease characteristics. Better adherence to medications and a greater number of lab tests per year were also associated with a higher odds of glycemic control after adjustment. Number of physician consultations was not associated with glycemic control after adjustment.ConclusionsThis study demonstrates a positive association between peer educator utilization and glycemic control incremental to other elements of diabetes management. These results suggest that peer educators may be a valuable addition to comprehensive diabetes management programs in low- and middle-income countries even when other health care services are accessible. The associations identified in this research warrant further prospective studies to explore the causal impact of peer educators on glycemic control relative to other disease management components.

ObjectivesTo examine provider determinants of new-onset disability in basic activities of daily living (ADLs) in community-dwelling elderly.DesignObservational study.SettingKing County, Washington.ParticipantsA random sample of 800 health maintenance organization (HMO) enrollees aged 65 and older participating in a prospective longitudinal cohort study of dementia and normal aging and their 56 primary care providers formed the study population.MeasurementsIncident ADL disability, defined as any new onset of difficulty performing any of the basic ADLs at follow-up assessments, was examined in relation to provider characteristics and practice style using logistic regression and adjusting for case-mix, patient and provider factors associated with ADL disability, and clustering by provider.ResultsNeither provider experience taking care of large numbers of elderly patients nor having a certificate of added qualifications in geriatrics was associated with patient ADL disability at 2 or 4 years of follow-up (adjusted odds ratio (AOR) for experience=1.29, 95% confidence interval (CI)=0.81-2.05; AOR for added qualifications=0.72, 95% CI=0.38-1.39; results at 4 years analogous). A practice style embodying traditional geriatric principles of care was not associated with a reduced likelihood of ADL disability over 4 years of follow-up (AOR for prescribing no high-risk medications=0.56, 95% CI=0.16-1.94; AOR for managing geriatric syndromes=0.94, 95% CI=0.40-2.19; AOR for a team care approach=1.35, 95% CI=0.66-2.75).ConclusionTaking care of a large number of elderly patients, obtaining a certificate of added qualifications in geriatrics, and practicing with a traditional geriatric orientation do not appear to influence the development of ADL disability in elder, community dwelling HMO enrollees.

Abstract Background Cardiovascular disease remains a major health care challenge. The knowledge about the underlying mechanisms of the respective vascular disease etiologies has greatly expanded over the last decades. This includes the contribution of microRNAs, endogenous non-coding RNA molecules, known to vastly influence gene expression. In addition, short interference RNA has been established as a mechanism to temporarily affect gene expression. This review discusses challenges relating to the design of a RNA interference therapy strategy for the modulation of vascular disease. Despite advances in medical and surgical therapies, atherosclerosis (ATH), aortic aneurysms (AA) are still associated with high morbidity and mortality. In addition, intimal hyperplasia (IH) remains a leading cause of late vein and prosthetic bypass graft failure. Pathomechanisms of all three entities include activation of endothelial cells (EC) and dedifferentiation of vascular smooth muscle cells (VSMC). RNA interference represents a promising technology that may be utilized to silence genes contributing to ATH, AA or IH. Successful RNAi delivery to the vessel wall faces multiple obstacles. These include the challenge of cell specific, targeted delivery of RNAi, anatomical barriers such as basal membrane, elastic laminae in arterial walls, multiple layers of VSMC, as well as adventitial tissues. Another major decision point is the route of delivery and potential methods of transfection. A plethora of transfection reagents and adjuncts have been described with varying efficacies and side effects. Timing and duration of RNAi therapy as well as target gene choice are further relevant aspects that need to be addressed in a temporo-spatial fashion. Conclusions While multiple preclinical studies reported encouraging results of RNAi delivery to the vascular wall, it remains to be seen if a single target can be sufficient to the achieve clinically desirable changes in the injured vascular wall in humans. It might be necessary to achieve simultaneous and/or sequential silencing of multiple, synergistically acting target genes. Some advances in cell specific RNAi delivery have been made, but a reliable vascular cell specific transfection strategy is still missing. Also, off-target effects of RNAi and unwanted effects of transfection agents on gene expression are challenges to be addressed. Close collaborative efforts between clinicians, geneticists, biologists, and chemical and medical engineers will be needed to provide tailored therapeutics for the various types of vascular diseases.

