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Biomedical subjects

Manuel Barrera

Publications and source records attributed to Manuel Barrera.

18 recordsLinked to original sources
PubMed2007

Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes.

BACKGROUND: Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors, psychosocial factors, and the social environment. This report examines the long-term effects of a multiple-risk-factor intervention. METHODS: Postmenopausal women (N = 279) with type 2 diabetes participated in the Mediterranean Lifestyle Program (MLP), a randomized, comprehensive lifestyle intervention study. The intervention targeted healthful eating, physical activity, stress management, smoking cessation, and social support. Outcomes included lifestyle behaviors (i.e., dietary intake, physical activity, stress management, smoking cessation), psychosocial variables (e.g., social support, problem solving, self-efficacy, depression, quality of life), and cost analyses at baseline, and 6, 12, and 24 months. RESULTS: MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception (there were too few smokers to analyze tobacco use effects), and in psychosocial measures of use of supportive resources, problem solving, self-efficacy, and quality of life. CONCLUSION: The MLP was more effective than usual care over 24 months in producing improvements on behavioral and psychosocial outcomes. Directions for future research include replication with other populations.

Journal Article↗
PubMed2006

Substance abuse prevention intervention research with Hispanic populations.

Selected studies with specific relevance to substance abuse prevention interventions with Hispanic youth and families were examined to identify prior findings and emerging issues that may guide the design of future substance abuse prevention intervention research and its implementation with Hispanic populations. The origins of prevention research and role of risk and protective factors are examined, including culturally-specific risk and protective factors for Hispanic populations. Correlational studies, non-experimental interventions, and randomized controlled trials were examined for the period of 1974-2003. The literature search yielded 15 articles selected for this review that exhibited adequate methodological rigor. An added search for more recent studies identified three additional articles, for a total of 18 prevention intervention articles that were reviewed. Theoretical and methodological issues and recommendations are presented for future research aimed at improving the efficacy and effectiveness of future prevention intervention studies and their cultural relevance for Hispanic populations.

Adolescent↗
PubMed2006

Social support and social-ecological resources as mediators of lifestyle intervention effects for type 2 diabetes.

A study was conducted to determine if an intervention could change social support and social-ecological resources of post-menopausal women diagnosed with type 2 diabetes, and if those changes mediated the intervention's effects on health behaviors and outcomes. Women (N = 279) were randomly assigned to receive a comprehensive 6-month Mediterranean Lifestyle Program (MLP) or usual care from their physicians (UC). MLP was successful in changing social embeddedness and social-ecological resources, but not a measure of perceived support. Changes in social-ecological resources mediated intervention effects on fat consumption, exercise and glycemic control. The experimental manipulation of mediators and the demonstrated mediation effects support the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes.

Diabetes Mellitus, Type 2↗
PubMed2005

Schools and homes in partnership (SHIP): long-term effects of a preventive intervention focused on social behavior and reading skill in early elementary school.

This paper reports a randomized controlled trial of the effects of behavioral parenting skills training, social skills training, and supplemental reading instruction on the social behavior of early elementary school children (K through 3). We selected children based on teacher-rated aggressive behavior or reading-skill deficits, delivered the intervention over a 2-year period, and obtained follow-up data for two additional years. The intervention affected only two of eight measures of child functioning--parent daily reports of antisocial behavior and parent ratings of coercive behavior. There was evidence that parents of boys in the intervention condition displayed significantly greater declines in their rated use of coercive discipline than did parents of boys in the control condition.

Aggression↗
PubMed2005

Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease.

BACKGROUND: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease (CHD) among postmenopausal women with diabetes. PURPOSE: Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes. METHODS: Participants (N = 279) were randomized to usual care (UC) or Mediterranean Lifestyle Program, a lifestyle change intervention aimed at the behavioral risk factors (eating patterns, physical activity, stress management, and social support) affecting risk for CHD in postmenopausal women with type 2 diabetes. RESULTS: In original and intent-to-treat analyses, Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors, physical activity, stress management, perceived support, and weight loss at 6 months compared to UC. CONCLUSIONS: This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes, showed that postmenopausal women could make comprehensive lifestyle changes, and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors.

