Prevention Program Research Research Articles

Reflecting on partnerships established and sustained over four cycles of a federally funded cancer prevention and control research program: lessons learned for community-academic networks.

The Centers for Disease Control and Prevention (CDC) funded Cancer Prevention and Control Research Network (CPCRN) is a national network which aims to accelerate the adoption and implementation of evidence-based cancer prevention and control strategies and interventions in communities, enhance large-scale efforts to reach underserved populations and reduce their cancer-related health disparities, and develop the capacity of the dissemination and implementation work force specifically in cancer prevention and control. Our site has been a part of the CPCRN since its inception in 2002 with the exception of the 2004-2009 funding cycle. As community-based participatory research is a core value of our center, we examined the development and continued engagement of our community partners using a qualitative, inductive approach to identify emergent themes from focus group sessions with current and past investigators. Several key themes were identified from our analysis including long-term commitment to community partnerships and interconnectedness with other work, authentic approach, valuing our community as experts, and mutual benefits. With our results, we provide evidence of common community-based participatory research (CBPR) principles which have supported the sustained engagement with those racial minorities who are most vulnerable in our community. While future analysis is planned to utilize this same approach with our community partners, this work marks an important step in reflecting upon the approaches which have led to our success and how they can be applied in future collaborations to maximize impact and sustained health improvements.

What works to prevent violence against women, domestic abuse and sexual violence (VAWDASV)? A systematic evidence assessment

This review identifies effective practice for the prevention of violence against women, domestic abuse and sexual violence (VAWDASV). The review is underpinned by public health principles which provide a useful framework to understand the causes and consequences of violence as well as prevention. This systematic evidence assessment had two stages: a database search identified reviews of interventions designed to prevent VAWDASV, published since 2014; a supplementary search identified primary studies published since 2018. Reviews (n=35) and primary studies (n=16) focus on a range of types of violence and interventions. At the individual and relationship level, interventions work to transform harmful gender norms, promote healthy relationships, and promote empowerment. In the community, effective interventions were identified in schools, the workplace, and health settings. Finally, at the societal level, interventions relate to legislation and alcohol policy. The findings reveal a wealth of literature relating to the prevention of VAWDASV. However, gaps in research were identified in relation to the prevention of trafficking, violence against women, domestic abuse, sexual violence among older age groups, and so-called honour-based abuse other than female genital mutilation. Also, while many interventions focus on change at the individual and relationship level and within community settings, there is less evidence for societal-level prevention. The prevention of VAWDASV is both feasible and effective and there is an imperative to invest both in prevention programming and high-quality research to continue to guide efforts to prevent VAWDASV.

Stakeholder engagement in a hypertension and diabetes prevention research program: Description and lessons learned.

Stakeholder engagement is important from the management point of view to capture knowledge, increase ownership, reduce conflict, encourage partnership, as well as to develop an ethical perspective that facilitates inclusive decision making and promotes equity. However, there is dearth of literature in the process of stakeholder engagement. The purpose of this paper is to describe the process of increasing stakeholder engagement and highlight the lessons learnt on stakeholder engagement while designing, implementing, and monitoring a study on diabetes and hypertension prevention in workplace settings in Nepal. We identified the stakeholders based on the 7P framework: Patients and public (clients), providers, payers, policy makers, product makers, principal investigators, and purchasers. The identified stakeholders were engaged in prioritization of the research questions, planning data collection, designing, implementing, and monitoring the intervention. Stakeholders were engaged through focus group discussions, in-depth interviews, participatory workshops, individual consultation, information sessions and representation in study team and implementation committees. The views of the stakeholders were synthesized in each step of the research process, from designing to interpreting the results. Stakeholder engagement helped to shape the methods and plan, and process for participant's recruitment and data collection. In addition, it enhanced adherence to intervention, mutual learning, and smooth intervention adoption. The major challenges were the time-consuming nature of the process, language barriers, and the differences in health and food beliefs between researchers and stakeholders. It was possible to engage and benefit from stakeholder's engagement on the design, implementation and monitoring of a workplace-based hypertension and diabetes management research program in Nepal.

The West Africa ICEMR Partnerships for Guiding Policy to Improve the Malaria Prevention and Control.