Objectives The success of prosthetic vascular grafts in the management of peripheral arterial disease is frequently limited by the development of anastomotic neointimal hyperplasia (ANIH), with the host response to prosthetic grafts beginning soon after implantation. To address this, we combine a platform of polyethylene terephthalate (PET) fabric with an applied cryogel layer containing biologic agents to create a bioactive prosthetic graft system, with the ability to deliver therapeutics targeting modulators of the ANIH-associated transcriptome response, along with antithrombotic agents. Methods Hybrid graft materials were synthesized by cryopolymerization of methacrylated alginate and heparin onto electrospun (ePET), knitted PET (kPET), or woven PET (wPET). Arg-Gly-Asp (RGD) peptides were added to increase cell adhesion. Scanning electron microscopy (SEM) was used to study the microstructure at 1 day, and 2, 4, and 8 weeks. Physical properties such as swelling ratio, pore connectivity, shape recovery, and stiffness were evaluated. Human aortic endothelial cell (HAoEC) adherence was visualized using confocal microscopy after 24 hours and proliferation was evaluated with a resazurin-based assay for 7 days. Confocal microscopy was used to assess delivery of adeno-associated virus (AAV-GFP) after incubation of hybrid grafts with HAoECs. Heparin activity of the materials was measured using an anti-Xa assay. Results SEM demonstrated large interconnected pores throughout the entire structure for all graft types, with minimal degradation of the cryogel after 8 weeks. Hybrid materials showed a trend towards increased shape recovery, increased stiffness, decreased swelling ratio, and no difference in pore connectivity. HAoECs incorporated, adhered, and proliferated over 7 days on all materials. HAoECs were successfully transduced with AAV-GFP from the hybrid graft materials. Anti-Xa assay confirmed continued activity of heparin from all materials for over 7 days. Conclusions We have developed a bioactive prosthetic graft system with a cryogel coating capable of delivering biologic agents with antithrombotic activity. By applying the cryogel and selected agents onto PET prior to graft implantation, this study sets the stage for the system to be individualized and tailored to the patient, with bioengineering and targeted gene therapy strategies dovetailing to create an improved prosthetic graft adaptable to emerging knowledge and technologies.

To evaluate the association of salt consumption with blood pressure in Viet Nam, a developing country with a high level of salt consumption.Analysis of a nationally representative sample of Vietnamese adults 25-65 years of age who were surveyed using the World Health Organization STEPwise approach to Surveillance protocol. Participants who reported acute illness, pregnancy, or current use of antihypertensive medications were excluded. Daily salt consumption was estimated from fasting mid-morning spot urine samples. Associations of salt consumption with systolic blood pressure and prevalent hypertension were assessed using adjusted linear and generalized linear models. Interaction terms were tested to assess differences by age, smoking, alcohol consumption, and rural/urban status.The analysis included 2,333 participants (mean age: 37 years, 46% male, 33% urban). The average estimated salt consumption was 10g/day. No associations of salt consumption with blood pressure or prevalent hypertension were observed at a national scale in men or women. The associations did not differ in subgroups defined by age, smoking, or alcohol consumption; however, associations differed between urban and rural participants (p-value for interaction of urban/rural status with salt consumption, p = 0.02), suggesting that higher salt consumption may be associated with higher systolic blood pressure in urban residents but lower systolic blood pressure in rural residents.Although there was no evidence of an association at a national level, associations of salt consumption with blood pressure differed between urban and rural residents in Viet Nam. The reasons for this differential association are not clear, and given the large rate of rural to urban migration experienced in Viet Nam, this topic warrants further investigation.

[This corrects the article DOI: 10.1371/journal.pone.0181582.].

Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo's diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007-2013.This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9-38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p

We investigated the differential role of two frontal regions in the processing of grammatical and semantic knowledge. Given the documented specificity of the prefrontal cortex for the grammatical class of verbs, and of the primary motor cortex for the semantic class of action words, we sought to investigate whether the prefrontal cortex is also sensitive to semantic effects, and whether the motor cortex is also sensitive to grammatical class effects. We used repetitive transcranial magnetic stimulation (rTMS) to suppress the excitability of a portion of left prefontal cortex (first experiment) and of the motor area (second experiment). In the first experiment we found that rTMS applied to the left prefrontal cortex delays the processing of action verbs' retrieval, but is not critical for retrieval of state verbs and state nouns. In the second experiment we found that rTMS applied to the left motor cortex delays the processing of action words, both name and verbs, while it is not critical for the processing of state words. These results support the notion that left prefrontal and motor cortex are involved in the process of action word retrieval. Left prefrontal cortex subserves processing of both grammatical and semantic information, whereas motor cortex contributes to the processing of semantic representation of action words without any involvement in the representation of grammatical categories. (Contains 3 figures.)

