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Phelan S, Tseng M, Kelleher A, Kim E, Macedo C, Charbonneau V, Gilbert I, Parro D, Rawlings L. Increasing Access to Medical Care for Hispanic Women Without Insurance: A Mobile Clinic Approach. J Immigr Minor Health 2024; 26:482-491. [PMID: 38170427 DOI: 10.1007/s10903-023-01575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
The purpose of this study was to describe the health status and barriers of people who sought care on a free mobile health clinic for women without insurance in California. Participants were 221 women who attended the Salud para Mujeres (Women's Health) mobile medical clinic between 2019 and 2021. Medical chart abstractions provided data on sociodemographic factors, medical history, barriers to care, depressive symptoms, and dietary factors. Anthropometric measure, blood pressure, and biomarkers of cardiometabolic disease risk were also abstracted. Participants were young adult (29.1 [SD 9.3] years), Hispanic (97.6%), farm-working (62.2%) women from Mexico (87.0%). Prevalent barriers to accessing (non-mobile) medical care included high cost (74.5%), language (47.6%), hours of operation (36.2%), and transportation (31.4%). The majority (89.5%) of patients had overweight (34.0%) or obesity (55.5%), and 27% had hypertension. Among those (n = 127) receiving a lipid panel, 60.3% had higher than recommended levels of low-density lipoprotein and 89% had lower than recommended levels of high-density lipoprotein. Point-of-care HbA1c tests (n = 133) indicated that 9.0% had diabetes and 24.8% had prediabetes. Over half (53.1%) of patients reported prevalent occupational exposure to pesticides and 19% had moderate to severe depressive symptoms. Weekly or more frequent consumption of sugar sweetened beverages (70.9%) and fast food (43.5%) were also prevalent. Mobile health units have potential for reaching women who face several barriers to care and experience major risk factors for cardometabolic disease. Findings suggest a compelling need to assure that Hispanic and Indigenous women and farmworkers have access to healthcare.
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Affiliation(s)
- Suzanne Phelan
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA.
| | - Marilyn Tseng
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Anita Kelleher
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Erin Kim
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Cristina Macedo
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Vicki Charbonneau
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - David Parro
- SLO NOOR Foundation, San Luis Obispo, CA, USA
| | - Luke Rawlings
- Marian Regional Medical Center, Santa Maria, CA, USA
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2
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Su K, Kim Y, Park Y. Prevalence of Metabolic Syndrome Based on Activity Type and Dietary Habits in Extremely Low-Income Individuals. Nutrients 2024; 16:1677. [PMID: 38892609 PMCID: PMC11175098 DOI: 10.3390/nu16111677] [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: 05/08/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
A high prevalence of metabolic syndrome (MS) and cardiovascular disease among low-income individuals has often been reported. However, there is still a lack of research on the relationship between basic livelihood security (BLS) and MS. This study investigated the prevalence of MS according to activity type, dietary habits, and the nutrient intake characteristics of individuals receiving BLS. Data from 14,803 men and 20,299 women were analyzed to assess the association between receiving BLS and MS. The associations between MS and various factors were analyzed separately in men and women by logistic regression analysis. In this cohort, 5.9% of men and 6.8% of women received BLS; of these, 46.9% and 47.7% had MS, respectively. High caloric intake, low-frequency breakfast consumption, and no nutritional education were associated with MS in both men and women. Among those with a low-frequency walking habit and strength training activity type, MS increased by 1.58 and 1.57 times in men and by 1.47 and 2.16 times in women, respectively. Men who were sedentary for 8 h or more had an increased risk of MS, but there was no association between these in women. BLS nutritional intake characteristics were high in carbohydrates and fat and low in dietary fiber and vitamin C (p < 0.05). In conclusion, establishing a healthy eating pattern through nutritional education and increasing walking and strength training may reduce the risk of MS.