Aged↗
PubMed2004

The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention.

There is great interest in, but few instruments to assess, multiple levels of support and community resources from a social-ecological perspective. This study evaluated the psychometric characteristics of the Chronic Illness Resources Survey (CIRS) and its sensitivity to a multifaceted social-ecological intervention to enhance personally relevant community resources supportive of healthful lifestyles. Participants were 293 post-menopausal women having type 2 diabetes who were part of a multiple-behavior lifestyle change program. Key measures included the CIRS, a validated Food Frequency Questionnaire, the Kristal Fat and Fiber Behavior Questionnaire, the CHAMPS Activities Questionnaire for Older Adults, and other measures of social support. Results revealed that the CIRS displayed good psychometric characteristics in this new sample, was significantly correlated as predicted with established measures of social support, was sensitive to intervention, and partially mediated the effects of intervention on both dietary and physical activity outcomes. The 22-item CIRS scale appears useful for assessing multilevel support resources, predicting successful behavior change and detecting social-ecological intervention effects.

Chronic Disease↗
PubMed2004

Revisiting Hispanic adolescents' resilience to the effects of parental problem drinking and life stress.

Two previous studies found that life stress and parental alcoholism were not as highly related to distress for Hispanic adolescents as they were for European American adolescents (M. Barrera Jr., S. A. Li, and L. Chassin, 1993, 1995). Those findings could be interpreted as evidence of Hispanic youths' resilience, but limitations of the stress measure and the homogeneity of the Hispanic sample threatened this interpretation. The present study improved on those previous studies by using a new measure of uncontrollable stressors and a more heterogeneous Mexican American sample. Participants in this study were 175 Mexican American and 59 European American adolescents and their parents. Unlike the previous studies, results did not show that Mexican American adolescents were more resilient to parental problem drinking or life stress than were European American adolescents. Overall, life stress was related to adolescents', mothers', and fathers' reports of adolescents' psychological distress above and beyond the effects of ethnicity and socioeconomic factors.

Adolescent↗
PubMed2004

Assessment of problem-solving: a key to successful diabetes self-management.

Problem-solving skill is important for chronic illness self-management. This project prospectively evaluated a measure of diabetes problem-solving skill for its reliability, convergent validity, sensitivity to intervention, and relationship to change in behavior. Postmenopausal women with type 2 diabetes (N = 279) participated in a RCT to evaluate a lifestyle modification program. The 9-item Diabetes Problem-Solving Inventory (DPSI) was used to assess how patients cope with challenges to diabetes self-care. The DPSI was found to have good inter-rater reliability and internal consistency for a brief scale, be moderately stable over time, and relate significantly to hypothesized variables. DPSI scores improved significantly more in the lifestyle change condition than in controls and were related to improved outcomes. Mediation analyses indicated that the increase in problem-solving was a partial mediator of outcomes. Results support the reliability, predictive ability, and sensitivity to change of the DPSI. Directions for future research on problem-solving and chronic illness are discussed.

Adult↗
PubMed2004

The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit.

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation-the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation-the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that "build in" adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.

Adolescent↗
PubMed2003

The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results.

BACKGROUND: A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education. METHODS: We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users. RESULTS: All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics. CONCLUSIONS: The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results.

Adult↗
PubMed2003

Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial.

OBJECTIVE: Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS: Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. RESULTS: Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c), BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance. CONCLUSIONS: These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.

Aged↗
PubMed2002

The longitudinal influence of peers on the development of alcohol use in late adolescence: a growth mixture analysis.

This study examines heterogeneity in the developmental trajectories of alcohol use in adolescents and the accompanying trajectory-specific longitudinal influence of exposure to their deviant peers. Using a national data set on alcohol use (N = 188), a growth mixture model capturing growth trajectories in adolescent alcohol use from ages 14 to 18 years was first examined. This was followed by an investigation of age-varying influences of peers on adolescent alcohol use and the co-development of peer influence and adolescent alcohol use. Results of growth mixture modeling of repeated-measures data on adolescent alcohol use showed two distinct latent classes of developmental trajectory with significant differences in levels of use. Analyses of exposure to deviant peer and adolescent alcohol use variables indicated differential effects of peers across trajectory classes. Stronger prospective influences for the trajectory group having a low initial status of use were found. Findings from this study suggest the need to consider heterogeneity in the study of peer influence on alcohol use during adolescence to facilitate more refined targeting of prevention/intervention programs.

