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Moukarzel S, Zlatar ZZ, Hartman SJ, Lomas D, Feldman HH, Banks SJ. Developing the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia program. Alzheimers Dement (N Y) 2024; 10:e12457. [PMID: 38440783 PMCID: PMC10909928 DOI: 10.1002/trc2.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION With Alzheimer's disease and related dementias (ADRD) representing an enormous public health challenge, there is a need to support individuals in learning about and addressing their modifiable risk factors (e.g., diet, sleep, and physical activity) to prevent or delay dementia onset. However, there is limited availability for evidence-informed tools that deliver both quality education and support for positive behavior change such as by increasing self-efficacy and personalizing goal setting. Tools that address the needs of Latino/a, at higher risk for ADRD, are even more scarce. METHODS We established a multidisciplinary team to develop the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia (HALT-AD) program, a bilingual online personalized platform to educate and motivate participants to modify their risk factors for dementia. Grounded in social cognitive theory and following a cultural adaptation framework with guidance from a community advisory board, we developed HALT-AD iteratively through several cycles of rapid prototype development, user-centered evaluation through pilot testing and community feedback, and refinement. RESULTS Using this iterative approach allowed for more than 100 improvements in the content, features, and design of HALT-AD to improve the program's usability and alignment with the interests and educational/behavior change support needs of its target audience. Illustrative examples of how pilot data and community feedback informed improvements are provided. DISCUSSION Developing HALT-AD iteratively required learning through trial and error and flexibility in workflows, contrary to traditional program development methods that rely on rigid, pre-set requirements. In addition to efficacy trials, studies are needed to identify mechanisms for effective behavior change, which might be culturally specific. Flexible and personalized educational offerings are likely to be important in modifying risk trajectories in ADRD.
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Affiliation(s)
- Sara Moukarzel
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer's Disease Cooperative StudyUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Zvinka Z. Zlatar
- Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Sheri J. Hartman
- Herbert Wertheim School of Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Derek Lomas
- Faculty of Industrial Design EngineeringUniversity of DelftDelftThe Netherlands
| | - Howard H. Feldman
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer's Disease Cooperative StudyUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Sarah J. Banks
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA
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Khedagi A, Ugowe F, Jackson LR. Incidence and Prevalence of Atrial Fibrillation in Latinos: What's New Since the Study in Latinos (SOL)? Curr Cardiol Rep 2023; 25:901-906. [PMID: 37421552 PMCID: PMC10528177 DOI: 10.1007/s11886-023-01910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW To assess contemporary epidemiological trends in AF incidence and prevalence in the LatinX population after the Hispanic Community Health Study/Study of Latinos. RECENT FINDINGS Atrial fibrillation (AF) remains the most abnormal heart rhythm condition globally and disproportionately impacts morbidity and mortality of communities that have been historically disadvantaged. The incidence and prevalence of AF is lower in the LatinX population compared to White individuals despite a higher burden of classic risk factors associated with AF. Since the Hispanic Community Health Study/Study of Latinos study on AF, recent data continues to demonstrate a similar lower burden of AF in the LatinX population compared to White individuals. However, the rates of incident AF may be accelerating faster in the LatinX population compared to their White counterparts. Furthermore, studies have found environmental and genetic risk factors that are associated with the development of AF within LatinX individuals, which may help explain the rising development of AF among the LatinX community. Recent research continues to show that LatinX populations are less likely to be treated with stroke reduction and rhythm control strategies and have a disproportionately higher burden of poor outcomes associated with AF compared to White patients. Our review illuminates that further inclusion of LatinX individuals in AF randomized control trials and observational studies is imperative to understand the incidence and prevalence of AF in the LatinX community and improve overall morbidity and mortality.