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Affiliation(s)
- Kunxia Su
- Department of Sports, Henan University of Chinese Medicine, Zhengzhou 450046, China;
| | - Yonghwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
| | - Yoonjung Park
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
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Vaid I, Blum E, Nwaise I. Women with Blood Pressure Improvement in the Well-Integrated Screening and Evaluation for Women Across the Nation Program by Race and Ethnicity, 2014-2018. J Womens Health (Larchmt) 2024; 33:467-472. [PMID: 38451720 DOI: 10.1089/jwh.2023.0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to improve the cardiovascular health of women aged 40-64 years with low incomes, and who are uninsured or underinsured. The objective is to examine WISEWOMAN participants with hypertension who had high blood pressure (BP) improvement from January 2014 to June 2018, by race and ethnicity. Also examined was participation in WISEWOMAN Healthy Behavior Support Services (HBSS) and adherence to antihypertensive medication. Materials and Methods: WISEWOMAN data from January 2014 to June 2018 were analyzed by race and ethnicity. BP improvement was defined as at least a 5 mm Hg decrease in systolic or diastolic BP values from baseline screening to rescreening. The prevalence of HBSS participation and antihypertensive medication adherence were calculated among hypertensive women with BP improvement. Results: Approximately 64.2% (4,984) of WISEWOMAN participants with hypertension had at least a 5 mm Hg BP improvement. These improvements were consistent across each race and ethnicity (p = 0.56) in the study. Nearly 70% of women who had BP improvement attended at least one HBSS. Hispanic women (80.1%) had the highest HBSS attendance percentage compared to non-Hispanic Black women (64.1%) and non-Hispanic White women (63.8%; p < 0.001). About 80% of women with BP improvement reported being adherent to antihypertensive medication in the previous 7 days. Conclusions: The proportion of women achieving BP improvement in the WISEWOMAN program was consistent across race and ethnicity. In addition, women with BP improvement reported adherence to antihypertensive medication and participation in HBSS.
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Affiliation(s)
- Isam Vaid
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ethan Blum
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac Nwaise
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fiorini G, Franchi M, Pellegrini G, Rigamonti AE, Sartorio A, Marazzi N, Corrao G, Cella SG. Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy. Sci Rep 2023; 13:7424. [PMID: 37156791 PMCID: PMC10167203 DOI: 10.1038/s41598-023-34572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86-0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58-0.67, RR 0.85 CI 0.78-0.92 respectively) and mental health disorders (RR 0.66 CI 0.61-0.71, RR 0.60 CI 0.54-0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01-1.13, RR 1.18 CI 1.11-1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44-1.97, RR 1.39 CI 1.21-1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi, GSD, Monza, Italy
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Antonello Emilio Rigamonti
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nicoletta Marazzi
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Silvano Gabriele Cella
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
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D’Adamo CR, Workman K, Barnabic C, Retener N, Siaton B, Piedrahita G, Bowden B, Norman N, Berman BM. Culinary Medicine Training in Core Medical School Curriculum Improved Medical Student Nutrition Knowledge and Confidence in Providing Nutrition Counseling. Am J Lifestyle Med 2022; 16:740-752. [PMID: 36389046 PMCID: PMC9644147 DOI: 10.1177/15598276211021749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2023] Open
Abstract
Background: Elective culinary medicine education has become popular to help fill important gaps in physician nutrition training. The implementation and outcomes among the inaugural cohort of medical students who received culinary medicine training as a required component of medical school curriculum at the University of Maryland School of Medicine are described. Methods: Following a series of elective pilot sessions, culinary medicine training was provided to all first-year medical students in the 2019-2020 academic year. The 3-hour training included evidence-based nutrition lecture, cooking simple recipes, and group discussion of the application to personal and patient care. Pre-/postsession questionnaires assessed nutrition knowledge, skills, and attitudes as well as nutritional counseling confidence. Paired t-tests estimated mean differences in outcomes pre- and posttraining. Qualitative data were subjected to thematic analysis. Results: Overall, 119 of 125 (95.2%) students provided pre- and posttraining outcomes data. All nutritional and patient counseling outcomes improved (P < .05). Themes of being better prepared to address healthy eating barriers in patient care and personal ability to make healthy dietary changes were noted in qualitative analysis. Conclusion: One session of culinary medicine training in core medical student curriculum was feasible and improved medical student nutrition knowledge, skills, and attitudes and confidence in patient nutrition counseling.
