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Salinas-Rehbein B, Ortiz MS, Robles TF. Perceived social support and treatment adherence in Chileans with Type 2 diabetes. J Health Psychol 2024:13591053241253370. [PMID: 38807432 DOI: 10.1177/13591053241253370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
This study aimed to determine if greater perceived social support was directly associated with better Type 2 diabetes (T2D) treatment adherence and if better T2D treatment adherence was related to lower HbA1c levels in Chilean adults with T2D. For this purpose, 200 adults were recruited from the Chilean Diabetic Association. Participants were asked to complete self-report instruments and provide a capillary blood sample to measure HbA1c. Structural equation model analyses were performed to determine direct associations. The study's results indicate that greater perceived social support was associated with healthier dietary habits, regular foot care, more frequent physical activity, and lower medication intake. Likewise, blood sugar testing and physical activity were related to HbA1c. These findings provide evidence of how perceived social support relates to T2D treatment adherence behaviors in Latino patients from South America and could be used for interventions to enhance social support from patients' families, partners, and friends.
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Affiliation(s)
| | - Manuel S Ortiz
- Department of Psychology, Universidad de La Frontera, Chile
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2
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Rawat P, Sehar U, Bisht J, Reddy AP, Reddy PH. Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers. Ageing Res Rev 2024; 93:102178. [PMID: 38154509 PMCID: PMC10807242 DOI: 10.1016/j.arr.2023.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA
| | - Jasbir Bisht
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Arubala P Reddy
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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3
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Vatavuk-Serrati G, Kershaw KN, Sotres-Alvarez D, Perreira KM, Guadamuz JS, Isasi CR, Hirsch JA, Van Horn LV, Daviglus ML, Albrecht SS. Residence in Hispanic/Latino Immigrant Neighborhoods, Away-From-Home Food Consumption, and Diet Quality: The Hispanic Community Health Study/Study of Latinos. J Acad Nutr Diet 2023; 123:1596-1605.e2. [PMID: 37355040 PMCID: PMC10592543 DOI: 10.1016/j.jand.2023.06.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Hispanics/Latinos are disproportionately burdened by nutrition-related diseases but immigrants appear healthier than their US-born counterparts. Neighborhoods characterized by high Hispanic/Latino immigrant segregation may provide environments to support healthier diets. OBJECTIVE To examine whether or not Hispanic/Latino immigrant segregation is associated with frequency of away-from-home food consumption and diet quality in a large, diverse sample of Hispanic/Latino adults. DESIGN Cross-sectional baseline data from the Hispanic Community Health Study/Study of Latinos were analyzed (2008-2011). Residential addresses were geocoded and linked to census tract-level 2008-2012 American Community Survey data. Hispanic/Latino immigrant segregation was characterized using the local Getis-Ord Gi∗ statistic, a spatial clustering measure that quantifies the extent to which demographically similar neighborhoods group together. PARTICIPANTS/SETTING Participants were 15,661 adults in the Hispanic Community Health Study/Study of Latinos, a population-based study of Hispanic/Latinos aged 18 to 74 years from 4 US regions (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA). MAIN OUTCOME MEASURES Away-from-home food consumption was assessed using a modified dietary behavior questionnaire. Diet quality was assessed using the Alternate Healthy Eating Index 2010 (range = 0 to 110) from two 24-hour recalls. STATISTICAL ANALYSIS Multilevel linear and logistic regression with multilevel weights were used to estimate associations between Hispanic/Latino immigrant segregation (low, medium, or high) with Alternate Healthy Eating Index 2010 score, and away-from-home food consumption (≥3 vs <3 times/week) in separate models, respectively. The mediating role of neighborhood poverty and whether or not associations differed by nativity were also assessed. RESULTS Higher levels of segregation were associated with higher adjusted mean Alternate Healthy Eating Index 2010 scores; estimates were further magnified after accounting for neighborhood poverty (low segregation: reference category; medium segregation: β = 2.43, 95% CI 1.10 to 3.77; and high segregation: β = 1.63, 95% CI .43 to 2.82). Associations were strongest among the foreign-born compared with the US-born. There was no association between segregation and away-from-home food consumption. CONCLUSIONS These results highlight the potential role of Hispanic/Latino immigrant neighborhoods in supporting healthy diets among residents, especially immigrants.
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Affiliation(s)
- Gabriela Vatavuk-Serrati
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jenny S Guadamuz
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jana A Hirsch
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, Illinois
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
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Vega-López S, Ayers S, Gonzalvez A, Campos AP, Marsiglia FF, Bruening M, Rankin L, Vega Luna B, Biggs E, Perilla A. Diet Outcomes from a Randomized Controlled Trial Assessing a Parenting Intervention Simultaneously Targeting Healthy Eating and Substance Use Prevention among Hispanic Middle-School Adolescents. Nutrients 2023; 15:3790. [PMID: 37686822 PMCID: PMC10489966 DOI: 10.3390/nu15173790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Parents play a significant role in adolescent health behaviors; however, few nutrition interventions for Hispanic adolescents involve parents. This study assessed the effects of a 10-week parenting intervention simultaneously targeting nutrition and substance use prevention. Hispanic parent/6th-8th-grade adolescent dyads (n = 239) were randomized to Families Preparing the New Generation Plus (FPNG+; nutrition/substance use prevention), FPNG (substance use prevention only), or Realizing the American Dream (RAD; academic success control). Surveys assessed diet, alcohol use, substance use intentions, and substance use norms at baseline (T1), immediately post-intervention (T2), and at 16 weeks post-intervention (T3). Latent change modeling assessed diet changes; adolescent substance use outcomes were assessed using effect sizes. Among adolescents, those in FPNG+ increased fruit (+0.32 cup equivalents, p = 0.022) and fiber intake (+1.06 g, p = 0.048) and did not change added sugars intake at T2; those in FPNG and RAD reduced their intake of fruit and fiber (p < 0.05 for both). FPNG+ parents marginally increased fruit/vegetable intake (+0.17 cup equivalents, p = 0.054) and increased whole grains intake (+0.25-ounce equivalents, p < 0.05), in contrast to the reduction among RAD and FPNG parents (p < 0.05). Reductions in added sugar intake at T2 were greater among FPNG and FPNG+ parents relative to RAD parents (p < 0.05). FPNG+ and FPNG had comparable substance use outcomes (i.e., both had lower alcohol use and intentions to use substances relative to RAD). Engaging parents in a nutrition and substance use prevention parenting intervention yielded positive changes in dietary intake and maintained substance use prevention outcomes among their adolescent children.
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Affiliation(s)
- Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Anaid Gonzalvez
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Ana Paola Campos
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
- Global Center for Applied Health Research, Arizona State University, Phoenix, AZ 85004, USA;
| | - Flavio F. Marsiglia
- Global Center for Applied Health Research, Arizona State University, Phoenix, AZ 85004, USA;
| | - Meg Bruening
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Lela Rankin
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Beatriz Vega Luna
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Elizabeth Biggs
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Alex Perilla
- WeGrad (Formerly American Dream Academy), Arizona State University, Phoenix, AZ 85004, USA;
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Rawat P, Sehar U, Bisht J, Reddy PH. Support Provided by Caregivers for Community-Dwelling Diabetic Hispanic Adults with Intellectual Disabilities and Comorbid Conditions. Int J Mol Sci 2023; 24:3848. [PMID: 36835260 PMCID: PMC9962604 DOI: 10.3390/ijms24043848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Diabetes is an age-related chronic health condition and a major public health concern. Diabetes is one of the significant causes of morbidity and mortality and a major contributing factor to dementia. Recent research reveals that Hispanic Americans are at an increased risk of chronic conditions such as diabetes, dementia, and obesity. Recent research also revealed that diabetes develops at least ten years earlier in Hispanics and Latinos than in neighboring non-Hispanic whites. Furthermore, the management of diabetes and providing necessary/timely support is a challenging task for healthcare professionals. Caregiver support is an emerging area of research for people with diabetes, mainly family caregiver support work for Hispanic and Native Americans. Our article discusses several aspects of diabetes, factors associated with diabetes among Hispanics, its management, and how caregivers can support individuals with diabetes.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jasbir Bisht
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology Department, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Martin MP, Obioha CU, Gaikwad S, Padron-Monedero A, Del Pino MJ, Curtis D, Villalba K. Perceptions, awareness, and barriers to care regarding obesity and diabetes among Latinx in Miami and Escambia, Florida: a qualitative geographical comparative study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.30829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Maria Pilar Martin
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA; Department of Public Health, University of West Florida, Pensacola, FL
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Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, García-Hermoso A. Racial differences in all-cause mortality and future complications among people with diabetes: a systematic review and meta-analysis of data from more than 2.4 million individuals. Diabetologia 2021; 64:2389-2401. [PMID: 34455457 DOI: 10.1007/s00125-021-05554-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to quantify racial/ethnic differences in risk for future diabetic complications and all-cause mortality by performing a meta-analysis of prospective studies. METHODS A systematic search in PubMed and EMBASE was performed from inception to May 2021. Prospective cohort studies that reported HRs and associated 95% CIs of diabetes complications and all-cause mortality among racial/ethnic groups, with White people as the reference group, were included. Study characteristics and HR estimates were extracted from each study. Estimates were pooled using random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman variance estimator. RESULTS A total of 23 studies were included, comprising 2,416,516 individuals diagnosed with diabetes (White 59.3%, Black 11.2%, Asian 1.3%, Hispanic-American 2.4%, Native American 0.2%, East Asian 1.9%, South Asian 0.8%, Pacific Islander 2.3%, Māori 2.4% and others 18.2%). Compared with White individuals with diabetes, individuals of Māori ethnicity were at higher risk for all-cause mortality (HR 1.88 [95% CI 1.61, 2.21]; I2 = 7.1%), Hispanic-American individuals had a significantly lower risk for CVD (HR 0.66 [95% CI 0.53, 0.81]; I2 = 0%) and Black individuals had higher risk for end-stage renal disease (HR 1.54 [95% CI 1.05, 2.24]; I2 = 95.4%). No significant higher risk for diabetes complications was found in other racial/ethnic groups relative to White people. CONCLUSIONS/INTERPRETATION Racial/ethnic differences exist in the risk for future diabetic complications and all-cause mortality. Our results support the use of such categories for international diabetes clinical guideline recommendations until better predictors become available. Efforts to identify high-risk groups and to better control cardiovascular risk factors across ethnically diverse populations are therefore needed. REGISTRATION PROSPERO registration ID CRD42021239274.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago, Chile.