We use the Early Childhood Longitudinal Study to investigate national patterns addressing (a) who repeats kindergarten, and (b) the subsequent cognitive effects of this event. Using OLS regression techniques, we investigate 1st-time kindergartners who are promoted, 1st-time kindergartners who are retained, and children who are already repeating kindergarten. Boys, children from low socioeconomic backgrounds, and children who enter kindergarten younger than typical age standards are consistently at risk for repeating kindergarten, but racial/ethnic patterns differ across the 2 cohorts of kindergarten repeaters. Evidence suggests that repeating kindergarten rarely leads to cognitive benefits in literacy or mathematics performance. On average, kindergarten repeaters continue to perform below their peers in terms of literacy skills both at the end of kindergarten and at the end of first grade (effect size [ES] = -0.20 and -0.24, respectively). In mathematics, the performance differentials are smaller but remain statistically significant. Evidence suggests that these differences vary somewhat by children's background and the school setting. Most children appear to receive little or no cognitive benefit from repeating kindergarten, suggesting the need for a careful reconsideration of current retention practices. (Contains 9 tables and 4 footnotes.)

This article presents a theoretical rationale and empirical evidence regarding the validity of scores obtained from two competing approaches to operationalizing scale items to measure emergent organizational properties. The authors consider whether items in scales intended to measure organizational properties should prompt survey takers to provide self- or group-referent responses. To achieve this, the general question of how items should be worded is studied through the specific case of the measurement of perceived collective efficacy, a perceptual variable referring to the beliefs of group members regarding their conjoint capability. Structural equation modeling results indicate that intergroup variability in goal attainment is explained well when organizational members are asked questions focused on group processes and outcomes. Aggregated perceptions of self-capability, on the other hand, do little to explain variability among groups in goal attainment. The results are important for the development of scales in future studies of emergent organizational properties. (Contains 1 table and 1 figure.)

The basics of No Child Left Behind (NCLB)--adequate yearly progress benchmarks, provision of supplemental services, and a "highly qualified" teacher in every classroom--are known. The intense scrutiny of the "how to" of those basics has resulted in a mix of impassioned criticism and effusive praise. What has been left largely unexamined in the hubbub is perhaps the law's central, if unspoken, principle: that a serious commitment to learning-for-all can help make it so. Indeed, the NCLB legislation calls for "greater responsibility" from teachers and schools for student learning. This article talks about a study conducted by the author to explore whether a teacher's own sense of responsibility for that learning makes any difference to students learning and how to nurture that sense of responsibility. The author's study of a nationally representative sample of 1st graders and their teachers suggests that teachers who take personal responsibility for student learning can improve student achievement, specifically, children with teachers who have a greater sense of responsibility for student outcomes learn more in reading during the 1st grade. Unfortunately, the findings presented here also suggest that the teachers of economically disadvantaged students are less likely to take responsibility for student outcomes. It should not be dedicated solely to the daunting task of identifying, hiring, and retaining more responsible teachers. In this article, the author found that a teacher's work environment has a strong relationship with the commitment to student learning. Teachers who report that their school's leadership is supportive of their efforts in the classroom have a much greater sense of responsibility, as do teachers in Catholic schools. Improving the quality of school leadership could also be an effective means of staffing the nation's classrooms with responsible teachers. (Contains 2 figures.)

