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Boswell E, Probst J, Hung P, Herbert L, Crouch E. Rural-Urban Differences in Self-Reported Participation in Diabetes Self-Management Education. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00239. [PMID: 39248720 DOI: 10.1097/phh.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
CONTEXT Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties. OBJECTIVE The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability. DESIGN This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence. SETTING BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States. PARTICIPANTS The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions. MAIN OUTCOME MEASURES The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves. RESULTS Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio = 0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]). CONCLUSIONS Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.
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Affiliation(s)
- Emma Boswell
- Author Affiliations: Rural and Minority Health Research Center, (Ms Boswell and Drs Probst and Crouch); Department of Health Services Policy and Management, Arnold School of Public Health, (Drs Hung and Crouch); and College of Nursing, University of South Carolina, Columbia, South Carolina (Dr Herbert)
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Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands. Disaster Med Public Health Prep 2021; 17:e50. [PMID: 34674786 DOI: 10.1017/dmp.2021.301] [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: 02/07/2023]
Abstract
OBJECTIVE The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands. METHODS Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018. RESULTS ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms. CONCLUSIONS Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.
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Avilés-Santa ML, Hsu L, Lam TK, Arteaga SS, Artiles L, Coady S, Cooper LS, Curry J, Desvigne-Nickens P, Nicastro HL, Rosario A. Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas. Front Public Health 2020; 8:330. [PMID: 33014952 PMCID: PMC7493677 DOI: 10.3389/fpubh.2020.00330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
Hispanics/Latinos are expected to constitute 25% of the U.S. population by 2060. Differences in the prevalence of health risk factors, chronic diseases, and access to and utilization of health-care services between Hispanics/Latinos and other populations in the U.S. have been documented. This study aimed to describe and analyze the landscape of Research Program Grants (RPGs) funded by the National Institutes of Health (NIH) between 2008 and 2015 involving Hispanic/Latino health research in six health condition areas-asthma, cancer, dementia, diabetes, liver/gallbladder disease, and obesity-and to identify opportunities for continued research in these areas. Using an NIH internal search engine, we identified new and renewal Hispanic/Latino health RPGs searching for specific Hispanic/Latino identifiers in the Title, Abstract, and Specific Aims. We used descriptive statistics to examine the distribution of funded RPGs by NIH disease-based classification codes for the six health condition areas of interest, and other selected characteristics. The most prominent clusters of research subtopics were identified within each health condition area, and performance sites were mapped at the city level. Within the selected time frame, 3,221 Hispanic/Latino health-related unique RPGs were funded (constituting 4.4% of all funded RPGs), and of those 625 RPGs were eligible for review and coding in the present study. Cancer and obesity were the most commonly studied health condition areas (72%), while studies on mechanisms of disease-biological and non-biological-(72.6%), behavioral research (42.1%) and epidemiological studies (38.1%) were the most common types of research. Most of the primary performance sites were in California, Texas, the northeastern U.S., and Illinois. The predominance of mechanistic, behavioral, and epidemiological studies in our analysis poses opportunities to evaluate knowledge gained and their clinical application, explore new research questions, or to update some methods or instruments. The findings of the present study suggest opportunities to expand research in understudied mechanisms of disease that could explain differences in prevalence of conditions like diabetes and cancer among different heritage groups. In addition, our findings suggest that the impact of interventions or policies designed to reduce health disparities, innovative multi-level interventions, implementation and dissemination studies, the role of health information technology on health outcomes, and the intersectionality of individual, sociocultural, geographic, and other factors on health outcomes, among others, are understudied approaches, which could potentially advance research in Hispanic/Latino health and contribute to the achievement of better health outcomes in this diverse population.
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Affiliation(s)
- M. Larissa Avilés-Santa
- Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Laura Hsu
- Division of Extramural Research Activities, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - S. Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Ligia Artiles
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Sean Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Jennifer Curry
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Holly L. Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Adelaida Rosario
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
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Li J, Gu L, Guo Y. An educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers. J Clin Nurs 2019; 28:2506-2516. [PMID: 30697849 DOI: 10.1111/jocn.14810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 01/14/2023]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of a 12-week educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers in China. BACKGROUND Diabetes with the coexistence of diabetic retinopathy and foot problems complicating diabetes not only represents a personal disaster, but also becomes a serious burden to public health in China. A foot self-care educational intervention is both cost-effective and feasible even in a health resource-limited setting, which should be developed and evaluated. DESIGN Quasi-experimental. METHODS From July-September 2017, we enrolled 80 eligible hospitalised diabetic retinopathy patients and their primary caregivers by convenient sampling method in a first-class comprehensive hospital in Nantong, in China. Before and after the educational intervention that is in accordance with the TREND statement (for details, see the "Supplementary File 1"), researchers and subjects filled out the self-designed questionnaire on foot problems complicating diabetes and the Diabetic Foot Self-care Behavior Scale, respectively. RESULTS Scores of foot self-care behaviour among the subjects significantly improved from 54.19 ± 8.01-75.85 ± 5.04. The number of patients with fasting blood glucoses <7.0 mmol/L improved from 43 (53.75%)-80 (100%). The results of incidence of foot problems complicating diabetes were not statistically significant. The complete execution of each item in Diabetic Foot Self-care Behavior Scale of subjects was apparently higher. CONCLUSIONS This educational intervention can facilitate positive foot self-care behaviours among the diabetic retinopathy patients with visual disability and their primary caregivers in China. RELEVANCE TO CLINICAL PRACTICE This study adds to the evidence of the effectiveness of an educational intervention to foster positive foot self-care behaviours. This educational intervention appears to be prospective in promoting diabetic home-based self-management in China, and the delivery method of the intervention may be applied to other chronic diseases.
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Affiliation(s)
- Jiayu Li
- School of Nursing, Nantong University, Nantong, China
| | - Lipei Gu
- School of Nursing, Nantong University, Nantong, China
| | - Yujie Guo
- School of Nursing, Nantong University, Nantong, China
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