1
|
Morales M, Ingram M, Sepulveda R, Nuño T, Wilkinson-Lee AM, Guernsey De Zapien JE, Carvajal S. Risk Factors Associated with Diabetes among Mexican-Origin Adults in Southern Arizona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6126. [PMID: 37372712 DOI: 10.3390/ijerph20126126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Diabetes is the seventh leading cause of death in the United States, and it is particularly problematic among the Latine population. This study employed multivariable logistic regression models to examine how hypertension, depression, and sociodemographics were associated with diabetes in a cross-sectional sample of Mexican-origin adults living in three counties of Southern Arizona. The overall prevalence of diabetes from this primary care sample was 39.4%. Holding covariates at fixed values, individuals having hypertension were 2.36 (95% CI: 1.15, 4.83) times more likely to have diabetes, when compared to individuals not having hypertension. The odds of having diabetes for individuals with ≥12 years of educational attainment were 0.29 (95% CI: 0.14, 0.61) times the corresponding odds of individuals with <12 years of educational attainment. For individuals with depression, the odds of having diabetes for those who were born in Mexico and had <30 years living in the US were 0.04 (95% CI: 0, 0.42) times the corresponding odds of individuals without depression and who were born in the US. Findings suggest clinical and public health systems should be aware of the potential increased risk of diabetes among Mexican-origin adults with hypertension and lower educational attainment.
Collapse
Affiliation(s)
- Mario Morales
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Maia Ingram
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Ramses Sepulveda
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Thomas Nuño
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Ada M Wilkinson-Lee
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
- Department of Mexican American Studies, The University of Arizona, Tucson, AZ 85724, USA
| | - Jill E Guernsey De Zapien
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Scott Carvajal
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| |
Collapse
|
2
|
Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms. Sci Diabetes Self Manag Care 2023; 49:91-100. [PMID: 36942695 DOI: 10.1177/26350106231158827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender. METHODS Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months. RESULTS Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support. CONCLUSIONS Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.
Collapse
Affiliation(s)
- Carol L Mansyur
- Department of Public Health, California State University, Sacramento, California
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, Texas
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
3
|
Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Psychosocial Contributors to Depressive Symptoms in Hispanic Patients With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:415-424. [PMID: 34715762 DOI: 10.1177/26350106211054420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation. METHODS The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors. RESULTS Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes. CONCLUSIONS Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women.
Collapse
Affiliation(s)
- Carol L Mansyur
- Department of Public Health, California State University, Sacramento, California.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
4
|
Martinez-Hollingsworth A, Hamilton N, Choi K, Heilemann M. The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms. Diabetes Res Clin Pract 2021; 175:108787. [PMID: 33845050 DOI: 10.1016/j.diabres.2021.108787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/20/2021] [Accepted: 03/29/2021] [Indexed: 11/20/2022]
Abstract
AIMS The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach. METHODS Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation. RESULTS Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation. CONCLUSION The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.
Collapse
Affiliation(s)
| | - Nalo Hamilton
- University of California, Los Angeles, 5-659 Factor Building, Los Angeles, CA, USA.
| | - Kristen Choi
- University of California, Los Angeles, Factor Building 3-238, Los Angeles, CA, USA.
| | - MarySue Heilemann
- University of California, Los Angeles, Factor Building: 5-252, Los Angeles, CA, USA.
| |
Collapse
|
5
|
Nini Shuhaida MH, Siti Suhaila MY, Azidah KA, Norhayati NM, Nani D, Juliawati M. Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes. J Taibah Univ Med Sci 2019; 14:268-276. [PMID: 31435416 PMCID: PMC6695081 DOI: 10.1016/j.jtumed.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study aims to identify risks induced by depression, anxiety, stress, and socio-demographic factors associated with poor glycaemic control among type II diabetes mellitus patients in Kuala Terengganu, Malaysia. METHODS This cross-sectional study was performed in two Malaysian health clinics by using the Malay version of a self-administered questionnaire. This instrument contains a diabetes care profile, a 21-item version of the Depression Anxiety Stress Scales (DASS21), and a Malaysian Medication Adherence Score (MalMAS). Simple and multiple logistic regression analyses were performed. RESULTS A total of 338 type II diabetes mellitus patients responded (response rate 93.1%). The proportion of patients with poor glycaemic control was 76.0%. Multiple logistic regression analysis showed that 1) social support scores [Adj. OR (95% CI): 1.06 (1.03,1.10); p = 0.001]; 2) unemployment [Adj. OR (95% CI): 0.46 (0.22,0.95); p = 0.035]; 3) pensioner status [Adj. OR (95% CI): 0.28 (0.13,0.61); p = 0.001]; and 4) perception of diabetes as interfering with daily living activities [Adj. OR (95% CI): 3.18 (1.17,8.70); p = 0.024] were significant factors for poor glycaemic control. CONCLUSIONS Unemployment, perception of diabetes' interference with daily living activities, and social support are significantly correlated with poor glycaemic control. Further studies assessing other important clinical and psychosocial factors that may influence glycaemic control are suggested. A younger age range of participants is recommended for better outcomes and interventional implementation of findings.