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Affiliation(s)
- Apurva Khedagi
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Francis Ugowe
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
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Scalco R, Saito N, Beckett L, Nguyen ML, Huie E, Wang HP, Flaherty DA, Honig LS, DeCarli C, Rissman RA, Teich AF, Jin LW, Dugger BN. The neuropathological landscape of Hispanic and non-Hispanic White decedents with Alzheimer disease. Acta Neuropathol Commun 2023; 11:105. [PMID: 37386610 PMCID: PMC10311731 DOI: 10.1186/s40478-023-01574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 07/01/2023] Open
Abstract
Despite the increasing demographic diversity of the United States' aging population, there remain significant gaps in post-mortem research investigating the ethnoracial heterogeneity in the neuropathological landscape of Alzheimer Disease (AD). Most autopsy-based studies have focused on cohorts of non-Hispanic White decedents (NHWD), with few studies including Hispanic decedents (HD). We aimed to characterize the neuropathologic landscape of AD in NHWD (n = 185) and HD (n = 92) evaluated in research programs across three institutions: University of California San Diego, University of California Davis, and Columbia University. Only persons with a neuropathologic diagnosis of intermediate/high AD determined by NIA Reagan and/or NIA-AA criteria were included. A frequency-balanced random sample without replacement was drawn from the NHWD group using a 2:1 age and sex matching scheme with HD. Four brain areas were evaluated: posterior hippocampus, frontal, temporal, and parietal cortices. Sections were stained with antibodies against Aβ (4G8) and phosphorylated tau (AT8). We compared the distribution and semi-quantitative densities for neurofibrillary tangles (NFTs), neuropil threads, core, diffuse, and neuritic plaques. All evaluations were conducted by an expert blinded to demographics and group status. Wilcoxon's two-sample test revealed higher levels of neuritic plaques in the frontal cortex (p = 0.02) and neuropil threads (p = 0.02) in HD, and higher levels of cored plaques in the temporal cortex in NHWD (p = 0.02). Results from ordinal logistic regression controlling for age, sex, and site of origin were similar. In other evaluated brain regions, semi-quantitative scores of plaques, tangles, and threads did not differ statistically between groups. Our results demonstrate HD may be disproportionately burdened by AD-related pathologies in select anatomic regions, particularly tau deposits. Further research is warranted to understand the contributions of demographic, genetic, and environmental factors to heterogeneous pathological presentations.
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Affiliation(s)
- Rebeca Scalco
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Laurel Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Emily Huie
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Hsin-Pei Wang
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Delaney A Flaherty
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Lawrence S Honig
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Charles DeCarli
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Andrew F Teich
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA.
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Page-Reeves J, Murray-Krezan C, Burge MR, Mishra SI, Regino L, Bleecker M, Perez D, McGrew HC, Bearer EL, Erhardt E. A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management. medRxiv 2023:2023.01.31.23285236. [PMID: 36778329 PMCID: PMC9915824 DOI: 10.1101/2023.01.31.23285236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.
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Affiliation(s)
- Janet Page-Reeves
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Cristina Murray-Krezan
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Shiraz I. Mishra
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lidia Regino
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Molly Bleecker
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Daniel Perez
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Elaine L. Bearer
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
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Rollins A, Wandell G, Epstein S, Bonilla-Velez J. Evaluating Patient and Family Experience Among Spanish-Speaking and LatinX Patients: a Scoping Review of Existing Instruments. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01371-x. [PMID: 35913545 DOI: 10.1007/s40615-022-01371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION LatinX populations are rapidly growing in the USA, but still report lower levels of patient centered care and satisfaction when compared to their non-LatinX white counterparts. This review encompasses literature which describes patient experience instruments that (1) evaluate LatinX experience, (2) have validated Spanish versions, or (3) measure language-concordant care experiences. METHODS A scoping review of literature in Ovid Medline, CINAHL, and PsycINFO was conducted. Articles were excluded if they were not applicable to the health care industry, did not include a patient experience instrument, or did not include LatinX or Spanish-speaking individuals within their study population. Data extraction was performed for concepts measured, study size, population, health care setting, and languages validated. RESULTS This review identified 224 manuscripts. Of these, 81 met full inclusion criteria and represented 60 unique instruments. These covered six categories: general patient experience (43%, n = 26/60), experiences of discrimination/mistrust (12%, n = 7/60), cultural factors (10%, n = 6/60), patient-provider relationship (10%, n = 6/60), and communication (8%, n = 5/60). The remaining instruments measured multiple categories (17%, n = 10/60). Just over one third of instruments (n = 24, 5 pediatric, 19 adult) were validated in Spanish and an additional 14 (23%) were validated in English alone. Finally, 4 (7%) instruments were identified which were developed for use in a language concordant setting. CONCLUSION Many instruments were identified which evaluate LatinX patient experience; however, none was both validated in Spanish and measured in all key categories of experience described above. Additionally, few instruments were developed for holistic evaluation of patient experience in pediatric or language concordant care settings.