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Affiliation(s)
- Christopher R. D’Adamo
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology & Public Health,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Kayli Workman
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Christine Barnabic
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Norman Retener
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
| | - Bernadette Siaton
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
| | | | - Brandin Bowden
- The Institute for Integrative Health,
Baltimore, Maryland
| | - Nicola Norman
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
- The Institute for Integrative Health,
Baltimore, Maryland
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Hynicka LM, Piedrahita G, Barnabic C, Rambob I, Berman BM, D'Adamo CR. Interprofessional Culinary Medicine Training Enhanced Nutrition Knowledge, Nutrition Counseling Confidence, and Interprofessional Experience. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:811-820. [PMID: 35834608 DOI: 10.1089/jicm.2022.0573] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Culinary medicine training combining evidence-based nutrition instruction with experiential cooking application has improved nutrition knowledge, skills, and attitudes in the professional and personal lives of medical students. However, interprofessional culinary training remains largely unstudied among professional students who will be involved in collaborative patient care. The goal of this study was to evaluate the feasibility and effectiveness of an elective interprofessional culinary medicine course for students in the medical, pharmacy, social work, nursing, law, and dentistry schools at the University of Maryland, Baltimore. Methods: The interprofessional culinary medicine course was offered in-person at the teaching kitchen of the Nova Institute for Health in 2020 and virtually in 2021 during the COVID pandemic. The training featured five workshops combining instruction in a variety of popular diets, cooking a meal inspired by the diet in focus, and group discussion. Paired t tests were utilized to evaluate changes in pre-/post-training nutrition and interprofessional experience outcomes. Linear regression models were constructed to compare outcomes between in-person and virtual delivery. Results: A total of 62 students participated in the culinary medicine training. Confidence in all nutrition knowledge, skills, and attitudes, as well as interprofessional experience outcomes, improved after the training (p < 0.05). Similar improvements were noted in most outcomes with in-person and virtual delivery in linear regression modeling. Discussion: Interprofessional culinary medicine training is feasible, and virtual delivery may help enhance replicability in other settings.
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Affiliation(s)
- Lauren M Hynicka
- Pharmacy Practice and Science Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Christine Barnabic
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isabel Rambob
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Brian M Berman
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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Walker AM, Lu G, Clifton SC, Ogunsanya ME, Chong BF. Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:916134. [PMID: 35899206 PMCID: PMC9311297 DOI: 10.3389/fmed.2022.916134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is a chronic autoimmune skin disease with potential for systemic involvement, disfigurement, and significant disease burden. The relationships of demographics and socioeconomic status with patients with CLE are emerging topics with important clinical implications. The primary objective of our study is to perform a literature review of studies that have investigated demographic and socioeconomic factors amongst patients with CLE and determine whether these factors influence diagnosis frequency, disease severity and outcomes or health related quality of life. We searched multiple databases to identify literature addressing CLE and concepts such as race, ethnicity, gender, income, education level and geographic location. Information regarding primary research objective was extracted from all full text articles, and a summary of findings was prepared. We found that race and ethnicity can influence CLE diagnosis frequency and disease outcomes. Chronic cutaneous lupus (CCLE) occurs more frequently in Black patients, often with higher overall disease damage. Differences between genders exist in CLE in terms of health-related quality of life, as female gender was a risk factor for worse quality of life in several studies. Lower income, low educational attainment, and lack of health insurance all contribute to poorer overall outcomes in CLE patients. This review will help inform physicians about populations at risk for potentially worse outcomes to guide treatment decisions for patients with CLE and provide important information to design interventions that address modifiable social determinants of health in this population.
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Affiliation(s)
- Amanda M. Walker
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Grace Lu
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Shari C. Clifton
- Health Sciences Library and Information Management, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Motolani E. Ogunsanya
- Department of Pharmacy, Clinical and Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Benjamin F. Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Benjamin F. Chong
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Economic and Cardiometabolic Risk Factors Are Predictors of Lower Thyroid Stimulating Hormone (TSH) Levels in Hispanic/Latinx Adults with Euthyroidism-A Community-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138142. [PMID: 35805800 PMCID: PMC9265905 DOI: 10.3390/ijerph19138142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Thyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM), and within the euthyroid range they may also impact other outcomes, such as mood disorders. This study aimed to observationally examine the relationship between TSH and social determinants of health and clinical measures in a euthyroid Hispanic/Latinx patient sample with a diagnosis of anxiety and/or depression disorders from a community health clinic. A needs assessment was completed using a random sample of 100 de-identified medical records of individuals who received free medical care, including mental health, at a community-based clinic. Those with low normal TSH (<2 mIU/L) compared with high normal TSH (≥2 mIU/L) had a greater odds of food insecurity (p = 0.016) and being at 100% of the federal poverty level (p = 0.015). The low normal TSH group had significantly higher fasting glucose (p = 0.046), hemoglobin A1c (p = 0.018), and total cholesterol (p = 0.034) compared with the high normal TSH group. In those with T2DM, individuals with low normal TSH had six-times greater odds of having high fasting glucose (p = 0.022) and high hemoglobin A1c (p = 0.029). These relationships warrant further study, to inform future public health policies and follow-up care for underserved and vulnerable communities.