The Mali National Malaria Control Program (NMCP) recently established a phased set of goals for eliminating malaria in Mali by 2030. Over the past decade, the scale-up of NMCP-led malaria control interventions has led to considerable progress, as evidenced by multiple malariometric indicators. The West Africa International Center of Excellence in Malaria Research (WA-ICEMR) is a multidisciplinary research program that works closely with the NMCP and its partners to address critical research needs for malaria control. This coordinated effort includes assessing the effectiveness of control interventions based on key malaria research topics, including immune status, parasite genetic diversity, insecticide and drug resistance, diagnostic accuracy, malaria vector populations and biting behaviors, and vectorial capacity. Several signature accomplishments of the WA-ICEMR include identifying changing malaria age demographic profiles, testing innovative approaches to improve control strategies, and providing regular reporting on drug and insecticide resistance status. The NMCP and WA-ICEMR partnership between the WA-ICEMR and the NMCP offers a comprehensive research platform that informs the design and implementation of malaria prevention and control research programs. These efforts build local expertise and capacity for the next generation of malaria researchers and guide local policy, which is crucial in sustaining efforts toward eliminating malaria in West Africa.

Editorial introductions.

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Joseph F. MaglioccaJoseph F. MaglioccaJoseph F. Magliocca, MD, is Assistant Professor in the Division of Transplantation in the Department of Surgery at Emory University School of Medicine. Dr Magliocca, a board certified surgeon specializing in liver transplantation, also serves as Surgical Director of the Liver Transplant Program at Children's Healthcare of Atlanta. Prior to his work at Emory, Dr Magliocca was the surgical director of adult and pediatric liver transplantation as well as pancreas transplantation at the University of Florida College of Medicine. He also directed the medical student and resident education components of University of Florida's transplant and hepatobiliary surgery program. Dr Magliocca belongs to numerous professional organizations including American College of Surgeons, American Society of Transplant Surgeons, The Transplantation Society, American Society of Transplantation, International Pediatric Transplant Association, International Pancreas and Islet Transplant Association, and Association for Academic Surgery. He is a member of the Cancer Prevention and Control Research Program at Winship. Dr Magliocca currently serves as an associate editor of the American Journal of Transplantation, and is actively engaged in clinical and translational research investigating the preservation and resuscitation of liver grafts. Dr Magliocca's research interests include organ preservation, ischemia/reperfusion injury and management of immunosuppression in patients following transplantation. Laurens J. CeulemansLaurens J. CeulemansLaurens J. Ceulemans (1985) graduated as medical doctor in 2010 at KU Leuven, Belgium (MD). In 2017 he obtained his PhD with his contributions to the clinical and basic science field of intestinal transplantation and ischemia reperfusion injury. After his specialization in general surgery (2018), he completed a clinical and research fellowship in thoracic surgery and transplantation at the University Hospitals and ETH Zürich in Switzerland. This fellowship was supported by several grants including the prestigious Horlait-Dapsens and ESOT schorlarships. Since 2019 he has worked as a thoracic and transplant surgeon at the department of Thoracic Surgery and the Leuven Intestinal Failure and Transplant (LIFT) center at the University Hospitals Leuven. He is appointed as professor in Surgery at KU Leuven and his basic research focuses on both the intestine and the lung. He is the author of 100 peer-reviewed papers and actively enrolled in several transplant societies. He is a council member for IRTA since 2018 and chair of the Membership and Education committee since 2021.

Identifying Suicidal Ideation and Attempt From Clinical Notes Within a Large Integrated Health Care System.

