The Healthy Children, Strong Families intervention: design and community participation.

Healthy Children, Strong Families (HCSF) is a 2-year, community-driven, family-based randomized controlled trial of a healthy lifestyles intervention conducted in partnership with four Wisconsin American Indian tribes. HCSF is composed of 1 year of targeted home visits to deliver nutritional and physical activity curricula. During Year 1, trained community mentors work with 2-5-year-old American Indian children and their primary caregivers to promote goal-based behavior change. During Year 2, intervention families receive monthly newsletters and attend monthly group meetings to participate in activities designed to reinforce and sustain changes made in Year 1. Control families receive only curricula materials during Year 1 and monthly newsletters during Year 2. Each of the two arms of the study comprises 60 families. Primary outcomes are decreased child body mass index (BMI) z-score and decreased primary caregiver BMI. Secondary outcomes include: increased fruit/vegetable consumption, decreased TV viewing, increased physical activity, decreased soda/sweetened drink consumption, improved primary caregiver biochemical indices, and increased primary caregiver self-efficacy to adopt healthy behaviors. Using community-based participatory research and our history of university-tribal partnerships, the community and academic researchers jointly designed this randomized trial. This article describes the study design and data collection strategies, including outcome measures, with emphasis on the communities' input in all aspects of the research.

Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review.

As an integral part of the United States health care delivery system, pharmacists are ideally positioned to provide diabetes mellitus management. In this systematic review, we assessed the effectiveness of diabetes quality improvement strategies delivered by pharmacists in outpatient settings. Five electronic databases were searched for articles published through August 2007. Only randomized controlled trials, controlled clinical trials, or cohort studies with a control group were eligible for inclusion. All interventions targeted adults with type 1 or 2 diabetes and measured diabetes-related complications and/or surrogate outcomes of hemoglobin A1c (A1C), blood pressure, or lipid profiles. Study data were abstracted by one author and checked by a second author following a standardized template. Results were synthesized narratively, and study-specific effect measures were calculated for the outcomes of interest. Twenty-one articles met the inclusion criteria: nine randomized controlled trials, one controlled clinical trial, and 11 cohort studies. All interventions involved additional visits by pharmacists with expanded roles to care for adult patients with diabetes. The A1C was the primary outcome of interest for all but two studies. Results of this review revealed overall improvement in A1C for patients in a diverse group of settings and across multiple study designs. Studies with smaller numbers of participants and those performed in the United States generally showed greater improvements in intervention group measures of A1C. A greater effect was also noted when pharmacists were afforded prescriptive authority. Only a few studies examined health care resource use; their results suggested that pharmacist interventions can reduce long-term costs by improving glycemic control and thus diminishing future diabetes complications. Findings from this review are limited by flaws in the study designs, including the high potential for selection bias in the study populations. However, due to the clinical significance of reported improvements in A1C, further trials with pharmacist case managers are warranted. Prospective assessments of the comparable efficacy of pharmacists to improve diabetes outcomes through self-management education and pharmacologic management are recommended.

Development of a culturally appropriate, home-based nutrition and physical activity curriculum for Wisconsin American Indian families.

We designed an obesity prevention intervention for American Indian families called Healthy Children, Strong Families using a participatory approach involving three Wisconsin tribes. Healthy Children, Strong Families promotes healthy eating and physical activity for preschool children and their caregivers while respecting each community's cultural and structural framework. Academic researchers, tribal wellness staff, and American Indian community mentors participated in development of the Healthy Children, Strong Families educational curriculum. The curriculum is based on social cognitive and family systems theories as well as on community eating and activity patterns with adaptation to American Indian cultural values. The curricular materials, which were delivered through a home-based mentoring model, have been successfully received and are being modified so that they can be tailored to individual family needs. The curriculum can serve as a nutrition and physical activity model for health educators that can be adapted for other American Indian preschool children and their families or as a model for development of a culturally specific curriculum.

Metabolic syndrome: what's in a name?

The term "metabolic syndrome" has recently become en vogue. But is the definition realistic, or helpful? This paper looks at the current definitions of metabolic syndrome and the bearing it has on clinicians both now and in the future.