This study investigated gender differences in kindergarteners' literacy skills, specifically, whether differences in children's classroom behaviors explained females' early learning advantage. Data included information on 16,883 kindergartners (8,701 boys and 8,182 girls) from the Early Childhood Longitudinal Study, Kindergarten Cohort of 1998-1999 (ECLS-K). The ECLS-K directly assessed children's cognitive skills and collected extensive data on children's sociodemographic and behavioral backgrounds through structured telephone interviews with parents and written surveys with children's teachers. Findings suggested that not only did girls enter kindergarten with somewhat stronger literacy skills but they also learned slightly more than boys over the kindergarten year. Taking into account teachers' reports of girls' more positive learning approaches (e.g., attentiveness, task persistence) explained almost two-thirds of the female advantage in literacy learning. Accounting for boys' more prevalent external behavior problems, thought by many to explain girls' advantage in literacy development, did little to diminish the gender gap.

This study examined the relationship between collective efficacy and high school student achievement in a state with an accountability system heavily focused on achievement, measured by mandatory assessments in multiple content areas. Using social cognitive theory, a theoretical model was developed linking school context and collective efficacy to differences among schools in 12th grader student achievement. Structural equation modeling was used to test the fit of the model to data drawn from students and teachers in 96 state high schools. Collective efficacy was positively influenced by past mastery experience and negatively related to school socioeconomic disadvantage. Additionally, after accounting for the influence of several aspects of school context, collective efficacy remained a significant positive predictor of student performance across all content areas tested by the state. The authors discuss the implications of these findings for social cognitive theory and school improvement in an era of school accountability for student performance on subject-specific achievement assessments.

Sociologists suggest that children from socially advantaged families continue to learn during the summer, whereas children from disadvantaged families learn either little or lose ground. This disparity in summer learning is hypothesized to result from differential participation in educationally beneficial summer activities. In this article, we test this theory with current and nationally representative data, the Early Childhood Longitudinal Study--Kindergarten Cohort. We examine how children's socioeconomic status (SES) is associated with their learning of literacy, mathematics, and general knowledge over the summer between kindergarten and the first grade. We also explore whether social-background differences in learning are explained by differential participation rates in summer activities. Our analytic models adjust for discrepancies between the timing of assessments and the timing of schools closing for the summer and opening in the fall. Much of the observed gain results from time in school. Nonetheless, social stratification characterizes summer learning between kindergarten and the first grade, with higher-SES children learning more. However, these social-background differences are only modestly explained by the activities in which children participate during the summer months.

Vein graft failure occurs between 1 and 6 months after implantation due to obstructive intimal hyperplasia, related in part to implantation injury. The cell-specific and temporal response of the transcriptome to vein graft implantation injury was determined by transcriptional profiling of laser capture microdissected endothelial cells (EC) and medial smooth muscle cells (SMC) from canine vein grafts, 2 hours (H) to 30 days (D) following surgery. Our results demonstrate a robust genomic response beginning at 2 H, peaking at 12-24 H, declining by 7 D, and resolving by 30 D. Gene ontology and pathway analyses of differentially expressed genes indicated that implantation injury affects inflammatory and immune responses, apoptosis, mitosis, and extracellular matrix reorganization in both cell types. Through backpropagation an integrated network was built, starting with genes differentially expressed at 30 D, followed by adding upstream interactive genes from each prior time-point. This identified significant enrichment of IL-6, IL-8, NF-κB, dendritic cell maturation, glucocorticoid receptor, and Triggering Receptor Expressed on Myeloid Cells (TREM-1) signaling, as well as PPARα activation pathways in graft EC and SMC. Interactive network-based analyses identified IL-6, IL-8, IL-1α, and Insulin Receptor (INSR) as focus hub genes within these pathways. Real-time PCR was used for the validation of two of these genes: IL-6 and IL-8, in addition to Collagen 11A1 (COL11A1), a cornerstone of the backpropagation. In conclusion, these results establish causality relationships clarifying the pathogenesis of vein graft implantation injury, and identifying novel targets for its prevention.

To date, there are no known estimates of the prevalence of chronic kidney disease within Cambodia, the vast majority of whose citizens live in rural areas with limited access to renal replacement therapy.Observational analysis of patients from the Takeo province in Cambodia who presented to MoPoTsyo, a non-governmental organization, for screening and management of diabetes mellitus between 2010 and 2012 (n = 402; 75% females). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi equation.On average, women were younger, with a higher percentage of hypercholesterolemia but also high-density lipoprotein level. Men had a higher serum creatinine level (1.31 mg/dl) than that of women (1.13 mg/dl) at 95% CI. More than half of all screened patients had a reduced eGFR; 60% (95% CI 55%, 65%) had an eGFR