The purpose of this study was to develop a natural language processing algorithm to identify suicidal ideation/attempt from free-text clinical notes. Clinical notes containing prespecified keywords related to suicidal ideation/attempts from 2010 to 2018 were extracted from our organization's electronic health record system. A random sample of 864 clinical notes was selected and equally divided into 4 subsets. These subsets were reviewed and classified as 1 of the following 3 suicidal ideation/attempt categories (current, historical, and no) by experienced research chart abstractors. The first 3 data sets were used to develop the rule-based computerized algorithm sequentially and the fourth data set was used to evaluate the algorithm's performance. The validated algorithm was then applied to the entire study sample of clinical notes. The computerized algorithm correctly identified 23 of the 26 confirmed current suicidal ideation/attempts and all 10 confirmed historical suicidal ideation/attempts in the validation data set. It produced an 88.5% sensitivity and a 100.0% positive predictive value for current suicidal ideation/attempts, and a 100.0% sensitivity and positive predictive value for historical suicidal ideation/attempts. After applying the computerized algorithm to the entire set of study notes, we identified a total of 1,050,287 current ideation/attempt events and 293,037 historical ideation/attempt events documented in clinical notes. Those for which current ideation/attempt events were documented were more likely to be female (59.5%), 25-44 years old (28.3%), and White (43.4%). Our study demonstrated that a computerized algorithm can effectively identify suicidal ideation/attempts from clinical notes. This algorithm can be utilized in support of suicide prevention research programs and patient care quality improvement initiatives.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Lifestyle intervention is superior to metformin in prevention of microvascular complications of diabetes in women, but socioeconomic barriers may lead to use of combination

A clinical decision report using: Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 2015;3(11):866-875. https://doi.org/10.1016/S2213-8587(15)00291-0 for a patient with pre-diabetes who is concerned about the prevention of microvascular complications through lifestyle intervention while managing her busy schedule as a traveling house cleaner.

Sustaining suicide prevention programs in American Indian and Alaska Native communities and Tribal health centers.

Background:Research on sustaining community-based interventions is limited. This is particularly true for suicide prevention programs and in American Indian and Alaska Native (AIAN) settings. Aiming to inform research in this area, this paper sought to identify factors and strategies that are key to sustain suicide prevention efforts in AIAN communities.Methods:We used a modified Nominal Group Technique with a purposeful sample of N = 35 suicide prevention research experts, program implementors and AIAN community leaders to develop a list of prioritized factors and sustainability strategies. We then compared this list with the Public Health Program Capacity for Sustainability Framework (PHPCSF) to examine the extent the factors identified aligned with the existing literature.Results:Major factors identified included cultural fit of intervention approaches, buy in from local communities, importance of leadership and policy making, and demonstrated program success. Strategies to promote these factors included partnership building, continuous growth of leadership, policy development, and ongoing strategic planning and advocacy. All domains of the PHPCF were representative, but additional factors and strategies were identified that emerged as important in AIAN settings.Conclusions:Sustaining effective and culturally informed suicide prevention efforts is of paramount importance to prevent suicide and save lives. Future research will focus on generating empirical evidence of these strategies and their effectiveness at promoting program sustainability in AIAN communities.

Abstract A23: Using Internet-platform technology to train community-based researchers in developing countries: Lessons Learned from a Caribbean study

Abstract As cancer increases as a global health challenge, the use of available technological platforms for communication is required. To develop a collaborative program of cancer prevention research between the U.S. and the Caribbean, we relied on several mobile phone and Internet-based communication platforms. In 2016-2017, a two-phase advocacy-engaged research study was initiated to determine 1) women’s perceptions of breast and cervical cancer screening and 2) gatekeepers’ perceptions of the quality and availability of breast and cervical cancer screening and treatment services in the four countries of the English-speaking Windward Islands. Our results revealed that mobile communication and Internet-platform technologies successfully trained Caribbean community researchers on qualitative data collection and analysis methods as well as dissemination strategies. In particular, mobile platforms including GoToTraining, WhatsApp, YouTube, Dedoose, Google Drive, and email were used to deliver interactive training modules to community researchers in the Caribbean. The Internet-based technology enhanced training, communication, and social interactions. Additionally, it facilitated the collaborative development of recruitment materials and data collection instruments, data management, reports, manuscripts, and results dissemination. Community and academic researchers agreed that use of technology fostered a cost-effective and efficient collaborative process. The availability and use of communication technology are especially critical for researchers addressing the raising global cancer burden, particularly in resource-poor countries. Advocacy-engaged, technology-facilitated cancer research has the potential to cultivate and sustain community capacity and infrastructure for international research partnerships by building bridges via the use of mobile and Internet-based technology. Citation Format: Kamilah B. Thomas-Purcell, Marva Primus-Joseph, Christine Richards, Ann Marie McBurnie James, Julie Blaze, Lydia Atkins, Patsy Wiley, Kimlin Tam Ashing. Using Internet-platform technology to train community-based researchers in developing countries: Lessons Learned from a Caribbean study [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A23.