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8
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Fernandez ML. Lifestyle Factors and Genetic Variants Associated to Health Disparities in the Hispanic Population. Nutrients 2021; 13:2189. [PMID: 34202120 PMCID: PMC8308310 DOI: 10.3390/nu13072189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Non-communicable diseases including type 2 diabetes mellitus, coronary heart disease, hepatic steatosis, and cancer are more prevalent in minority groups including Hispanics when compared to Non-Hispanic Whites, leading to the well-recognized terminology of health disparities. Although lifestyle factors including inadequate dietary habits, decreased physical activity, and more prominently, an unhealthy body weight, may be partly responsible for this disproportion in chronic diseases, genetic variations also make a substantial contribution to this problem. In this review, the well-recognized obesity problem in Hispanics that has been associated with chronic disease is examined as well as the influence of diet on promoting an inflammatory environment leading to increased cardiometabolic risk, insulin resistance, fatty liver disease, and cancer. In addition, some of the more studied genetic variations in Hispanics and their association with chronic disease is reviewed.
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Affiliation(s)
- Maria Luz Fernandez
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
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Vencio S, Manosalva JP, Mathieu C, Proot P, Lozno HY, Paldánius PM. Exploring early combination strategy in Latin American patients with newly diagnosed type 2 diabetes: a sub-analysis of the VERIFY study. Diabetol Metab Syndr 2021; 13:68. [PMID: 34130731 PMCID: PMC8207702 DOI: 10.1186/s13098-021-00686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) from Latin American countries face challenges in access to healthcare, leading to under-diagnosis, under-achievement of glycemic target, and long-term complications. Early diagnosis and treatment initiation are of paramount importance in this population due to the high prevalence of risk factors such as obesity and metabolic syndrome. The VERIFY study in patients with newly diagnosed T2DM (across 34 countries), assessed the normoglycemic durability (5 years), with early combination (EC) therapy approach versus the traditional stepwise approach of initiating treatment with metformin monotherapy (MET). Here we present the results from the VERIFY study for participants from eight countries in Latin America. METHODS Newly diagnosed adult patients with T2DM, HbA1c 6.5-7.5% and body-mass index (BMI) of 22-40 kg/m2 were enrolled. The primary endpoint was time to initial treatment failure (TF; HbA1c ≥ 7.0% at two consecutive scheduled visits 13 weeks apart). Time to second TF was evaluated when patients in both groups were receiving and failing on the vildagliptin combination. Safety and tolerability were also assessed for both treatment approaches during the study. RESULTS A total of 537 eligible patients (female, 58.8%) were randomly assigned to receive either EC (n = 266) or MET (n = 271). EC significantly reduced the relative risk of time to initial TF by 47% versus MET [HR (95% CI) 0.53 (0.4, 0.7) p < 0.0001]. Overall, 46.4% versus 66.3% of patients achieved the primary endpoint in the EC and MET groups, with a median [interquartile range (IQR)] time to TF of 59.8 (27.5, not evaluable) and 33.4 (12.2, 60.1) months, respectively. The risk for time to second TF was 31% lower with EC (p < 0.0092). A higher proportion of patients receiving EC maintained durable HbA1c < 7.0%, < 6.5%, and < 6.0%. Both treatment approaches were well tolerated, and only 3.2% of participants discontinued the study due to adverse events. All hypoglycemic events (EC: n = 7 and MET: n = 3) were single, mild episodes and did not lead to study discontinuation. CONCLUSION Similar to the global population, long-term clinical benefits were achieved more frequently and without tolerability issues with EC versus standard-of-care MET in this Latin American sub-population. This study is registered with ClinicalTrials.gov, NCT01528254.
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Affiliation(s)
- Sérgio Vencio
- Federal University of Goiás-Post Graduation Programme, Goiânia, Brazil.
- ICF, Pharmaceutical Institute of Science, Av. Rio Verde, S/N - Cidade Vera Cruz, Aparecida de Goiânia, GO, 74935-530, Brazil.
| | | | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, University of Leuven, Leuven, Belgium
| | | | | | - Päivi M Paldánius
- Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
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10
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de la Cruz JPS, Morales DLG, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez L, Hernández-Díaz Y, Ble-Castillo JL, Pérez-Hernández N, Rodriguez-Perez JM. Quality of life of Latin-American individuals with type 2 diabetes mellitus: A systematic review. Prim Care Diabetes 2020; 14:317-334. [PMID: 31564515 DOI: 10.1016/j.pcd.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Diabetes mellitus is a serious public health problem that causes a decrease in the patients' quality of life. The present study was aimed to analyze the quality of life of patients with diabetes mellitus in Latin-American population through a systematic review, using the two instruments of greater validity and reliability at international level, SF-36 and WHOQOL. METHODS We performed extensive searches in Redalyc, SciELO, PubMed, Scopus and Web of Science databases. To delimit our search, we only included countries that are members of the Latin American Association of Diabetes. We identified 2168 articles, where 35 were considered relevant for this systematic review. RESULTS Our results showed that patients that regularly receive guidance and treatment to control the diabetes, showed better quality of life; in contrast, patients with foot ulcers or comorbidities showed the worse quality of life. CONCLUSION The current literature analysis suggests that this disease greatly influences in the quality of life of the patients.
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Affiliation(s)
- Juan Pablo Sánchez de la Cruz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Diana Laura González Morales
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico
| | | | - Yazmin Hernández-Díaz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, Mexico
| | - Jorge Luis Ble-Castillo
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico
| | - Nonancit Pérez-Hernández
- Department of Molecular Biology, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico
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11
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Burner E, Terp S, Lam CN, Neill E, Menchine M, Arora S. Access to care, nativity and disease management among Latinos with diabetes in a safety-net healthcare setting. AIMS Public Health 2019; 6:488-501. [PMID: 31909069 PMCID: PMC6940585 DOI: 10.3934/publichealth.2019.4.488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Latinos in the U.S. are disproportionately affected by diabetes and its complications. The role of access to care and nativity in diabetes management are important areas of research, as these findings can help direct tailored interventions. Methods We examined associations between access to care, acculturation and glycemic control among Latino patients with diabetes seen in a safety net emergency department. We used regression models to estimate the individual predictors' associations with glycemic control and then estimated adjusted associations by controlling for all relevant predictors. We tested for a moderating role of nativity in the associations between access to care and glycemic control. Results In unadjusted analysis, we found the most significant predictors of glycemic control to be access to primary care (β = −0.89, p = 0.011), capacity for self-monitoring glucose (β = −0.68, p = 0.022), mental health comorbidities (β = 0.95, p = 0.013), male gender (β = −0.49, p = 0.091) and nativity (β = −0.81, p = 0.034). In adjusted analysis, nativity was no longer a significant predictor of glycemic control (β = −0.32, p = 0.541). Nativity did not significantly moderate the association of access to care and glycemic control. Conclusions Our findings show a direct association between access to care and glycemic control among low-income Latinos seeking care in the emergency department. This supports concerns that many researchers, clinicians and policy analysts have expressed regarding access to care for immigrants. The importance of primary care and access to supplies to perform self-management in achieving glycemic control and reducing risk of complications indicate that ensuring access to quality care is critical to the health of this vulnerable group.