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Affiliation(s)
- Allison Rollins
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Grace Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA. .,Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail Stop OA.9.220, Seattle, WA, 98105, USA. .,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
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El-Khayat Y, Franco N, Miller L. Community Conversations About COVID-19. Med Ref Serv Q 2022; 41:223-235. [PMID: 35980632 DOI: 10.1080/02763869.2022.2095815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.
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Affiliation(s)
| | - Nora Franco
- ZSFG Library, University of California San Francisco, USA
| | - Lara Miller
- Oxford College Library, Emory University, Georgia, USA
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Perrino T, Brincks AM, Estrada Y, Messiah SE, Prado G. Reducing Screen-Based Sedentary Behavior Among Overweight and Obese Hispanic Adolescents Through a Family-Based Intervention. J Phys Act Health 2022; 19:509-17. [PMID: 35894971 DOI: 10.1123/jpah.2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sedentary behaviors, including screen-based activities, are associated with obesity, cardiovascular, and mental health risks. In the US, minority and socioeconomically disadvantaged youth engage in substantial sedentariness, requiring targeted interventions. Familias Unidas for Health and Wellness (FUHW) is a family intervention to reduce risks among Hispanic youth with overweight and obesity. Analyses examined (1) FUHW's impact on parent and adolescent screen-based sedentary behavior and (2) differential intervention effects by adolescent gender, internalizing symptoms, and body mass index. METHODS A total of 280 overweight/obese Hispanic middle schoolers and parents were randomized to FUHW or control and assessed at baseline, 6, 12, and 24 months between 2015 and 2019. RESULTS Linear growth models showed that exposure to FUHW was not associated with parent sedentary behavior over time (b = -0.11, P = .32) but was associated with decreases in adolescent sedentary behavior (b = -0.27, P = .03). Neither gender nor internalizing symptoms moderated intervention effects, but there were differential effects by body mass index. Compared to controls, FUHW showed significant decreases in sedentary behavior among overweight (b = -0.85, P < .01) and obese (b = -0.79, P < .01) youth but not severely obese youth. CONCLUSIONS FUHW reduced youth screen-based sedentary behavior. Youth with severe obesity require additional intervention.
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Abdul-Mutakabbir JC, Arya V, Butler L. Acknowledging the intersection of gender inequity and racism: Identifying a path forward in pharmacy. Am J Health Syst Pharm 2021; 79:696-700. [PMID: 34864836 DOI: 10.1093/ajhp/zxab461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Jacinda C Abdul-Mutakabbir
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Vibhuti Arya
- Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, Queens, NY, USA
| | - Lakesha Butler
- Department of Pharmacy Practice, Southern Illinois University ‒ Edwardsville School of Pharmacy, Edwardsville, IL, USA
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Taylor DE. College Students and Nature: Differing Thoughts of Fear, Danger, Disconnection, and Loathing. Environ Manage 2019; 64:79-96. [PMID: 31076829 PMCID: PMC6598941 DOI: 10.1007/s00267-019-01172-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Despite the existence of a robust body of research that investigates human-nature connections, few scholars have examined what people tend to ponder when they think of nature. The objective of the study is to find out how college and university students think about nature. The study also seeks to identify which factors are most significant in influencing students' thoughts about nature. This paper analyzes racial, gender, class, and academic differences in the way college students think about nature. The study of 287 American students found that respondents thought about a wide range of concepts and ideas when they contemplate nature. This article focuses on the demographic differences in thoughts about fear, danger, and loathing. This set of ideas has been the subject of scholarly research, and the findings presented herein contribute to this body of scholarship. The paper discusses both descriptive and multivariate techniques that are used to explore the topic. The study found that white students are less likely than racial/ethnic minorities to think about disconnection, predators, getting lost, loathsome or hateful places, fear, and danger when they think of nature. However, the results also show that it would be inaccurate to describe racial/ethnic minorities as universally fearful of and disconnected from nature. Moreover, the paper demonstrates that race is not the only explanatory variable that has significant impacts in multivariate models-the student's academic interest has significant impacts on thoughts about natural hazards, disconnection, predators, human-made hazards, and loathsome or hateful places. Gender, age, parental education, and first-generation college attendance also has significant impacts on the dependent variables.
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Affiliation(s)
- Dorceta E Taylor
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA.
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