Student Knowledge Gain Following the Second Step Child Protection Unit: the Influence of Treatment Integrity.

Treatment integrity is an important yet understudied component of school-based prevention programming, particularly for sensitive topics such as child sexual abuse prevention (CSA). This study examined student- and teacher-level characteristics, including components of treatment integrity, that contributed to greater knowledge gain among students participating in the Second Step Child Protection Unit (CPU). The study was conducted with 1132 students and 57 teachers from four elementary schools enrolled in a randomized controlled trial of the CPU. Students were administered assessments at pre-test, post-test, 6-month follow-up, and 12-month follow-up. Teachers were observed and rated on Content Integrity (CI; adherence to content), Process Integrity (PI; teacher enthusiasm, encouragement, behavior management), and Dose Received (DR; student behavior and interest) when delivering the lessons. Hierarchical linear growth modeling indicated that students who received the CPU made gains in the knowledge of CSA concepts and skills over a 12-month follow-up period. Girls had significantly greater CSA knowledge than boys immediately after the intervention, with gender remaining significant even when accounting for level-3 variables. Older children had better knowledge scores at post-test, but growth over time results revealed that younger students made greater gains. For students in 2nd through 4th grade, CI was more important for post-test outcomes, while for all students, CI and grade taught were important to post-test scores. Teachers of lower grades had students with a faster growth rate on correct responses to vignettes. Implications for CSA prevention programming and future research are discussed.

Characteristics and diagnosis rate of 5630 subjects receiving SARS-CoV-2 nucleic acid tests from Wuhan, China.

BACKGROUNDThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a novel viral pneumonia (COVID-19), which is rapidly spreading throughout the world. The positive result of nucleic acid test is a golden criterion to confirm SARS-CoV-2 infection, but the detection features remain unclear.METHODSWe performed a retrospective analysis in 5630 high-risk individuals receiving SARS-CoV-2 nucleic acid tests in Wuhan, China, and investigated their characteristics and diagnosis rates.RESULTSThe overall diagnosis rate was 34.7% (1952/5630). Male (P = 0.025) and older populations (P = 2.525 × 10-39) were at significantly higher risk of SARS-CoV-2 infection. People were generally susceptible, and most cases concentrated in people of 30-79 years. Furthermore, we investigated the association between diagnosis rate and the amount of testing in 501 subjects. Results revealed a 1.27-fold improvement (from 27.9% to 35.5%) of diagnosis rate from testing once to twice (P = 5.847 × 10-9) and a 1.43-fold improvement (from 27.9% to 39.9%) from testing once to 3 times (P = 7.797 × 10-14). More than 3 testing administrations was not helpful for further improvement. However, this improvement was not observed in subjects with pneumonia (P = 0.097).CONCLUSIONAll populations are susceptible to SARS-CoV-2 infection, and male and older-aged populations are at significantly higher risk. Increasing the amount of testing could significantly improve diagnosis rates, except for subjects with pneumonia. It is recommended to test twice in those high-risk individuals whose results are negative the first time, and performing 3 tests is better, if possible.FUNDINGThis work was supported by National Mega Project on Major Infectious Disease Prevention (no. 2017ZX10103005-007) and National Key Research and Development Program of China (no. 2018YFE0204500).

Treatment Integrity and Social Validity of the FRIENDS for Life Programme in a Northeastern Canadian School System

AbstractThe FRIENDS for Life (FFL) programme, a school-based anxiety prevention programme, targets anxiety reduction and resiliency development in elementary school-aged children (Barrett, Sonderegger & Xenos, 2003). In the context of equivocal effectiveness findings regarding FFL in Canadian schools, the present study assessed pre–post changes in anxiety, self-esteem, and prosocial behaviour in a school system in Northeastern Canada. To yield further insight to the potential sources of equivocal FFL effectiveness findings, we also evaluated FFL treatment integrity (TI) and social validity (SV). Few studies have assessed FFL TI at the level of identifying which programme sessions, or within-session content, have or have not been adhered to (Higgins & O'Sullivan S, 2015). Similarly, few studies have provided detailed programme SV data or perceived programme benefits by children and parents. TI and SV can provide programme data beyond anxiety reduction, which is key in prevention programming research, as pre–post changes are challenging to detect in ‘healthy’ samples (Durlak & Wells, 1997). Treatment outcome, TI, and SV data were collected from classrooms across 10 elementary schools administering FFL. The sample included 210 child and 108 parent participants; post-testing occurred 1 week following FFL programme completion. Findings indicated significant decreases from pre- to post-test in child-reported anxiety and self-esteem but no changes in prosocial behaviours. Findings suggest that low TI ratings may have impacted anxiety, self-esteem, and prosocial behaviour results, and that child-reported SV may be more related to programme outcomes than parent-reported SV. Implications for FFL programme developers and future FFL evaluation studies are discussed.