Adolescent↗
PubMed2002

Early elementary school intervention to reduce conduct problems: a randomized trial with Hispanic and non-Hispanic children.

Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.

Child↗
PubMed2002

Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management.

Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self-management coach, (c) a social support intervention, or (d) a personal self-management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long-term effects of Internet-based support for diabetes self-management. The discussion identifies directions for future research.

Adult↗
PubMed2002

Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial.

This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle management intervention for 279 postmenopausal women with type 2 diabetes who are at elevated risk for coronary heart disease (CHD). The intervention, called the Mediterranean Lifestyle Trial, is focused on dietary factors, physical activity, social support and stress management. The Mediterranean Lifestyle Trial relies on a synthesis of Social Cognitive Theory and Social Ecologic Theory, as well as goal-systems theory, to explicitly inform the lifestyle intervention and to address maintenance. Thus, the trial should help illuminate the theoretical mechanisms responsible for lifestyle change. Primary outcome variables are dietary, stress management and physical activity behavior change, quality of life, and CHD-related biological risk factors. Hypothesized mediating variables include self-efficacy, coping, and social and environmental support. Following the initial 6-month intervention, participants in the intervention condition are randomized to one of two groups designed to enhance maintenance of effects: either a peer-led support group or a personalized multilevel community resources maintenance condition. Unlike the peer group, the personalized approach focuses on multiple levels of community resources to promote healthful lifestyle change. Because this research focuses on issues of generalization and translation to practice, the RE-AIM evaluation framework is being used to evaluate Reach, Effectiveness, Adoption, Implementation and Maintenance. This framework will help to translate research into practice by directing researchers' attention to important but seldom-investigated strategies for enhancing longer-term maintenance. Specifically, the study tests how long-term maintenance may be improved through the use of existing community resources, an intervention based on multiple environmental factors and multiple lifestyle behaviors, and lay leaders versus personalized professional support.

Aged↗
PubMedDate not supplied

Roles of definitional and assessment models in the identification of new or second language learners of English for special education.

This article examines the efficacy of current definitional perspectives on learning disabilities (LD) and related assessment models to support appropriate instructional and support services for learners of English with learning-related difficulties. A revised framework for defining LD and an associated assessment model, curriculum-based dynamic assessment (CDA), are proposed. The results of a teacher assessment study are reported to exemplify how this revised framework may be studied. The study examined the following questions: (a) Can curriculum-based dynamic assessments of authentic learning tasks help educators to differentiate between the work of students with limited English proficiency and their peers identified as having LD? (b) What are the characteristics of curriculum-based work samples of limited English proficient students with LD that may predictably differentiate them from their peers without LD?

Child↗
PubMedDate not supplied

[Uncommon metastases in renal carcinoma].

INTRODUCTION: Renal clear cell carcinoma (RCCCa) represents 2-3% of the neoplasms in the adult population, and can be metastastatic in up to 30% at the time of diagnosis. In these cases its mortality can be of up to 99% in 5 years, due to the lack of response to current treatments, unless it is a single, surgically resectable metastasis. Currently, there is no explanation for its routes of progression, it even seems to be non existent based on the rare tumor implant sites. OBJECTIVE: To report unusual metastasis from RCCCa and a review of the literature. MATERIAL AND METHODS: We reviewed retrospectively 15 years of patient records diagnosed with metastasic CaRCC different from: local lymph nodes, lung, bone or liver. We identified 11 cases: brain (2), duodenum (2), tonsils, thyroid, esophagus, diaphragm, testicle, adrenal gland and soft tissue of the knee. CONCLUSION: A description of this and other literature series with rare metastasis was done, as well as an analysis of possible routes and mechanisms responsible for the unusual tumor progression in RCCCa. We need to continue investigating the dissemination pathways and other cellular conditions involved in metastastatic kidney cancer in order to better understand and improve the treatment of patients in advanced stages.

Adult↗