ABSTRACT
The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.
Subject(s)
Mass Screening , Medically Underserved Area , Mobile Health Units/standards , Primary Prevention , Adolescent , Adult , Boston , Cost-Benefit Analysis , Data Collection/methods , Female , Health Services Accessibility/organization & administration , Humans , Logistic Models , Male , Mass Screening/economics , Middle Aged , Poverty Areas , Primary Prevention/economics , Young AdultSubject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Autoimmunity/drug effects , HIV Infections , Immune Reconstitution Inflammatory Syndrome , Lupus Erythematosus, Systemic , Adult , Antiretroviral Therapy, Highly Active/methods , Autoimmunity/immunology , Disease Management , Female , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/immunology , Humans , Immune Reconstitution Inflammatory Syndrome/etiology , Immune Reconstitution Inflammatory Syndrome/immunology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/physiopathology , Lupus Erythematosus, Systemic/therapyABSTRACT
OBJECTIVE: Insulin resistance has been described in type 1 diabetes mellitus, is related to risk of vascular complications, and may be more common in certain ethnic groups. Estimated glucose disposal rate (eGDR) is a validated clinical tool for estimating insulin sensitivity in type 1 diabetes. Because previous reports of eGDR in adults with type 1 diabetes have included few ethnic minorities, this study explored interethnic differences in eGDR and the relationship of eGDR with diabetic vascular complications. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study using a sample that included 207 white, black, or Hispanic adults with prior clinical diagnosis of type 1 diabetes who were receiving care at an urban academic medical center. eGDR (milligrams per kilogram per minute) was calculated using HbA1c, waist circumference, and hypertensive status. Race/ethnicity was self-reported. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CIs of association of eGDR with diabetes complications (cardiovascular disease, retinopathy, albuminuria, and chronic kidney disease above stage 3). RESULTS: Forty-two percent of the participants were women, and mean age was 45 ± 15 years; 34% were white, 32% were Hispanic, and 34% were black. Ethnicity was significantly associated with eGDR; blacks had significantly lower eGDR (5.66 ± 2.34) than Hispanics (6.70 ± 2.29) and whites (7.20 ± 2.03) (P < 0.001). Patients with the lowest eGDR compared with the highest had a significantly greater risk of any diabetes complication (OR 3.1 [95% CI 1.2-8.1]) compared with the least insulin-resistant patients. CONCLUSIONS: In an urban clinic population of patients with type 1 diabetes, blacks were significantly less insulin sensitive than whites or Hispanics, and lower eGDR was associated with diabetes complications. Further study is needed to determine whether using eGDR to target interventions can improve outcomes.
Subject(s)
Diabetes Mellitus, Type 1/physiopathology , Glucose/metabolism , Insulin Resistance , Adult , Black People/statistics & numerical data , Cross-Sectional Studies , Diabetes Complications/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Ethnicity , Female , Glycated Hemoglobin/analysis , Hispanic or Latino/statistics & numerical data , Humans , Hypertension/complications , Hypertension/ethnology , Male , Middle Aged , New York City/epidemiology , Waist Circumference/ethnology , White People/statistics & numerical dataABSTRACT
This study investigated relationships of culture and physiology with chocolate cravings. Gender differences in chocolate cravings in Spaniards and Americans were examined using parallel Spanish- and English-version questionnaires administered to 259 undergraduate students at one university in Spain and 306 at one university in the US. Responses were examined separately for men and women in American and Spanish samples using multivariate analyses to control for variables like chocolate availability and cultural involvement (which was described by country of birth, years spent in that country, media use, and cultural identification). Chocolate was the most craved food among all Spanish students, but only female American students. A total of 91% of American women and 59% of American men reported chocolate cravings, and this significant difference persisted when controlling for American cultural involvement. In contrast, 90% of Spanish women versus 78% of Spanish men reported chocolate cravings, but the gender difference was no longer significant when controlling for Spanish cultural involvement. These results do not reject a role of physiology in chocolate cravings, but suggest that American culture encourages disproportionately more chocolate cravings among females than males, and that globalization may have led to a similar craving pattern among Spaniards, although gender differences in cravings are less clear-cut than they are in the US.