Transcriptomic Characteristics of Bronchoalveolar Lavage Fluid and Peripheral Blood Mononuclear Cells in COVID-19 Patients

Circulating in China and 75 other countries and territories, the ongoing COVID-19 outbreak has caused devastating mortality and posed a great threat to public health. However, efforts to identify effectively supportive therapeutic drugs and treatments has been hampered by our limited understanding of host immune response for this fatal disease. To characterize the transcriptional signatures of host inflammatory response to SARS-CoV-2 infection, we carried out transcriptome sequencing of the RNAs isolated from the bronchoalveolar lavage fluid (BALF) and peripheral blood mononuclear cells (PBMC) specimens of COVID-19 patients. Our results reveal distinct host inflammatory cytokine profiles to SARS-CoV-2 infection in patients, and highlight the association between COVID-19 pathogenesis and excessive cytokine release such as CCL2/MCP-1, CXCL10/IP-10, CCL3/MIP-1A, and CCL4/MIP1B. Furthermore, SARS-CoV-2 induced activation of apoptosis and P53 signaling pathway in lymphocytes may be the cause of patients’ lymphopenia. The transcriptome dataset of COVID-19 patients would be a valuable resource for clinical guidance on anti-inflammatory medication and understanding the molecular mechansims of host response. Funding: This study was supported by Special Fund for COVID-19 Research of Wuhan University, National Science and Technology Major Project (#2018ZX10733403), China NSFC grants (#81672008, 31871316), Hubei Natural Science Foundation (#2018CFA035), Basic Scientific Research Foundation of Central Universities (#2042019gf0026), Ministry of Science and Technology of China, the National Mega Project on Major Infectious Disease Prevention (#2017ZX10103005) and National Key Research and Development Program of China (#2018YFE0204500). Declaration of Interest: The authors declare no competing interests. Ethical Approval: This study was approved by the Ethics Committee of the Zhongnan Hospital of Wuhan University. The RNA-seq analyses of BALF samples and PBMC were performed on existing samples collected during standard diagnostic tests, posing no extra burden to patients.

Case Reports on Diabetes-Related Outcomes for Pregnant Women in the National Diabetes Prevention Program.

Previous interventions to lower diabetes risks among pregnant women have been largely ineffective (1–3), and the identification of effective prevention tools is needed to protect both maternal and child health (4). The National Diabetes Prevention Program (NDPP) is a widely disseminated translation of the highly successful lifestyle change intervention from the Diabetes Prevention Program research study (5,6). The NDPP promotes weight loss of ≥5% through diet and physical activity, benefiting individuals who participate regularly (6). Eighty percent of participants are women (6), but most are beyond child-bearing years (7), and those who are pregnant at enrollment are excluded (8). Increasing enrollment in the NDPP among women of childbearing age has been identified as a priority (7), yet outcomes for those who become pregnant during the year-long program are unknown. To explore whether the NDPP may support beneficial outcomes during pregnancy, we examined case studies of women who became pregnant while participating in the NDPP. We delivered the year-long NDPP intervention in a Denver, Colo., health care system to eligible adults with diabetes risks (i.e., ≥24 kg/m2 and prediabetes, history of gestational diabetes mellitus [GDM], or positive score on a diabetes risk questionnaire [8]). Participants were largely referred by their primary care providers. Trained NDPP coaches led 22–25 group sessions over 1 year following guidelines developed by the Centers for Disease Control and Prevention (9). From March 2013 to March 2018, 924 women participated. Five women who subsequently reported having become pregnant were able to continue, but were no longer prescribed the NDPP’s weight loss goal. This article describes diabetes-related outcomes in pregnancy among three women using medical records available as of May 2018. An additional case was excluded because detailed records were unavailable, and another was excluded because of the early stage of the pregnancy. …

Use of Social or Behavioral Theories in Exercise-Related Injury Prevention Program Research: A Systematic Review.