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Rivera Rivero B, Makarova A, Sidig D, Niazi S, Abddelgader R, Mirza S, Joud H, Urfi M, Ahmed A, Jureyda O, Khan F, Swanson J, Siddique M, Weare-Regales N, Mirza AS. Nutritional Literacy Among Uninsured Patients With Diabetes Mellitus: A Free Clinic Study. Cureus 2021; 13:e16355. [PMID: 34414041 PMCID: PMC8364779 DOI: 10.7759/cureus.16355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Evaluate nutrition literacy in uninsured subjects with diabetes mellitus (DM) who presented to free diabetes management classes. Design This single-site, cross-sectional observational study recruited thirty subjects from a free clinic for uninsured patients to attend diabetes mellitus, self-management classes. Before starting the classes, DM care-related data were collected, and subjects were administered the Nutrition Literacy Assessment Instrument (NLit). The assessment covers six subscales in nutrition and categorizes results into three possible categories: the likelihood of poor nutrition literacy (NLit Score ≤ 44), the possibility of poor nutrition literacy (NLit Score- 45-57), and the likelihood of good nutrition literacy (NLit score ≥ 58). Results Median glycated haemoglobin (HbA1c) was 7.45% for study participants. The mean NLit score was 38.1 (SD ± 9.4), correlating with a likelihood of poor nutrition literacy. All participants had either likelihood or the possibility of poor nutrition literacy based on the NLit Assessment. There were no participants who scored in the range of likelihood of good nutrition literacy. Subjects who scored in the range of likelihood of poor nutrition literacy had a significantly higher mean HbA1c (8.6 %) than those who scored in the possibility of poor nutrition literacy (6.9 %, p=0.005). Conclusions Poor nutrition literacy is associated with worse glycemic control among uninsured subjects with diabetes mellitus.
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Affiliation(s)
| | - Alena Makarova
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Dina Sidig
- General Medicine, Red Crescent Clinic, Tampa , USA
| | - Saniya Niazi
- General Medicine, Red Crescent Clinic, Tampa, USA
| | | | - Sabbir Mirza
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Hadi Joud
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mustafa Urfi
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Abdillahi Ahmed
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Omar Jureyda
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Firaas Khan
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Justin Swanson
- Miscellaneous, University of South Florida College of Public Health, Tampa, USA
| | - Maqsood Siddique
- Cardiology, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Natalia Weare-Regales
- Endocrinology, Diabetes and Metabolism, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Abu-Sayeef Mirza
- Internal Medicine, University of South Florida Morsani College of Medicine, Florida, USA
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10
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Banerjee S, Puddu A. Outcomes in Pulmonary Hypertension in Relation to Insurance Status: National Hospital Discharge Survey, 2000-2010. Turk Thorac J 2021; 22:182-183. [PMID: 33871345 PMCID: PMC8051291 DOI: 10.5152/turkthoracj.2021.19163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/16/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Srikanta Banerjee
- Walden University, Core Faculty, School of Health Sciences, Minneapolis, USA
| | - Alessandro Puddu
- Department of Biological Sciences, University of New England, Biddeford, United States
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11
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MacDonald MR, Zarriello S, Swanson J, Ayoubi N, Mhaskar R, Mirza AS. Secondary prevention among uninsured stroke patients: A free clinic study. SAGE Open Med 2020; 8:2050312120965325. [PMID: 33110604 PMCID: PMC7564623 DOI: 10.1177/2050312120965325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/18/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.
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Affiliation(s)
| | - Sydney Zarriello
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Justin Swanson
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Noura Ayoubi
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
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12
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Crespo R, Alvarez C, Hernandez I, García C. A spatially explicit analysis of chronic diseases in small areas: a case study of diabetes in Santiago, Chile. Int J Health Geogr 2020; 19:24. [PMID: 32576179 PMCID: PMC7310447 DOI: 10.1186/s12942-020-00217-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/15/2020] [Indexed: 01/25/2023] Open
Abstract
Background There is a strong spatial correlation between demographics and chronic diseases in urban areas. Thus, most of the public policies aimed at improving prevention plans and optimizing the allocation of resources in health networks should be designed specifically for the socioeconomic reality of the population. One way to tackle this challenge is by exploring within a small geographical area the spatial patterns that link the sociodemographic attributes that characterize a community, its risk of suffering chronic diseases, and the accessibility of health treatment. Due to the inherent complexity of cities, soft clustering methods are recommended to find fuzzy spatial patterns. Our main motivation is to provide health planners with valuable spatial information to support decision-making. For the case study, we chose to investigate diabetes in Santiago, Chile. Methods To deal with spatiality, we combine two statistical techniques: spatial microsimulation and a self-organizing map (SOM). Spatial microsimulation allows spatial disaggregation of health indicators data to a small area level. In turn, SOM, unlike classical clustering methods, incorporates a learning component through neural networks, which makes it more appropriate to model complex adaptive systems, such as cities. Thus, while spatial microsimulation generates the data for the analysis, the SOM method finds the relevant socio-economic clusters. We selected age, sex, income, prevalence of diabetes, distance to public health services, and type of health insurance as input variables. We used public surveys as input data. Results We found four significant spatial clusters representing 75 percent of the whole population in Santiago. Two clusters correspond to people with low educational levels, low income, high accessibility to public health services, and a high prevalence of diabetes. However, one presents a significantly higher level of diabetes than the other. The second pair of clusters is made up of people with high educational levels, high income, and low prevalence of diabetes. What differentiates both clusters is accessibility to health centers. The average distance to the health centers of one group almost doubles that of the other. Conclusions In this study, we combined two statistical techniques: spatial microsimulation and selforganising maps to explore the relationship between diabetes and socio-demographics in Santiago, Chile. The results have allowed us to corroborate the importance of the spatial factor in the analysis of chronic diseases as a way of suggesting differentiated solutions to spatially explicit problems. SOM turned out to be a good choice to deal with fuzzy health and socioeconomic data. The method explored and uncovered valuable spatial patterns for health decision-making. In turn, spatial microsimulation.