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Affiliation(s)
- Elizabeth Burner
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Sophie Terp
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Chun Nok Lam
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Emily Neill
- University of California San Francisco, San Francisco, USA
| | - Michael Menchine
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Sanjay Arora
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
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Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev 2019; 35:e3097. [PMID: 30445663 PMCID: PMC6953173 DOI: 10.1002/dmrr.3097] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022]
Abstract
The prevalence and incidence of type 2 diabetes (T2D) among the Hispanic population in the United States are higher than the national average. This is partly due to sociocultural factors, such as lower income and decreased access to education and health care, as well as a genetic susceptibility to obesity and higher insulin resistance. This review focuses on understanding the Hispanic population living in the United States from a multidisciplinary approach and underlines the importance of cultural, social, and biological factors in determining the increased risk of T2D in this population. An overview of the acute and chronic complications of T2D upon this population is included, which is of paramount importance to understand the toll that diabetes has upon this population, the health system, and society as a whole. Specific interventions directed to the Hispanic populations are needed to prevent and alleviate some of the burdens of T2D. Different prevention strategies based on medications, lifestyle modifications, and educational programmes are discussed herein. Diabetes self-management education (DSME) is a critical element of care of all people with diabetes and is considered necessary to improve patient outcomes. To be more effective, programmes should take into consideration cultural factors that influence the development and progression of diabetes. These interventions aim to enhance long-term effects by reducing the incidence, morbidity, and mortality of T2D in the Hispanic population of the United States.
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Affiliation(s)
| | - Paula Diaque
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Surgery Department, University of Chicago, Chicago, Illinois, USA
| | - Silvia Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aleksandar Kostic
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
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Garcia ML, Gatdula N, Bonilla E, Frank GC, Bird M, Rascón MS, Rios-Ellis B. Engaging Intergenerational Hispanics/Latinos to Examine Factors Influencing Childhood Obesity Using the PRECEDE–PROCEED Model. Matern Child Health J 2019; 23:802-810. [DOI: 10.1007/s10995-018-02696-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Cardiovascular health and cognitive function among Mexican older adults: cross-sectional results from the WHO Study on Global Ageing and Adult Health. Int Psychogeriatr 2018; 30:1827-1836. [PMID: 29667567 PMCID: PMC6193870 DOI: 10.1017/s1041610218000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED ABSTRACTObjectives:To assess the association between cardiovascular health and cognitive function among Mexican older adults. DESIGN Nationally representative cross-sectional survey. SETTING Households in Mexico. PARTICIPANTS Individuals aged 50 years and older (n = 1,492) from the Mexico-SAGE project Wave 1. MEASUREMENTS A continuous and a categorical index of cardiovascular health was calculated based on exercise, smoking, body mass index, and blood pressure ranging from 0 to 4. Cognitive function was obtained by averaging the standardized scores (z scores) of five psychometric tests. Associations were conducted using linear regression. RESULTS The continuous index of cardiovascular health was not associated with cognitive function. Using the categorical index, participants with the best levels of cardiovascular (score of 4) health performed better on global cognitive function than groups with lower cardiovascular health (scores of 0, 0.41 SD; 1, 0.39 SD; and 2, 0.56 SD). The association was moderated by age, reaching significance only among those 50-64 years old. CONCLUSIONS If longitudinal research confirms these findings, results would suggest that dementia-related policies in Mexico need to focus on achieving optimal levels of cardiovascular health, especially in midlife.
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Loya JC. Systematic Review of Physical Activity Interventions in Hispanic Adults. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:174-188. [PMID: 30474403 DOI: 10.1177/1540415318809427] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Physical activity (PA) has demonstrated substantial physical and psychological benefits. However, Hispanics engage in less leisure-time PA when compared with other groups, putting them at higher risk for diseases associated with obesity, such as diabetes mellitus type 2. This literature review was conducted to identify best practices with regard to interventions designed to increase PA among Hispanic adults. METHODS Extensive searching located 21 randomized controlled studies conducted in the United States. RESULTS Common conceptual frameworks were the transtheoretical model and social cognitive theory. Most interventions used educational sessions with a variety of topics and many used promotoras to increase PA. Outcomes were predominantly examined using self-report PA measures. Walking was the most commonly reported PA behavior. Studies with significant results were those that measured moderate-to-vigorous PA and used theory to guide interventions. Male and older participants were underrepresented. CONCLUSIONS Effective culturally appropriate PA interventions for Hispanics adults are needed. Particular attention to intervention tailoring based on country of origin could enhance intervention effectiveness.
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Portacio FG, Botero P, St George SM, Stoutenberg M. Informing the Adaptation and Implementation of a Lifestyle Modification Program in Hispanics: A Qualitative Study Among Low-Income Hispanic Adults. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:204-212. [PMID: 30426783 DOI: 10.1177/1540415318808831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-income Hispanics are a hard to reach population that face unique challenges in achieving behavior change. Understanding such challenges can inform the adaptation of lifestyle behavioral interventions and increase participant engagement. This descriptive qualitative study aimed to (1) inform lifestyle modification programs focused on improving the physical activity and healthy eating of low-income Hispanic adults and (2) explore potential gender differences necessary for consideration. Five gender-specific focus groups were conducted with Hispanic adults from a free community clinic (n = 45, 64% women, 53.1 ± 10.1 years). Sessions were audio-recorded, transcribed, and coded using a general inductive approach. The qualitative software program Dedoose was used to perform a content analysis. Emergent themes included topics of interest, methods of increasing engagement in healthy behaviors, and the delivery of lifestyle modification programs. Men expressed greater interest in physical activity, while women desired to learn about healthy eating. Men described the importance of physician communication, while women focused on the role of social support as facilitators for participating in such programs. Both genders described education as key to behavior change and viewed text messaging as a valuable complement. Results from this study can inform the adaptation of lifestyle modification programs and increase the engagement of low-income Hispanic populations.
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Affiliation(s)
- Francia G Portacio
- University of Miami, Miami, FL, USA.,University of Tennessee at Chattanooga, TN, USA
| | | | | | - Mark Stoutenberg
- University of Miami, Miami, FL, USA.,University of Tennessee at Chattanooga, TN, USA
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Burner ERE, Menchine MD, Kubicek K, Robles M, Kagawa Singer M, Arora S. Perceptions of Family Among Low-Income Patients With Diabetes in a Text-Based Mobile Health Intervention. J Diabetes Sci Technol 2018; 12:1203-1210. [PMID: 29681170 PMCID: PMC6232730 DOI: 10.1177/1932296818770702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diabetes disproportionately affects the US Latino population, due to socioeconomic pressures, genetics, reduced access to care and cultural practices. While efforts to improve self-care through interventions incorporating family are highly rated by Latinos, family can be both supportive and obstructive. To develop effective interventions, this role needs clarification. METHODS We conducted group interviews in Spanish and English with 24 participants with diabetes from a mobile health diabetes self-care intervention. We imported transcripts into Dedoose, a qualitative computer analysis program and analyzed them with a modified grounded theory technique. Utilizing an iterative process, we reexamined transcripts with new codes derived in each round of analysis until saturation was reached. We employed techniques to improve trustworthiness (co-coding, member checking). Broad categorical themes arose from the initial codes and were developed into a conceptual model of barriers to and strategies for diabetes management. RESULTS Family and family responsibilities emerged as both a supportive and obstructive force for diabetes self-care. While the desire to care for family motivated patients, food at family gatherings and pressure from managing multiple family responsibilities contributed to poor diet choices. Yet, some patients believed their diabetes caused their immediate family to make healthier choices. CONCLUSIONS Among these predominantly Latino patients, family and family responsibilities were key motivators as well as obstacles to self-care, particularly regarding nutrition. Finding the ideal design for social support mHealth-based interventions will require careful study and creation of culturally based programs to match the needs of specific populations, and may require educating family members to provide effective social support.
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Affiliation(s)
- Elizabeth R. E. Burner
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Michael D. Menchine
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Katrina Kubicek
- Community Engagement, SC Clinical &
Translational Science Institute
| | - Marisela Robles
- Community Engagement, SC Clinical &
Translational Science Institute
| | | | - Sanjay Arora
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
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18
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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19
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Burner E, Lam CN, DeRoss R, Kagawa-Singer M, Menchine M, Arora S. Using Mobile Health to Improve Social Support for Low-Income Latino Patients with Diabetes: A Mixed-Methods Analysis of the Feasibility Trial of TExT-MED + FANS. Diabetes Technol Ther 2018; 20:39-48. [PMID: 29227155 PMCID: PMC5770080 DOI: 10.1089/dia.2017.0198] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Social support interventions can improve diabetes self-care, particularly for Latinos, but are time and resource intensive. Mobile health may overcome these barriers by engaging and training supporters remotely. METHODS We conducted a randomized controlled feasibility trial of emergency department patients with diabetes to determine the feasibility of enrolling patients and supporters, acceptability of the intervention, and preliminary efficacy results to power a larger trial. All patients received an existing mHealth curriculum (TExT-MED). After identifying a supporter, patients were randomized to intervention: supporters receiving FANS (family and friends network support), a text message support curriculum synchronized to patient messages, or control: supporters receiving a mailed pamphlet of the same information. Participants followed up at 3 months. FANS intervention participants came to postintervention interviews as part of a qualitative analysis. RESULTS We enrolled 44 patients (22 per arm) and followed up 36 at 3 months. Participants were positive about the program. FANS intervention improved HbA1c (intervention mean decreased from 10.4% to 9.0% vs. from 10.1% to 9.5%, delta -0.8%, confidence interval [CI] -0.4 to 2, P = 0.30), self-monitoring of glucose (intervention increased 1.6 days/week vs. control decreased 2 days/week, delta 2.3 days/week, CI 4-0.6, P = 0.02), and physical activity (mean Godin leisure time activity score improved 16.1 vs. decreased 9.6 for control, delta 25.7, CI 49.2-2.3, P = 0.10). In qualitative analysis, patients reported improved motivation, behaviors, and relationships. Supporters reported making healthier decisions for themselves. CONCLUSIONS mHealth is a feasible, acceptable, and promising avenue to improve social support and diabetes outcomes.