The use of social or behavioral theories within exercise-related injury prevention program (ERIPP) research may lead to a better understanding of why adherence to the programs is low and inform the development of interventions to improve program adherence. There is a need to determine which theories have been used within the literature and at what level theory was used to further the field. To determine which social or behavioral science theories have been incorporated within ERIPP research and assess the level at which the theories were used. The key question guiding the search was "What social or behavioral theories have been used within ERIPP research?" A systematic review of the literature was completed with an appraisal of bias risk using a custom critical appraisal tool. An electronic search of EBSCOhost (Academic Search Complete, CINAHL, Medline, Psychology and Behavioral Sciences Collection) and PubMed was completed from inception to October 2018. Studies investigating attitudes towards ERIPP participation with the use of a social or behavioral theoretical model or framework were eligible for inclusion. The electronic search returned 7482 results and two articles were identified though a hand search, which resulted in ten articles meeting inclusion criteria. Four different behavioral or social theoretical models or frameworks were identified including the health action process approach model, health belief model, self-determination theory, and theory of planned behavior. Six studies utilized the theory at a B level meaning a theoretical construct was measured while four utilized the theory at the C level meaning the theory was tested. The mean critical appraisal score was 78%, indicating a majority of the studies were higher quality. There has been an increase in the use of theory within literature that is specific to ERIPP participation. Additionally, the use of theory has shifted from guiding program design to the measurement of theoretical constructs and testing of the theoretical models.

SAT-102 Self-efficacy As A Predictor Of Weight Loss In Veterans With Obesity Participating In Medical Weight Management.

Background: Overweight and obesity are major health burdens in veterans, occurring at higher rates than the general population (78% vs 69%) and associate with chronic disease development. Self-efficacy is a person's ability to overcome the difficulties inherent in performing a specific task in a particular situation such as smoking cessation. We evaluated if a simple self-efficacy score may serve as a predictor of weight control in de-identified records of veterans with obesity undergoing a weight loss intervention consisting of lifestyle modification with pharmacotherapy through a VA weight management clinic. Methods We reviewed deidentified records for 22 obese (BMI ≥ 30) participants (17 males, 5 females, age range = 43–69, race/ethnicity 45% Black, 32% White, 18% Latino, and 5% Asian) in the VA weight management clinic. As part of the intake assessment, we used 2 validated questions to assess participants’ confidence in their ability to lose weight. Individuals were asked: “How ready are you to commit time, energy and resources to weight loss therapy?" and "How confident are you in your ability to lose weight?" Answers were rated from 1 (not ready or not confident) to 3 (ready or confident). Self-efficacy was scored as high (5-6), intermediate (3-4) or low (0-2). Results: Participants were on average 56 years old with weight of 275±49 lb at baseline. Eight records were classified as having high self-efficacy, 7 had moderate self-efficacy, and 3 had low self-efficacy. After 3 months of lifestyle plus pharmacotherapy intervention, weight loss in the high self-efficacy group was 8.8 ± 4.6 lb vs -0.4 ± 1.2 lb (mean±SE, p = 0.088) in the non-high self-efficacy group. Excess body weight in high vs non-high self-efficacy groups at 3 months was 3.08% ± 0.02% vs -0.26% ± 0.01 (p = 0.094). Conclusions: Our data suggests that veterans with obesity and high self-efficacy may lose more weight than those with lower self-efficacy. This simple tool may serve as an important first screen for weight management clinical practice. References -Diabetes Prevention Program Research, G., et al., 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 2009. 374(9702): p. 1677-86. -Tsai et al. Readiness Redefined: A Behavioral Task during Screening Predicted 1-Year Weight Loss in the Look AHEAD Study. Obesity (Silver Spring). 2014 April ; 22(4): 1016–1023. doi:10.1002/oby.20648.

SAT-148 Vitamin B12 Deficiency Among Patients with Metformin and Diabetic Neuropathy.