BACKGROUND: Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of non-communicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease. METHODOLOGY/PRINCIPAL FINDINGS: We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher's Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n = 1,786) were men, and 64.4% (n = 3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI ≥ 23.0 kg/m(2) and with WC >80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all p-values

Introduction We report on development and preliminary validation of a brief, telephone-based measurement tool for assessing physical activity in older adults. The Telephone Assessment of Physical Activity (TAPA) questionnaire is based on the University of Washington Health Promotion Research Center’s Rapid Assessment of Physical Activity (RAPA), a written questionnaire.MethodsThe Rapid Assessment of Physical Activity questionnaire was modified to permit interviewers to administer it as a telephone interview. We retained its scoring levels and interpretation. The pilot test of the telephone version assessed the questionnaire’s ease of administration and construct validity in a community-based sample of older adults. Spearman rho and kappa statistics were computed for comparison with the Rapid Assessment of Physical Activity questionnaire and the Community Healthy Activities Model Program for Seniors questionnaire.ResultsThirty-four older adults completed the telephone assessment. A Spearman rho of 0.74 and a kappa statistic of 0.48 were found between TAPA and the written RAPA.ConclusionThe pilot test demonstrated that the TAPA questionnaire is a promising instrument for use as a brief, telephone-based questionnaire for assessing physical activity in older adults.

IntroductionOur study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years.MethodsThis retrospective cohort study used administrative and claims data from a Medicare Advantage plan. Participants (n = 4766) were enrolled in the plan for at least 1 year before participating in the plan-sponsored health club benefit (Silver Sneakers). Controls (n = 9035) were matched to participants by age and sex according to the index date of Silver Sneakers enrollment. Multivariate regression models were used to estimate health care use and costs and to make subgroup comparisons according to frequency of health club visits.ResultsCompared with controls, Silver Sneakers participants were older and more likely to be male, used more preventive services, and had higher total health care costs at baseline. Adjusted total health care costs for Silver Sneakers participants and controls did not differ significantly in year 1. By year 2, compared with controls, Silver Sneakers participants had significantly fewer inpatient admissions (−2.3%, 95% confidence interval, −3.3% to −1.2%; P < .001) and lower total health care costs (−$500; 95% confidence interval, −$892 to −$106; P = .01]. Silver Sneakers participants who averaged at least two health club visits per week over 2 years incurred at least $1252 (95% confidence interval, −$1937 to −$567; P < .001) less in health care costs in year 2 than did those who visited on average less than once per week.ConclusionRegular use of a health club benefit was associated with slower growth in total health care costs in the long term but not in the short term. These findings warrant additional prospective investigations to determine whether policies to offer health club benefits and promote physical activity among older adults can reduce increases in health care costs.

BackgroundRegular physical activity is an important goal for elders with chronic health conditions.ContextThis report describes Physical Activity for a Lifetime of Success (PALS), an attempt to translate a motivational support program for physical activity, Active Choices, for use by a group of diverse, low-income, community-dwelling elders with diabetes.MethodsPALS linked physical activity assessment and brief counseling by primary care providers with a structured referral to a community-based motivational telephone support program delivered by older adult volunteers. People with diabetes aged 65 years or older who were receiving care at two community clinics were randomized to receive either immediate or delayed intervention. The main intended outcome measure was physical activity level; the secondary outcome measure was mean hemoglobin A1c.ConsequencesOne-third of those offered referral to the PALS program in the clinic setting declined. Another 44% subsequently declined enrollment or were unreachable by the support center. Only 14 (21%) of those offered referral enrolled in the program. Among these 14, the percentage who were sufficiently active was higher at follow-up than at enrollment, though not significantly so. Using an intent-to-treat analysis, which included all randomized clinic patients, we found no significant change in mean hemoglobin A1c for the intervention group compared with controls.Interpretation A community-based referral and support program to increase physical activity among elderly, ethnically diverse, low-income people with diabetes, many of whom are not English-speaking, may be thwarted by unforeseen barriers. Those who enroll and participate in the PALS program appear to increase their level of physical activity.

Introduction Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. Methods Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants primary language and ranged in size from 713 participants. Mean age was 71.6 years (range from 52 to 85 years; SD + 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. Results Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. Conclusion Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.