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rebecca DeRoss
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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20
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Controversies and evidence for cardiovascular disease in the diverse Hispanic population. J Vasc Surg 2017; 67:960-969. [PMID: 28951154 DOI: 10.1016/j.jvs.2017.06.111] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/23/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Hispanics account for approximately 17% of the U.S. POPULATION They are one of the fastest growing racial/ethnic groups, second only to Asians. This heterogeneous population has diverse socioeconomic conditions, making the prevention, diagnosis, and management of vascular disease difficult. This paper discusses the cultural, racial, and social aspects of the Hispanic community in the United States and assesses how they affect vascular disease within this population. Furthermore, it explores risk factors, medical and surgical treatments, and outcomes of vascular disease in the Hispanic population; generational evolution of these conditions; and the phenomenon called the Hispanic paradox. METHODS A systematic search of the literature was performed to identify all English-language publications from 1991 to 2014 using PubMed, which draws from the National Institutes of Health and U.S. National Library of Medicine, with the words "cardiovascular disease," "prevalence," "vascular," and "Hispanic." An additional search was performed using "cardiovascular disease and Mexico," "cardiovascular disease and Cuba," "cardiovascular disease and Puerto Rico," and "cardiovascular disease and Latin America" as well as for complications, management, outcomes, surgery, vascular disease, and Hispanic paradox. The resulting publications were queried for generational data (spanning multiple well-defined age groups) regarding cardiovascular disease, and cross-references were obtained from their bibliographies. Results are segmented by country of origin. RESULTS Compared with non-Hispanic whites, Hispanics face higher risks of cardiovascular diseases because of a high prevalence of high blood pressure, obesity, diabetes mellitus, and ischemic stroke. However, the incidence of peripheral arterial disease and carotid disease appears to be significantly lower than in whites. The Hispanic paradox (lower mortality in spite of higher cardiovascular risk factors) may relate to challenges in ascribing life expectancy and cause of death in this diverse population. Low socioeconomic status and high prevalence of concomitant diseases negatively influence the outcomes of all patients, independent of being Hispanic. CONCLUSIONS Understanding the cultural diversity in Hispanics is important in terms of targeting preventive measures to modify cardiovascular risk factors, which affect development and outcomes of vascular disease. The available literature regarding vascular disease in the Hispanic population is limited, and further longitudinal study is warranted to improve health care delivery and outcomes in this group.
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Corsino L, Sotres-Alvarez D, Butera NM, Siega-Riz AM, Palacios C, Pérez CM, Albrecht SS, Espinoza Giacinto RA, Perera MJ, Horn LV, Avilés-Santa ML. Association of the DASH dietary pattern with insulin resistance and diabetes in US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). BMJ Open Diabetes Res Care 2017; 5:e000402. [PMID: 28761660 PMCID: PMC5530245 DOI: 10.1136/bmjdrc-2017-000402] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To examine the association between diet quality and both diabetes status and insulin resistance in Hispanic/Latino adults, and the extent to which differences in diet quality contribute to differences in outcomes across Hispanic/Latino heritage. RESEARCH DESIGN AND METHODS Cross-sectional study. Data are from 15 942 individuals enrolled in the Hispanic Community Health Study/Study of Latinos. Diet was ascertained using two 24-hour dietary recalls, and diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) score (range: 0-80, lowest to highest). Diabetes status was defined based on self-reported diagnosis, use of antihyperglycemic medications, or unrecognized diabetes (determined by baseline laboratory measures). Insulin resistance was determined using homeostatic model assessment of β-cell function and insulin resistance (HOMA-IR). The association between DASH and diabetes status was examined using multinomial logistic regression. The association between DASH and HOMA-IR was assessed using linear regression, and we tested whether the association was modified by Hispanic/Latino heritage or diabetes status. RESULTS DASH score was highest in those with self-reported diabetes (controlled) and no medications (44.8%). A higher DASH score was associated with a lower HOMA-IR, and the association was the same regardless of diabetes status (p>0.8 for the interaction). CONCLUSIONS The association between DASH and diabetes status was strongest for those with controlled self-reported diabetes and who were not taking antihyperglycemic medications. A higher DASH score was associated with less insulin resistance among Hispanics/Latinos. Differences in DASH scores by Hispanic/Latino heritage did not explain the differences in prevalence of diabetes and insulin resistance reported in the diverse Hispanic/Latino population. CLINICAL TRIAL NUMBER NCT02060344.
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Affiliation(s)
- Leonor Corsino
- Department of Medicine/Endocrinology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina Health Care System, Chapel Hill, North Carolina, USA
| | - Nicole M Butera
- University of North Carolina Health Care System, Chapel Hill, North Carolina, USA
| | - Anna María Siega-Riz
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Cristina Palacios
- Department of Biostatistics and Epidemiology, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico
| | - Cynthia M Pérez
- Department of Biostatistics and Epidemiology, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico
| | - Sandra S Albrecht
- Department of Biostatistics, University of North Carolina Health Care System, Chapel Hill, North Carolina, USA
| | - Rebecca A Espinoza Giacinto
- Department of Medicine/Endocrinology, Duke University School of Medicine, Durham, North Carolina, USA
- San Diego State University, San Diego, California, USA
| | | | - Linda Van Horn
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, Maryland, USA
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23
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Caban A, Walker EA. A Systematic Review of Research on Culturally Relevant Issues for Hispanics With Diabetes. DIABETES EDUCATOR 2016; 32:584-95. [PMID: 16873596 DOI: 10.1177/0145721706290435] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this review is to provide a description of current research on culturally relevant issues among Hispanics subgroups with diabetes throughout the United States. Methods A search of 2655 abstracts was conducted using Medline, PubMed, and Psychlit. Sixty articles were identified, and 33 were reviewed. Results Most studies focused on Mexican Americans, and little is known about the unique and shared health beliefs of different Hispanics subgroups within the United States. Personal models of illness varied across groups and were influenced by levels of acculturation. Definitions and treatments for susto varied considerably: Puerto Ricans did not identify it as a cause of diabetes. Patients'thoughts about God and diabetes differed, and little is known about how these thoughts affect diabetes self-management. There is also limited research on Hispanics' use of curanderos (folk healers) for diabetes-related care, and only some participants reported using alternative treatments in conjunction with standard medical care. There is limited evidence that fatalistic thinking is unique to Hispanic culture, and its relationship to diabetes self-management remains unclear. Conclusions More research is needed to determine how cultural factors influence Hispanics' approaches to diabetes self-management. Clinicians and educators would benefit from exploring cultural belief systems with patients, as they may enhance the patient-provider relationship and serve as tools in identifying appropriate treatment strategies.
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Affiliation(s)
- Arlene Caban
- The Albert Einstein College of Medicine, the Bronx, New York
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Abstract
Hispanic Americans are the fastest growing minority group in the United States. They face a distinct set of health challenges, resulting in persistent health disparities. Chronic disease self-management programs hold promise in addressing individual-level, behavioral risks factors, such as dietary habits and physical activity patterns. In light of the unique barriers Hispanic men face, including low participation in evidence-based health intervention research, this article argues for a gendered perspective when approaching Hispanic men’s physical and mental health needs. Through the analysis of data collected from male-only focus groups ( N = 3, n = 15) with Hispanic Americans in west central Florida, this study identified that masculine identity is influenced by chronic disease and comorbid depression status. Diagnosis with a chronic disease and/or depression is accompanied by lifestyle adaptations, activity restrictions, and changes in income and health care demands that can undermine traditional notions of Hispanic masculinity. Consequently, masculine identity is associated with self-management strategies in complex ways. Public health interventions aimed at addressing comorbid chronic disease and depression among Hispanic men must take into consideration the role of gender identity and relevant conceptualizations of masculinity in order to better serve this underserved and understudied population.
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Chilton L, Hu J, Wallace DC. Health-Promoting Lifestyle and Diabetes Knowledge in Hispanic American Adults. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822306288059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the relationships among demographics, a health-promoting lifestyle, and diabetes knowledge. A descriptive study was conducted in a convenience sample of 40 Hispanic American adults. Participants were recruited from Hispanic churches in the southeastern United States. The Health Promoting Lifestyle Profile II and the Diabetes Knowledge Questionnaire were used to assess participants’ health-promoting lifestyle and diabetes knowledge. Participants had low levels of a health-promoting lifestyle and a strong deficiency in diabetes knowledge. Income was found to be associated with physical activity lifestyle. Age and education were significantly related to diabetes knowledge. This study suggested that community health nurses should assess and educate Hispanic American adults for a health-promoting lifestyle and diabetes knowledge and use appropriate methods of teaching with low-literacy and audiovisual materials to provide culturally specific care to this vulnerable group.