Collapse
Affiliation(s)
| | - Mohd Y. Siti Suhaila
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Kadir A. Azidah
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor M. Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Draman Nani
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Muhammad Juliawati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| |
Collapse
|
6
|
Bergmans RS, Zivin K, Mezuk B. Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study. J Psychosom Res 2019; 117:22-29. [PMID: 30665592 PMCID: PMC6467465 DOI: 10.1016/j.jpsychores.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes. METHODS Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms. RESULTS Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014. CONCLUSION The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.
Collapse
Affiliation(s)
- Rachel S Bergmans
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States; Department of Veterans Affairs, Ann Arbor, MI, United States
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
| |
Collapse
|
7
|
Oh H, Ell K. Associations Between Changes in Depressive Symptoms and Social Support and Diabetes Management Among Low-Income, Predominantly Hispanic Patients in Patient-Centered Care. Diabetes Care 2018; 41:1149-1156. [PMID: 29588293 DOI: 10.2337/dc17-2000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/04/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. RESEARCH DESIGN AND METHODS Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a self-management intervention assisted by a promotora (Hispanic community health worker). Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. RESULTS Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. CONCLUSIONS Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management.
Collapse
Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University, Phoenix, AZ
| | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| |
Collapse
|
8
|
Salinas JJ, Gonzalez JMR, Al Snih S. Type 2 diabetes, depressive symptoms and disability over a 15-year follow-up period in older Mexican Americans living in the southwestern United States. J Diabetes Complications 2018; 32:75-82. [PMID: 29074123 PMCID: PMC5662478 DOI: 10.1016/j.jdiacomp.2016.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/18/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate how depression and diabetes severity impact disability progression among Mexican Americans over a 15-year period. METHODS We used seven waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Primary disability outcomes included the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Explanatory variables included time since diagnosis with diabetes (no type 2 diabetes, 1-10, 11-20, 21+), an indicator of disease severity, and depression. Longitudinal generalized estimating equation models were used to estimate the relationship between time since diabetes diagnosis, depressive symptoms and ADL and IADL disability progression over a 15-year time period. RESULTS Years since diabetes diagnosis was associated with more rapid ADL and IADL disability progression compared to those without type 2 diabetes. Depression accelerated the disabling process in participants who were diagnosed with diabetes 11years or more years ago. CONCLUSIONS Longer duration of diabetes and greater symptoms of depression increase vulnerability for disability among older Mexican American adults.
Collapse
Affiliation(s)
- Jennifer J Salinas
- Department of Epidemiology, Human Genetics, Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, United States, 1101 N. Campbell St., El Paso, TX 79902, USA.
| | - Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics, Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 6011 Harry Hines Blvd., Suite V8.112, Dallas, TX 75390, USA.
| | - Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, Internal Medicine, Division of Geriatrics, Sealy Center on Aging Rebecca Sealy Bldg 5.112A, 301 University Blvd. Rt. 0177, Galveston, TX, 77555, USA.
| |
Collapse
|
9
|
Diabetes Distress and Depression in South Asian Canadians with Type 2 Diabetes. Can J Diabetes 2017; 41:69-72. [DOI: 10.1016/j.jcjd.2016.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 07/25/2016] [Indexed: 12/16/2022]
|
10
|
D'Amato C, Morganti R, Greco C, Di Gennaro F, Cacciotti L, Longo S, Mataluni G, Lauro D, Marfia GA, Spallone V. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res 2016; 13:418-428. [PMID: 27334483 DOI: 10.1177/1479164116653240] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. METHODS In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. RESULTS In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). CONCLUSION Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.
Collapse
Affiliation(s)
- Cinzia D'Amato
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Morganti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Di Gennaro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Laura Cacciotti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Longo
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgia Mataluni
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Girolama A Marfia
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|