Building Leadership Effectiveness This program encourages leaders to develop practices that transform values into action, vision into realities, obstacles into innovations, and risks into rewards. Participants will be introduced to the five practices of exemplary leadership: modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart Coaching & Communicating for Performance Coaching & Communicating for Performance is a highly interactive program that will give supervisors and managers the opportunity to build skills that will enable them to share expectations and set objectives for employees, provide constructive feedback, more effectively engage in learning conversations, and coaching opportunities. Skillful Conflict Management for Leaders As a leader, it is important to understand conflict and be effective at conflict management because the way conflict is resolved becomes an integral component of our university’s culture. This series of conflict management sessions help leaders learn and put into practice effective strategies for managing conflict.

기독교 사역과 Leadership

Objective
Provide the most recent data on the prevalence of obesity and severe obesity among United States children and adolescents aged 2 to 19 years.

Methods
The National Health and Nutrition Examination Survey, 1999–2014, was used. Weight status was defined using measured height and weight and standard definitions as follows: overweight as ≥85th percentile for age- and sex-specific BMI; class I obesity as ≥95th percentile; class II obesity as ≥120 of the 95th percentile, or BMI ≥35; and class III obesity as ≥140% of the 95th percentile, or BMI ≥40. This study reports the prevalence of obesity by 2-year National Health and Nutrition Examination Survey cycle and Wald tests comparing the 2011–2012 cycle with the 2013–2014 cycle, as well as the linear trend from 1999 to 2014. Multivariable logistic regression models estimated odds ratios for differences by each 2-year cycle.

Results
In 2013–2014, 17.4% of children met criteria for class I obesity, including 6.3% for class II and 2.4% for class III, none statistically different than 2011–2012. A clear, statistically significant increase in all classes of obesity continued from 1999 through 2014.

Conclusions
There is no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/oby.21497

Prevalence of obesity and severe obesity in US children, 1999-2014.

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review.

Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications.

Glucose homeostasis is maintained by a balance between insulin secretion from the pancreatic β-cells and sensitivity to insulin in skeletal muscle, adipose tissue, and liver (1). When insulin sensitivity declines, insulin secretion must increase to maintain glucose tolerance, and, in most youth, decreased insulin sensitivity due to puberty and/or obesity is compensated by increased insulin secretion. However, when β-cells cannot secrete sufficient insulin to compensate for insulin resistance, abnormalities in glucose homeostasis ensue, potentially progressing to prediabetes and type 2 diabetes as β-cell function deteriorates further (2–9). The relationship between β-cell function and insulin sensitivity in adults and youth has been demonstrated to be a hyperbolic function and can be described mathematically as the product of insulin sensitivity and β-cell function, called the disposition index (DI) (1). The DI essentially expresses the amount of insulin being secreted relative to the degree of insulin resistance and is a constant for a given degree of glucose tolerance in any one individual.

Overweight and obesity are major acquired contributors to the development of insulin resistance, particularly in the face of the physiologic insulin resistance characteristic of puberty. Robust pancreatic β-cell compensatory insulin secretion maintains normal glucose homeostasis. However, in adolescents with obesity who develop type 2 diabetes, there is severe peripheral and hepatic insulin resistance, with ∼50% lower peripheral insulin sensitivity than peers with obesity without diabetes, along with increased fasting hepatic glucose production and inadequate first- and second-phase insulin secretion, resulting …

/pdf/evaluation-and-management-of-youth-onset-type-2-diabetes-a-3c02you14v.pdf

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

Objective To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. Design Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. Data sources Medline, Embase, CINAHL, and reference lists of relevant publications. Eligibility criteria Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. Results Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. Conclusions The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. Systematic review registration Prospero CRD42018092287.

https://www.bmj.com/content/bmj/366/bmj.l5003.full.pdf

Trends in incidence of total or type 2 diabetes: systematic review

Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.

Lisel Loy

Papers

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases

Cross-sector responses to obesity: Models for change