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Affiliation(s)
| | - Jie Hu
- University of North Carolina at Greensboro
| | - Debra C. Wallace
- School of Nursing, at the University of North Carolina at Greensboro
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López L, Tan-McGrory A, Horner G, Betancourt JR. Eliminating disparities among Latinos with type 2 diabetes: Effective eHealth strategies. J Diabetes Complications 2016; 30:554-60. [PMID: 26774790 PMCID: PMC5006182 DOI: 10.1016/j.jdiacomp.2015.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/16/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022]
Abstract
Latinos are at increased risk for obesity and type 2 diabetes (T2D). Well-designed information technology (IT) interventions have been shown to be generally efficacious in improving diabetes self-management. However, there are very few published IT intervention studies focused on Latinos. With the documented close of the digital divide, Latinos stand to benefit from such advances. There are limited studies on how best to address the unique socio-cultural-linguistic characteristics that would optimize adoption, use and benefit among Latinos. Successful e-health programs involve frequent communication, bidirectionality including feedback, and multimodal delivery of the intervention. The use of community health workers (CHWs) has been shown consistently to improve T2D outcomes in Latinos. Incorporating CHWs into eHealth interventions is likely to address barriers with technology literacy and improve patient activation, satisfaction and adherence. Additionally, tailored interventions are more successful in improving patient activation. It is important to note that tailoring is more than linguistic translation; tailoring interventions to the Latino population will need to address educational, language, literacy and acculturation levels, along with unique illness beliefs and attitudes about T2D found among Latinos. Interventions will need to go beyond the lone participant and include shared decision making models that incorporate family members and friends.
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Affiliation(s)
- Lenny López
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA; Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA.
| | - Aswita Tan-McGrory
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Gabrielle Horner
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
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Perez A, Elrod S, Sanchez J. Differences in the Use and Quality of Antidiabetic Therapies in Mexican American and Non-Hispanic Whites With Uncontrolled Type 2 Diabetes in the US. DIABETES EDUCATOR 2015; 41:582-91. [DOI: 10.1177/0145721715593813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to determine the use of clinical guideline–recommended antidiabetic therapies among Mexican Americans (MA) and non-Hispanic whites with uncontrolled type 2 diabetes. Methods A secondary data analysis based on the National Health and Nutrition Examination Survey (NHANES) 2003-2012 cohort data including MA and non-Hispanic white adults with uncontrolled (A1C ≥6.5%) type 2 diabetes. Results There was no difference in the use of recommended regimens across race/ethnic group (MA, 63.6% vs whites, 65.7%); however, MA were less likely to have regimens intensified to non-insulin triple therapies (7.3% vs 11.3%) or insulin-based therapies (23.7% vs 30.5%) and were more likely to be on no medications (17.2% vs 10.4%). Mexican Americans and whites who were most uncontrolled were least likely to be on recommended regimens (A1C 6.5%-7.4%, 83.0%; A1C 7.5%-9%, 60.6%; and A1C >9%, 50.4%). This pattern was most pronounced among MA compared to whites. Use of recommended therapies decreased 50.5 percentage points for MA and 20.1 percentage points among whites from an A1C level of 6.5% to 7.4% to >9%, respectively. Conclusions The quality of antidiabetic therapies of MA and whites with type 2 diabetes who are most uncontrolled need improvement. Intensifying pharmacotherapies among MA may help improve glycemic control disparities. The innovative outcome used in this report may be useful in quality of care studies in the future.
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Affiliation(s)
- Alexandra Perez
- Nova Southeastern University College of Pharmacy, Davie, Florida (Dr Perez, Dr Sanchez)
- University of North Texas System College of Pharmacy, Fort Worth, Texas (Dr Elrod)
| | - Shara Elrod
- Nova Southeastern University College of Pharmacy, Davie, Florida (Dr Perez, Dr Sanchez)
- University of North Texas System College of Pharmacy, Fort Worth, Texas (Dr Elrod)
| | - Jesus Sanchez
- Nova Southeastern University College of Pharmacy, Davie, Florida (Dr Perez, Dr Sanchez)
- University of North Texas System College of Pharmacy, Fort Worth, Texas (Dr Elrod)
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Dube L, Van den Broucke S, Housiaux M, Dhoore W, Rendall-Mkosi K. Type 2 diabetes self-management education programs in high and low mortality developing countries: a systematic review. DIABETES EDUCATOR 2014; 41:69-85. [PMID: 25392297 DOI: 10.1177/0145721714558305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Although self-management education is a key factor in the care for diabetes patients, its implementation in developing countries is not well documented. This systematic review considers the published literature on diabetes self-management education in high and low mortality developing countries. The aim is to provide a state of the art of current practices and assess program outcomes, cultural sensitivity, and accessibility to low literate patients. METHODS The Cochrane Library, PubMed, MEDLINE, PsycInfo, and PsycArticles databases were searched for peer-reviewed articles on type 2 diabetes published in English between 2009 and 2013. The World Bank and WHO burden of disease criteria were applied to distinguish between developing countries with high and low mortality. Information was extracted using a validated checklist. RESULTS Three reviews and 23 primary studies were identified, 18 of which were from low mortality developing countries. Studies from high mortality countries were mostly quasi-experimental, those from low mortality countries experimental. Interventions were generally effective on behavior change and patients' glycemic control in the short term (≤9 months). While 57% of the studies mentioned cultural tailoring of interventions, only 17% reported on training of providers, and 39% were designed to be accessible for people with low literacy. CONCLUSIONS The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Marie Housiaux
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - William Dhoore
- Institute of Health and Society, Université catholique de Louvain, Belgium (Prof Dhoore)
| | - Kirstie Rendall-Mkosi
- School of Health Systems and Public Health, University of Pretoria, South Africa (Dr Rendall-Mkosi)
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Moreno JP, Johnston CA. Considering the Impact of Acculturation on Lifestyle Interventions for Latinos. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614553912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals of Latino descent are one of the fastest growing groups in the United States. They also experience multiple health disparities. To effectively treat individuals from these cultures, several issues should be considered. Assessing the degree of an individual’s acculturation and tailoring interventions to be more compatible with a patient’s cultural values are important steps to be taken.
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Affiliation(s)
- Jennette P. Moreno
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | - Craig A. Johnston
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
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Calo WA, Ortiz AP, Suárez E, Guzmán M, Pérez CM, Pérez CM. Association of cigarette smoking and metabolic syndrome in a Puerto Rican adult population. J Immigr Minor Health 2014; 15:810-6. [PMID: 22729380 DOI: 10.1007/s10903-012-9660-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Metabolic syndrome (MetSyn) is related to an increased risk for type 2 diabetes and cardiovascular disease. Smokers are at greater risk than nonsmokers of becoming insulin resistant and to develop cardiovascular disease. This study aimed to explore the association between cigarette smoking, MetSyn and its components among Puerto Rican adults. A representative sample of 856 persons aged 21-79 years from the San Juan Metropolitan area participated in this study. Demographic and lifestyle characteristics, including smoking habits, were gathered from a self-reported questionnaire. MetSyn was defined according to the revised NCEP-ATP III criteria and measured using biochemical measurements and anthropometric indices. Logistic regression models were used to estimate prevalence odds ratios (POR) and its 95 % confidence intervals (CI). MetSyn was significantly (P < 0.001) more prevalent in former smokers (48.4 %) as compared to current (42.7 %) and never smokers (40.0 %). However, after adjusting for possible confounders, current smokers who used more than 20 cigarettes per day were 2.24 (95 % CI = 1.00-4.99) times more likely to have MetSyn as compared to never smokers. Heavy smokers were also more likely to have high triglyceride levels (POR = 2.22, 95 % CI = 1.12-4.38) and low HDL-cholesterol levels (POR = 2.49, 95 % CI = 1.28-4.86) as compared to never smokers. This study supports previous reports of an increased risk of MetSyn among current smokers, particularly those with a heavier consumption. Tobacco control strategies, such as preventing smoking initiation and disseminating evidence-based cessation programs, are necessary to reduce the burden of MetSyn in Puerto Rico.
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Affiliation(s)
- William A Calo
- Division of Management, Policy, and Community Health, University of Texas School of Public Health, 7000 Fannin, Room 2510G, Houston, TX 77030, USA.
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Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:671-8. [PMID: 24745315 DOI: 10.1016/j.jse.2014.01.046] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty, its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored. The purpose of the study was to determine the association of diabetes with in-hospital death, complications, length of stay, non-homebound disposition, and cost in patients undergoing shoulder arthroplasty. METHODS By use of the Nationwide Inpatient Sample database for the year 2011, an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with (21%) and without (79%) diabetes mellitus. Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling. RESULTS Diabetes mellitus was independently associated with in-hospital death, a number of perioperative complications, prolonged hospital stay, and increased non-homebound disposition after shoulder arthroplasty. The presence of diabetes was not associated with increased hospital cost. CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty. Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes.