Introduction: Vitamin B12 deficiency due to metformin use has been demonstrated in multiple studies with variable prevalence. There are no studies in our population that demonstrate the prevalence of vitamin B12 deficiency in patients with metformin and diabetic neuropathy. The objective of this study is to describe its prevalence and the characteristics of the patients who present vitamin B12 deficiency. Methodology: Cross sectional study. 162 patients were included. The level of vitamin B12 was considered low, less than 200 pg / ml and borderline, 201 to 300 pg / ml. The level of vitamin B12 was analized according to age, sex, metformin dose, metformin time of use, time from the diagnosis of diabetes or prediabetes and the presence of diabetic neuropathy. A linear regression model was used to evaluate the variables that correlate with vitamin B12 levels. Results: 162 patients were collected. An altered level of vitamin B12 was found in 29% (CI95%: 22% to 36%) and a low level of vitamin B12 in 7.3% (CI 95%: 4.0% to 12%). In patients with diabetic neuropathy the prevalence of altered B12 levels was 64% (95% CI 47-78%), while in patients without diabetic neuropathy it was 17% (95% CI 10-26%). Patients with diabetic neuropathy had lower levels of vitamin B12 compared with patients without neuropathy (coefficient -110.8, CI 95%: -165.8 to -59.7). A higher dose of metformin showed correlation with lower levels of vitamin B12 (coef -0.061 CI 95%: - 0.09 to -0.024). Female patients had higher levels of vitamin B12 compared to men (coef 49.1 CI 95%: 2.3 to 95). Conclusions: Vitamin B12 deficiency is frequent in our population of patients treated with metformin, with prevalences higher than those described in other populations. Patients with diabetic neuropathy have much higher prevalence of vitamin B12 deficiency. Male patients with higher doses of metformin and patients with diabetic neuropathy have the lowest levels of vitamin B12. More studies are needed to establish an association between vitamin b12 deficiency and diabetic neuropathy. Bibliography Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. Diabetologia. 1969;5:405- 412. Aroda VR, Edelstein SL, Goldberg RB. Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J ClinEndocrinolMetab. 2016 Apr; 101(4): 1754-1761. Reinstatler L, Qi YP, Williamson RS, et al. Association of biochemical B₁₂ deficiency with metformin therapy and vitamin B₁₂ supplements: the National Health and Nutrition Examination Survey, 1999-2006.Diabetes Care. 2012 Feb;35(2):327-33.1. Roy RP, Ghosh K, Ghosh M; et al. Study of vitamin B12 deficiency and peripheral neuropathy in metformin treated early Type 2 diabetes mellitus. Indian J EndocrinolMetab. 2016; 20(6): 895.

Digital Health–Supported Lifestyle Change Programs to Prevent Type 2 Diabetes

IN BRIEF Type 2 diabetes can be prevented or delayed in people with prediabetes through participation in an intensive lifestyle change program (LCP), particularly one based on the Diabetes Prevention Program research study. Digital health offers opportunities to extend the reach of such LCPs and possibly improve on these programs, which traditionally have been delivered in person. In this review, we describe the current state of evidence regarding digital health–supported LCPs and discuss gaps in research and opportunities for future efforts.

Kenyan Youth Understanding of Cancer, Cancer Risk and Cancer Prevention: An Ethnographic Study

Background: Cancer incidence and mortality continues to rise worldwide including in Kenya. Among the groups that are likely to get cancer in future are Kenyan youth that engage in behavior that can increase their lifetime cancer risk. Despite this awareness, little is known about Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Such awareness is needed to inform germane cancer prevention and health promotion initiatives. Aim: The purpose of this ethnographic study was to explore Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Methods: Fifty-three youth (ages 12-19) took part in individual interviews and focus group discussions. Results: In their conceptualization of cancer, youth described cancer in ways that are grouped into two themes: there is no other disease like it and lay understanding through metaphors. In their conceptualization of cancer risk, youth described cancer in ways that are grouped as cancer risk as lifestyle factors and the process of risk perception. Finally, in conceptualization of cancer prevention, youth described cancer prevention in ways that are grouped into the following themes: avoiding cancer risk factors, avoiding peers who partake in risk factors, and being healthy. Conclusion: This study is the first of its kind to be conducted in Kenya and adds to the body of knowledge in this area. Despite limited cancer control plans, youth described the grim consequences of getting cancer, their chances of getting the disease, and proposed opportunities for prevention. The study results will create a platform for future cancer prevention research and health promotion programs in Kenya and other part of Africa.