: Context: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes mellitus. Methods: In the intervention practice, an advanced practice nurse visited the practice weekly for 12 months and facilitated diabetes education, patient flow, and management. Patients participated in a 4‐session group visit education/support program led by a nurse, a physician, a pharmacist, and a nutritionist. The control patients in a separate practice received usual care. Findings: Median hemoglobin A1c (HbA1c) was not significantly different at baseline in the intervention and control groups but was significantly different at the end of the 12‐month follow‐up period (P<.05). In the intervention group, median HbA1c at baseline was 8.2 ± 2.6%, and median HbA1c at an average follow‐up of 11.3 months was 7.1 ± 2.3%, (P<.0001). In the control group, median HbA1c increased from 8.3 ± 2.0% to 8.6 ± 2.4% (P<.05) over the same time period. In the intervention group, 61% of patients had a reduction in HbA1c, and the percentage of patients with a HbA1c of less than 7% improved from 32% to 45% (P<.05). Conclusions: These findings suggest that a redesigned care management model that combines nurse‐led case management with structured group education visits can be successfully incorporated into rural primary care practices and can significantly improve glycemic control.

Controlling for personal and family characteristics, perceived weight status was significantly associated with suicidal thoughts and actions in middle school boys and girls.

IntroductionResidents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings.MethodsThe review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the “COCOMO” strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus.ResultsOf the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships.ConclusionsFindings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.

The goal of this study was to evaluate the relationships between self-reported and measured height, weight, and body mass index (BMI) in a sample of eighth-grade students. The study population consisted of eighth-grade students in eastern North Carolina who completed a cross-sectional survey, self-reported their height and weight, and had their height and weight measured (N = 416). Fifty-nine percent of the sample was male; 42% African American, 46% white, and 12% other races. Mean self-reported weight (62.9 kg) was significantly lower than mean measured weight (64.4 kg). Mean self-reported BMI (22.8 kg/m2) was significantly lower than mean measured BMI (23.3 kg/m2). Race and BMI category were significantly associated with reporting errors. Specifically, African American and white students were significantly less likely to under-report their height compared to other race students. African American students were more likely to underestimate their weight compared to other race students. BMI was more likely to be underestimated in African American and white students compared to other race students. Students who were at risk for overweight and those that were overweight were more likely to underestimate their weight and BMI than students who were normal weight. Approximately 17% of students were misclassified in BMI categories when self-reported data were used. The results indicate that eighth-grade students significantly underestimate their weight, but on average provide valid estimates of their height. Race and measured BMI category influence this discrepancy. School-based research that addresses the prevalence of obesity in adolescents should utilize measured height and weight when feasible.

A redesigned care delivery system that uses case management with structured group visits and an electronic registry can be successfully incorporated into rural primary care practices and appears to significantly improve both care processes and practice productivity.