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Hsieh S, Klassen AC, Curriero FC, Caulfield LE, Cheskin LJ, Davis JN, Goran MI, Weigensberg MJ, Spruijt-Metz D. Fast-food restaurants, park access, and insulin resistance among Hispanic youth. Am J Prev Med 2014; 46:378-87. [PMID: 24650840 DOI: 10.1016/j.amepre.2013.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/19/2013] [Accepted: 12/06/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence of associations between the built environment and obesity risk has been steadily building, yet few studies have focused on the relationship between the built environment and aspects of metabolism related to obesity's most tightly linked comorbidity, type 2 diabetes. PURPOSE To examine the relationship between aspects of the neighborhood built environment and insulin resistance using accurate laboratory measures to account for fat distribution and adiposity. METHODS Data on 453 Hispanic youth (aged 8-18 years) from 2001 to 2011 were paired with neighborhood built environment and 2000 Census data. Analyses were conducted in 2011. Walking-distance buffers were built around participants' residential locations. Body composition and fat distribution were assessed using dual x-ray absorptiometry and waist circumference. Variables for park space, food access, walkability, and neighborhood sociocultural aspects were entered into a multivariate regression model predicting insulin resistance as determined by the homeostasis model assessment. RESULTS Independent of obesity measures, greater fast-food restaurant density was associated with higher insulin resistance. Increased park space and neighborhood linguistic isolation were associated with lower insulin resistance among boys. Among girls, park space was associated with lower insulin resistance, but greater neighborhood linguistic isolation was associated with higher insulin resistance. A significant interaction between waist circumference and neighborhood linguistic isolation indicated that the negative association between neighborhood linguistic isolation and insulin resistance diminished with increased waist circumference. CONCLUSIONS Reducing access to fast food and increasing public park space may be valuable to addressing insulin resistance and type 2 diabetes, but effects may vary by gender.
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Affiliation(s)
- Stephanie Hsieh
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Ann C Klassen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Community Health and Prevention, Drexel University School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Frank C Curriero
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Cheskin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jaimie N Davis
- Department of Nutritional Sciences, University of Texas, Austin, Texas
| | - Michael I Goran
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Physiology & Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marc J Weigensberg
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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Carliner H, Collins PY, Cabassa LJ, McNallen A, Joestl SS, Lewis-Fernández R. Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Compr Psychiatry 2014; 55:233-47. [PMID: 24269193 PMCID: PMC4164219 DOI: 10.1016/j.comppsych.2013.09.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/10/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE People with serious mental illness (SMI) die at least 11 years earlier than the general U.S. population, on average, due largely to cardiovascular disease (CVD). Disparities in CVD morbidity and mortality also occur among some U.S. racial and ethnic minorities. The combined effect of race/ethnicity and SMI on CVD-related risk factors, however, remains unclear. To address this gap, we conducted a critical literature review of studies assessing the prevalence of CVD risk factors (overweight/obesity, diabetes mellitus, metabolic syndrome, hypercholesterolemia, hypertension, cigarette smoking, and physical inactivity) among U.S. racial/ethnic groups with schizophrenia-spectrum and bipolar disorders. METHODS AND RESULTS We searched MEDLINE and PsycINFO for articles published between 1986 and 2013. The search ultimately yielded 40 articles. There was great variation in sampling, methodology, and study populations. Results were mixed, though there was some evidence for increased risk for obesity and diabetes mellitus among African Americans, and to a lesser degree for Hispanics, compared to non-Hispanic Whites. Sex emerged as an important possible effect modifier of risk, as women had higher CVD risk among all racial/ethnic subgroups where stratified analyses were reported. CONCLUSIONS Compared to general population estimates, there was some evidence for an additive risk for CVD risk factors among racial/ethnic minorities with SMI. Future studies should include longitudinal assessment, stratification by sex, subgroup analyses to clarify the mechanisms leading to potentially elevated risk, and the evaluation of culturally appropriate interventions to eliminate the extra burden of disease in this population.
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Affiliation(s)
- Hannah Carliner
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Pamela Y Collins
- Office for Research on Disparities and Global Mental Health, National Institute of Mental Health/NIH, Bethesda, MD, USA
| | - Leopoldo J Cabassa
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Columbia University School of Social Work, New York, NY, USA
| | - Ann McNallen
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah S Joestl
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY, USA
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Burner E, Menchine M, Taylor E, Arora S. Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients. J Diabetes Sci Technol 2013; 7:111-8. [PMID: 23439166 PMCID: PMC3692222 DOI: 10.1177/193229681300700113] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The benefit of mobile health (mHealth) on diabetes management among low-income, inner-city patients is largely unknown, particularly for Latino patients. TExT-MED (Trial to Examine Text Message for Emergency Department Patients with Diabetes) is a text message-based program designed to improve disease knowledge, self-efficacy, and glycemic control among low-income, inner-city Latinos. In phase I, 23 patients participated in an acceptability and feasibility study. Contrary to our model, there was no increase in knowledge despite increases in self-efficacy and healthy behaviors. In phase II, we performed a mixed-methods analysis to understand how TExT-MED achieved these seemingly contradictory findings. METHOD We performed a qualitative analysis of focus groups with patients from phase I. We explored patients' receipt of health information from TExT-MED and other information sources. We used these qualitative findings to perform a mixed-methods analysis of the outcomes from phase I, reanalyzing the quantitative measures of self-efficacy, diabetes knowledge, and healthy behaviors. RESULTS We conducted two focus groups, one in English and one in Spanish. Through qualitative analysis, we found gender differences in information sources, dietary self-efficacy, and desired educational content. Applying this knowledge, we re-stratified phase I outcomes by gender and found differential changes in diabetes knowledge, self-efficacy, and behaviors. Men had increased self-efficacy while women showed increased knowledge. CONCLUSIONS The efficacy of mHealth on diabetes management was affected by gender. Specifically, men and women differ in their dietary self-efficacy, information sources, and desired topics in future mHealth interventions. To achieve maximal impact, future mHealth interventions should be mindful of this gender difference.
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Abstract
The Mexican health paradox refers to initially favorable health and mental health outcomes among recent Mexican immigrants to the United States. The subsequent rapid decline in Mexican health outcomes has been attributed to the process of acculturation to U.S. culture. However, the construct of acculturation has come under significant criticism for oversimplifying complex relations between health, behavior, race and ethnic relations, and the environment. Moreover, measurement issues for the construct abound. This article reviews the current state of the acculturation debate, and argues for an integration of current theoretical perspectives and critiques of the construct in order to strengthen the explanatory power of acculturation with regard to the Mexican health paradox.
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Connor A, Baumgartner RN, Kerber RA, O'Brien E, Rai SN, Wolff RK, Slattery ML, Giuliano AR, Risendal BC, Byers TE, Baumgartner KB. ADRB2 G-G haplotype associated with breast cancer risk among Hispanic and non-Hispanic white women: interaction with type 2 diabetes and obesity. Cancer Causes Control 2012; 23:1653-63. [PMID: 22864926 DOI: 10.1007/s10552-012-0043-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/25/2012] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Polymorphisms in the beta-2-adrenergic receptor (ADRB2) gene have been studied in relation to risk of type 2 diabetes and obesity, risk factors that have received increased attention in relation to breast cancer. We evaluated the hypothesis that ADRB2 variants (rs1042713, rs1042714) are associated with breast cancer risk in non-Hispanic white (NHW) and Hispanic (H) women using data from a population-based case-control study conducted in the southwestern United States. METHODS Data on lifestyle and medical history, and blood samples, were collected during in-person interviews for incident primary breast cancer cases (1,244 NHW, 606 H) and controls (1,330 NHW, 728 H). ADRB2 genotypes for rs1042713(G/A) and rs1042714(G/C) were determined using TaqMan assays. The associations of each variant and corresponding haplotypes with breast cancer were estimated using multivariable logistic regression. RESULTS Two copies compared to one or zero copies of the ADRB2 G-G haplotype were associated with increased breast cancer risk for NHW women [odds ratio (OR), 1.95; 95 % confidence interval (95 % CI), 1.26-3.01], but with reduced risk for H women [OR, 0.74; 95 % CI, 0.50-1.09]. Effect estimates were strengthened for women with a body mass index (BMI) ≥25 kg/m(2) [H: OR, 0.50; 95 % CI, 0.31-0.82; NHW: OR, 3.85; 95 % CI, 1.88-7.88] and for H women with a history of diabetes [H: OR, 0.32; 95 % CI, 0.12-0.89]. CONCLUSIONS These data suggest that ethnicity modifies the association between the ADRB2 G-G haplotype and breast cancer risk, and being overweight or obese enhances the divergence of risk between H and NHW women.
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Affiliation(s)
- Avonne Connor
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA.