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Affiliation(s)
- Ricardo Crespo
- Departamento de Ingeniería Geográfica, Universidad de Santiago de Chile, Avenida Libertador Bernardo O'Higgins, 3363, Estación Central, Santiago, Chile.
| | - Claudio Alvarez
- Departamento de Ingeniería Geográfica, Universidad de Santiago de Chile, Avenida Libertador Bernardo O'Higgins, 3363, Estación Central, Santiago, Chile
| | - Ignacio Hernandez
- Departamento de Ingeniería Geográfica, Universidad de Santiago de Chile, Avenida Libertador Bernardo O'Higgins, 3363, Estación Central, Santiago, Chile
| | - Christian García
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
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Mirza AS, Chen L, Amirzadeh S, Majethia S, Joppen J, Mirza S, Mhaskar R, Jaglal M, Ashraf N. Health disparities and chronic disease associated with anemia in free clinics: A retrospective study of uninsured patients in Tampa Bay. Postgrad Med 2019; 131:612-618. [PMID: 31524033 DOI: 10.1080/00325481.2019.1668241] [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: 10/26/2022]
Abstract
Objectives: The objective of this study was to assess the diagnosis and management of anemic patients in free clinics around the Tampa Bay area.Methods: In this retrospective study we extracted data including demographics, chronic diseases, and laboratory values from medical charts of uninsured patients seen in 9 free clinics from January 2016 through December 2017 in the Tampa Bay area, FL, USA. Multiple logistic regression analysis was used to assess relationships between socioeconomic variables and a documented history of anemia.Results: From two years of documented data, 6971 patients were included, of which 367 (5%) had a documented diagnosis of anemia. Most were women (315, 86%), and the median age was 41 years (6-91). Among the 367 patients with anemia,191 (52%) patients had an unspecified type of anemia, 144 (39%) were diagnosed with IDA, 16 (4%) with anemia of chronic disease, and the remaining were other uncommon causes. Only 67% (97/144) of IDA patients had documented iron replacement. Colonoscopies were documented in only 32 (9%) of all patients with anemia, and in 23 (16%) IDA patients. Several chronic diseases were statistically associated and comorbid with a diagnosis of anemia.Conclusions: Uninsured patients with IDA are prescribed iron and undergo colonoscopies at sub-optimal rates. Increasing resources, awareness, and education of providers in these settings could lead to improved treatment practices and decrease the risk of morbidity and mortality.
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Affiliation(s)
- Abu-Sayeef Mirza
- Department of Internal Medicine, University of South Florida, Tampa, USA
| | - Liwei Chen
- Evidenced Based Medicine, University of South Florida, Tampa, USA
| | - Sean Amirzadeh
- Department of Internal Medicine, University of South Florida, Tampa, USA
| | - Saagar Majethia
- College of Arts and Sciences, University of South Florida, Tampa, USA
| | - Jeffrey Joppen
- College of Arts and Sciences, University of South Florida, Tampa, USA
| | - Sabbir Mirza
- College of Arts and Sciences, University of South Florida, Tampa, USA
| | - Rahul Mhaskar
- Evidenced Based Medicine, University of South Florida, Tampa, USA
| | - Michael Jaglal
- Department of Hematology and Oncology, University of South Florida, Tampa, USA
| | - Noman Ashraf
- Department of Hematology and Oncology, University of South Florida, Tampa, USA
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