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Verna EC, Valadao R, Farrand E, Pichardo EM, Lai JC, Terrault NA, Brown RS. Effects of ethnicity and socioeconomic status on survival and severity of fibrosis in liver transplant recipients with hepatitis C virus. Liver Transpl 2012; 18:461-7. [PMID: 22467547 PMCID: PMC3674870 DOI: 10.1002/lt.23376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The ethnicity and socioeconomic status of the host may affect the progression of hepatitis C virus (HCV). We aimed to compare survival and fibrosis progression in Hispanic white (HW) and non-Hispanic white (NHW) recipients of liver transplantation (LT) with HCV. All HW and NHW patients with HCV who underwent transplantation between January 2000 and December 2007 at 2 centers were retrospectively assessed. The primary outcomes were the time to death, death or graft loss due to HCV, and significant fibrosis [at least stage 2 of 4]. Five hundred eleven patients were studied (159 HW patients and 352 NHW patients), and the baseline demographics were similar for the 2 groups. NHW patients were more likely to be male, to have attended college, and to have private insurance, and they had a higher median household income (MHI). The unadjusted rates of survival (log-rank P = 0.93), death or graft loss due to HCV (P = 0.89), and significant fibrosis (P = 0.95) were similar between groups. In a multivariate analysis controlling for center, age [hazard ratio (HR) per 10 years = 1.43, P = 0.01], donor age (HR per 10 years = 1.25, P < 0.001), and rejection (HR = 1.47, P = 0.048) predicted death, whereas HW ethnicity (HR = 1.06, P = 0.77) was not significant. Independent predictors of significant fibrosis were HW ethnicity (HR = 2.42, P = 0.046), MHI (HR per $10,000 = 1.11, P = 0.01), donor age (HR per 10 years = 1.13, P = 0.02), cold ischemia time (HR = 1.06, P = 0.03), and the interaction between ethnicity and MHI (HR = 0.82, P = 0.03). In conclusion, there is no difference in post-LT survival or graft loss due to HCV between HW patients and NHW patients. Socioeconomic factors may influence disease severity; this is suggested by our findings of more significant fibrosis in HW patients with a low MHI.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Rosa Valadao
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Erica Farrand
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Elsa M. Pichardo
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jennifer C. Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Medicine, University of California San Francisco, San Francisco, CA
,Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Robert S. Brown
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
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Abstract
The prevalence of type 2 diabetes mellitus is higher in Hispanic/Latino individuals living in the United States compared with their non-Hispanic white counterparts. Many factors contribute to the increased prevalence of type 2 diabetes, including biological characteristics, socioeconomic conditions, and cultural aspects. The contribution of genetics to the risk of type 2 diabetes in Hispanic/Latino patients is becoming increasingly clear, but this inherent risk factor cannot be modified. However, certain socioeconomic and cultural factors, such as reduced access to healthcare, language barriers, cultural beliefs, and lack of cultural competence by the healthcare provider, are modifiable and should be overcome in order to improve the management of type 2 diabetes in Hispanic/Latino patients. At the healthcare system level, policies should be put into place to reduce disparities between Hispanics/Latinos and non-Hispanic whites regarding health insurance coverage and access to healthcare. At the healthcare provider and patient level, cultural beliefs should be taken into consideration when selecting adequate treatment. Overall, type 2 diabetes management should be individualized by identifying the preferred language and level of acculturation for each patient. These considerations are necessary to further improve communication through culturally appropriate educational materials and programs. These strategies may help to overcome the barriers in the treatment of type 2 diabetes in Hispanic/Latino patients.
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Affiliation(s)
- Eugenio Cersosimo
- Texas Diabetes Institute, University of Texas Health Science Center, San Antonio, TX 78284, USA.
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Abstract
The Hispanic/Latino population is the largest minority group in the United States, representing approximately 16% of the population in 2010. The US Census Bureau defines Hispanic/Latino origin as ethnicity, which tends to be associated with culture and is distinct from race. Based on the US Census Bureau classifications, Hispanics/Latinos have at least 3 main racial backgrounds (white, black, and Native Indian), with the combination and proportion differing among Hispanic/Latino subgroups. The reflection of these racial differences in genetic ancestry partly explains why biological characteristics differ among Hispanic/Latino subgroups. Partly as a result of variations in biological characteristics, the risk of type 2 diabetes mellitus varies among Hispanic/Latino subgroups. According to data from the 1982 to 1984 Hispanic Health and Nutrition Examination Survey (HHANES), the prevalence of diagnosed and undiagnosed type 2 diabetes among adults aged 45 to 74 years was higher in Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%). In addition to genetics, there are multiple social and cultural factors that affect the prevalence and course of type 2 diabetes in Hispanic/Latino individuals. Although certain aspects of Hispanic/Latino culture may become barriers in the management of type 2 diabetes in this population, these cultural characteristics may also represent an opportunity for prevention and/or improvement of care. It is important for healthcare providers to have an understanding and appreciation of Hispanic/Latino culture in order to provide their Hispanic/Latino patients with healthcare that is culturally and socially appropriate. Only by considering genetic, social, and cultural factors can type 2 diabetes be successfully prevented, treated, and managed in Hispanic/Latino patients.
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Hanley AJG, Wagenknecht LE, Norris JM, Bergman R, Anderson A, Chen YI, Lorenzo C, Haffner SM. Adiponectin and the incidence of type 2 diabetes in Hispanics and African Americans: the IRAS Family Study. Diabetes Care 2011; 34:2231-6. [PMID: 21816973 PMCID: PMC3177725 DOI: 10.2337/dc11-0531] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A recent meta-analysis of 13 prospective studies reported that higher levels of adiponectin were significantly associated with lower risk of type 2 diabetes. Most previous studies, however, were limited in their ability to adjust for appropriate confounding variables. Our objective, therefore, was to study this association after adjustment for directly measured adiposity and insulin sensitivity, expressed as the insulin sensitivity index (S(I)). RESEARCH DESIGN AND METHODS The study included 1,096 Hispanic and African American participants free of diabetes at baseline (2000-2002) who returned for follow-up after 5 years. S(I) was determined from frequently sampled intravenous glucose tolerance tests with minimal model analysis. Visceral adipose tissue (VAT) area was determined by computed tomography. Diabetes and impaired fasting glucose (IFG) were defined using American Diabetes Association criteria. Multivariate generalized estimating equation logistic regression models were used to account for correlations within families. RESULTS A total of 82 subjects met criteria for incident diabetes. After adjustment for age, sex, ethnicity, and smoking, adiponectin was significantly inversely associated with diabetes (odds ratio [OR] 0.54 per 1 SD difference [95% CI 0.38-0.76]). The association remained significant after additional adjustment in individual models for BMI, homeostasis model assessment of insulin resistance, or VAT (all P < 0.05). However, adiponectin was no longer associated in separate models adjusted for S(I) or IFG (OR 0.81 [0.56-1.16] and 0.75 [0.53-1.06], respectively). CONCLUSIONS Adiponectin was inversely associated with incident diabetes after adjustment for conventional anthropometric and metabolic variables or VAT. Adjustment for detailed measures of S(I) attenuated this relationship, however, suggesting that the link between adiponectin and diabetes may operate at least in part through insulin resistance.
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Affiliation(s)
- Anthony J G Hanley
- Department of Nutritional Sciences and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Abstract
In the United States, the prevalence of adults who are overweight or obese is higher in Hispanics/Latinos compared with non-Hispanic whites. In addition, data from the National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of type 2 diabetes mellitus is consistently greater in racial/ethnic minority groups, such as Hispanics/Latinos, compared with non-Hispanic whites. In fact, data from the Centers for Disease Control and Prevention (CDC) from 2007 to 2009 suggest that the prevalence of type 2 diabetes is almost twice as high in Hispanics/Latinos compared with non-Hispanic whites (11.8% vs. 7.1%, respectively). Although genetics plays a role in the increased prevalence of type 2 diabetes in Hispanics/Latinos, cultural and environmental factors also contribute. In addition to the increased prevalence of type 2 diabetes in Hispanics/Latinos, evidence suggests that the patients in this population are often undertreated and, therefore, less likely to achieve control of their glucose, blood pressure, and lipid levels. Because individuals with type 2 diabetes have a 2- to 4-fold increased risk of cardiovascular disease compared with individuals with normal glucose levels, there is consensus that targeting environmental factors, particularly the development of obesity at an early age, is the most cost-effective approach to prevent the development of type 2 diabetes and its broad spectrum of complications, including cardiovascular disease. Cultural and socioeconomic barriers, such as language, cost, and access to goods and services, must be overcome to improve management of type 2 diabetes in this high-risk population. By increasing healthcare provider awareness and the availability of programs tailored to Hispanic/Latino individuals, the current treatment gap among ethnic minorities in the United States will progressively narrow, and eventually, disappear.
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Abstract
AIMS The burden of diabetes is considerable for racial and ethnic minority populations in many places in the USA and worldwide, often disproportionately affecting immigrant communities. This paper reports findings from a community-based participatory research study that described diabetes risk and awareness, assessed the association between perceived and actual risk (high, two or more diabetes risk factors; low, fewer than two risk factors) and identified factors associated with disease risk among Chinese and Hispanic/Latino immigrant populations in Portland, OR, USA. METHODS Cross-sectional, self-reported data were collected from a purposive sample of 324 Chinese (n=159) and Hispanic/Latino (n=165) adults, aged 18-86 years [mean (SD) age, 45.2(17.9) years; 50.7% women). Analyses described differences in variable distributions. Logistic regression estimated odds ratios and 95% confidence intervals in pooled and ethnic group-specific samples. RESULTS Approximately 43% of participants were at high risk for diabetes, regardless of ethnicity or age. Of those unaware of their risk, or who perceived themselves not to be at risk, 25-53% had two or more risk factors (high risk); these patterns varied by ethnicity. The proportion of participants who reported two or more risk factors and were unaware of their risk status (31.8% Hispanic/Latino; 17% Chinese) or self-identified as not at risk (12.5% Hispanic/Latino; 13.0% Chinese) was substantial. Factors associated with diabetes risk also varied by ethnicity. CONCLUSIONS This study assessed the degree and determinants of diabetes risk and awareness among local Hispanic/Latino and Chinese communities and identified significant variation between groups. The results are important because they highlight substantial diabetes risk among persons who misestimate or are unaware of their risk status, regardless of ethnicity, and, in the USA, the Chinese immigrant population commonly is not considered a high-risk group for Type 2 diabetes.
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Affiliation(s)
- S C Maty
- School of Community Health, Portland State University, Portland, OR 97207-0751, USA.
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Osuna D, Barrera M, Strycker LA, Toobert DJ, Glasgow RE, Geno CR, Almeida F, Perdomo M, King D, Doty AT. Methods for the cultural adaptation of a diabetes lifestyle intervention for Latinas: an illustrative project. Health Promot Pract 2009; 12:341-8. [PMID: 19843703 DOI: 10.1177/1524839909343279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because Latinas experience a high prevalence of type 2 diabetes and its complications, there is an urgent need to reach them with interventions that promote healthful lifestyles. This article illustrates a sequential approach that took an effective multiple-risk-factor behavior-change program and adapted it for Latinas with type 2 diabetes. Adaptation stages include (a) information gathering from literature and focus groups, (b) preliminary adaptation design, and (c) preliminary adaptation test. In this third stage, a pilot study finds that participants were highly satisfied with the intervention and showed improvement across diverse outcomes. Key implications for applications include the importance of a model for guiding cultural adaptations, and the value of procedures for obtaining continuous feedback from staff and participants during the preliminary adaptation test.
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Affiliation(s)
- Diego Osuna
- Kaiser Permanente, Denver, Colorado 80237-8066, USA.
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Aguilar-Salinas CA, Canizales-Quinteros S, Rojas-Martínez R, Mehta R, Villarreal-Molina MT, Arellano-Campos O, Riba L, Gómez-Pérez FJ, Tusié-Luna MT. Hypoalphalipoproteinemia in populations of Native American ancestry: an opportunity to assess the interaction of genes and the environment. Curr Opin Lipidol 2009; 20:92-7. [PMID: 19280764 DOI: 10.1097/mol.0b013e3283295e96] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THIS REVIEW Our aim is to review the environmental and genetic factors associated with hypoalphalipoproteinemia in populations of Native American ancestry. We examine the strength of the association and outline the population-specific genetic factors that lead to a higher susceptibilty for this condition. RECENT FINDINGS Low HDL is the most common lipid abnormality in populations of Native American ancestry. Population-based surveys carried out in Latin America and in Mexican Americans shows that 40-60% of adults have hypoalphalipoproteinemia. The contribution of this trait to the metabolic syndrome is greater in individuals with Native American ancestry than in other ethnic groups. Several environmental factors have contributed to this phenomenon (i.e. high dietary content of carbohydrates and fat due to cultural factors and a growing incidence of obesity). In addition, results from recent genetic studies show that certain hypoalphalipoproteinemia susceptibility alleles are ethnic specific for Native Americans. The variant R230C of the ATP-binding cassette transporter subfamily A member 1 gene (ABC-A1) is common among mestizos (10.9% in Mexican mestizos) and its presence has a significant negative effect on HDL cholesterol levels (-4.2%). An additional noteworthy finding is that the R230C variant appears to be specific for the Amerindian populations. Its allele frequency is 0.28 in Mayans, 0.214 in Purepechas, 0.203 in Yaquis and 0.179 among Teenek. In contrast, the C230 allele has not been found in African, European, Chinese or South Asian populations. SUMMARY The assessment of the genetic and environmental determinants of hypoalphalipoproteinemia in populations of Native American origin provides an opportunity to assess the population-specific interactions between genes and the environment
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Affiliation(s)
- Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
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Merriam PA, Tellez TL, Rosal MC, Olendzki BC, Ma Y, Pagoto SL, Ockene IS. Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community. BMC Med Res Methodol 2009; 9:20. [PMID: 19284663 PMCID: PMC2662878 DOI: 10.1186/1471-2288-9-20] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 03/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latinos comprise the largest racial/ethnic group in the United States and have 2-3 times the prevalence of type 2 diabetes mellitus as Caucasians. METHODS AND DESIGN The Lawrence Latino Diabetes Prevention Project (LLDPP) is a community-based translational research study which aims to reduce the risk of diabetes among Latinos who have a >/= 30% probability of developing diabetes in the next 7.5 years per a predictive equation. The project was conducted in Lawrence, Massachusetts, a predominantly Caribbean-origin urban Latino community. Individuals were identified primarily from a community health center's patient panel, screened for study eligibility, randomized to either a usual care or a lifestyle intervention condition, and followed for one year. Like the efficacious Diabetes Prevention Program (DPP), the LLDPP intervention targeted weight loss through dietary change and increased physical activity. However, unlike the DPP, the LLDPP intervention was less intensive, tailored to literacy needs and cultural preferences, and delivered in Spanish. The group format of the intervention (13 group sessions over 1 year) was complemented by 3 individual home visits and was implemented by individuals from the community with training and supervision by a clinical research nutritionist and a behavioral psychologist. Study measures included demographics, Stern predictive equation components (age, gender, ethnicity, fasting glucose, systolic blood pressure, HDL-cholesterol, body mass index, and family history of diabetes), glycosylated hemoglobin, dietary intake, physical activity, depressive symptoms, social support, quality of life, and medication use. Body weight was measured at baseline, 6-months, and one-year; all other measures were assessed at baseline and one-year. All surveys were orally administered in Spanish. RESULTS A community-academic partnership enabled the successful recruitment, intervention, and assessment of Latinos at risk of diabetes with a one-year study retention rate of 93%. TRIAL REGISTRATION NCT00810290.
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Affiliation(s)
- Philip A Merriam
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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Gorawara-Bhat R, Huang ES, Chin MH. Communicating with older diabetes patients: self-management and social comparison. PATIENT EDUCATION AND COUNSELING 2008; 72:411-417. [PMID: 18639997 PMCID: PMC3723802 DOI: 10.1016/j.pec.2008.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/22/2008] [Accepted: 05/28/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process. METHODS Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes. RESULTS Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care. CONCLUSION The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management. PRACTICE IMPLICATIONS Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices.
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Affiliation(s)
- Rita Gorawara-Bhat
- The University of Chicago, Department of Medicine, Chicago, IL 60637, USA.
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Abstract
Latinos are the largest minority in the USA and have higher rates of HCV infection. The course of chronic hepatitis C in Latinos is more aggressive, with higher risk to develop cirrhosis than any other ethnic group or race. Available information suggests that more rapid progression of liver disease is aggravated by decreased efficacy to treatment with available therapies. The causes for more aggressive progression and decreased efficacy of treatment are complex. Factors related to metabolic syndrome, insulin resistance, and hepatic steatosis are important, as well as genetic differences, not only for metabolic syndrome but for immune responses to interferon. In addition, there are substantial barriers for Latinos to access medical care. Language, cultural differences, and socioeconomic factors, including lack of medical insurance, more frequent use of alcohol, and possible medical care provider bias, are significant obstacles to diagnosis and treatment. The severity of the liver disease and the association to metabolic syndrome medical conditions justify that Latinos be considered a special population with urgent need of intervention strategies. In this article we present all the available evidence on epidemiology, natural history of chronic hepatitis C, and efficacy of anti-HCV therapy in Latinos infected with HCV.
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Neighborhood Resources for Physical Activity and Healthy Foods and Their Association With Insulin Resistance. Epidemiology 2008; 19:146-57. [DOI: 10.1097/ede.0b013e31815c480] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diabetes mellitus in the Hispanic/Latino population: an increasing health care challenge in the United States. Am J Med Sci 2007; 334:274-82. [PMID: 18030184 DOI: 10.1097/maj.0b013e3180a6efe3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of diabetes in the U.S. Hispanic population has grown to epidemic proportions. The prevalence of diagnosed diabetes in Hispanics is 1.9 times higher than that in Caucasians. Diabetes is diagnosed at an earlier age, and, for a multiplicity of reasons, Hispanics suffer from higher rates of diabetic complications and mortality. The etiology for the higher prevalence of diabetes and its complications is not clear, but it is thought to be related to genetic and environmental factors. In this manuscript, we review recent epidemiologic information on the prevalence, pathophysiology, and complications of diabetes, as well as the recommendations for the management of Hispanics with type 2 diabetes.
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Affiliation(s)
- A Enrique Caballero
- Latino Diabetes Initiative, Professional Education, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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