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1.
Nature ; 531(7592): 83-7, 2016 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-26878237

RESUMEN

Copper and zinc form an important group of hydroxycarbonate minerals that include zincian malachite, aurichalcite, rosasite and the exceptionally rare and unstable--and hence little known and largely ignored--georgeite. The first three of these minerals are widely used as catalyst precursors for the industrially important methanol-synthesis and low-temperature water-gas shift (LTS) reactions, with the choice of precursor phase strongly influencing the activity of the final catalyst. The preferred phase is usually zincian malachite. This is prepared by a co-precipitation method that involves the transient formation of georgeite; with few exceptions it uses sodium carbonate as the carbonate source, but this also introduces sodium ions--a potential catalyst poison. Here we show that supercritical antisolvent (SAS) precipitation using carbon dioxide (refs 13, 14), a process that exploits the high diffusion rates and solvation power of supercritical carbon dioxide to rapidly expand and supersaturate solutions, can be used to prepare copper/zinc hydroxycarbonate precursors with low sodium content. These include stable georgeite, which we find to be a precursor to highly active methanol-synthesis and superior LTS catalysts. Our findings highlight the value of advanced synthesis methods in accessing unusual mineral phases, and show that there is room for exploring improvements to established industrial catalysts.

2.
Acc Chem Res ; 52(10): 2950-2959, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31571486

RESUMEN

Lead halide perovskites (LHPs) are attractive material systems for light emission, thanks to the ease and diverse routes of synthesis, the broad tunability in color, the high emission quantum efficiencies, and the strong light-matter coupling which may potentially lead to exciton-polariton condensation. This account contrasts the laser-like coherent light emission from highly lossy Fabry-Perot cavities, formed naturally from LHP nanowires (NWs) and nanoplates (NPs), with highly reflective cavities made of LHP gain media, sandwiched between two distributed Bragg reflector (DBR) mirrors. The mechanism responsible for the operation of conventional semiconductor lasers involves stimulated emission of electron and hole pairs bound by the Coulomb potential, i.e., excitons or, at excitation density above the so-called Mott threshold, an electron-hole plasma (EHP). We discuss how lasing from LHP NWs or NPs likely originates from stimulated emission of an EHP, not excitons or exciton-polaritons. A character central to this kind of lasing is the dynamically changing photonic properties in the naturally formed cavity. In contrast to the more static conditions of a DBR cavity, lasing modes and gain profiles are extremely sensitive to material properties and excitation conditions in an NW/NP cavity. While such unstable photonic cavities pose engineering challenges in the application of NW/NP lasers, they provide excellent probes of many-body physics in the LHP material. For sufficiently strong light-matter coupling expected for LHPs in DBR cavities, an exciton-polariton, i.e., the superposition state between the exciton and the cavity photon, can form. An exciting prospect of strong light-matter coupling is the potential formation of an exciton polariton condensate, which possesses many interesting quantum and nonlinear effects, such as superfluidity, long-range coherence, and laserlike light emission. However, it is difficult to distinguish coherent light from an exciton-polariton condensate and that from conventional stimulated laser emission. Several reports have established the condition of strong coupling for LHPs in DBR cavities. We stress, however, that these studies have not included necessary experiments to unambiguously establish the formation of exciton-polariton condensation, and several experiments and routes of analysis are needed to make a more convincing case for exciton-polariton condensation in LHP based systems. The potential of exciton-polariton condensation expands the horizon of LHP materials from conventional optoelectronics to quantum devices.

3.
Hum Biol ; 92(1): 45-57, 2020 11 17.
Artículo en Inglés | MEDLINE | ID: mdl-33231026

RESUMEN

Native Hawaiian and other Pacific Islanders, and the environment they are in relationship with, have been the targets of exploitation, extraction, and destruction. Environmental atrocities throughout the Pacific have demonstrated how imperialism, capitalism, and white supremacy drive destruction through efforts to dominate and exploit for material gain. The relationship between Pacific people and the environment, which defines who they are socially, spiritually, and ancestrally, continues to be damaged and even severed by these injustices. The purpose of this article is to provide examples of major environmental injustices in the Pacific and to develop a deeper understanding of the relationship between settler colonialism and environmental injustices. Indigenous knowledge, with a focus on traditional ecological knowledge, is incorporated not just to demonstrate the deep impact of injustices on Pacific people's cultures but also to highlight how this way of knowing cultivates a path to revitalization and community resilience. Cultural practices rooted in traditional ecological knowledge, such as the preservation of food systems, promote reciprocity between living beings and self-determination, necessary for community flourishing. With this understanding, Pacific peoples' relationship with their land offers further evidence of the critical role culture and Indigenous knowledge can play in environmental justice policies and practices.


Asunto(s)
Colonialismo , Nativos de Hawái y Otras Islas del Pacífico , Hawaii , Humanos , Población Blanca
4.
J Ethn Cult Divers Soc Work ; 30(1-2): 1-12, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-34135696

RESUMEN

This special issue and introduction focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean. We provide an overview of the current state of health equity across social, physical, and mental health domains. In Part 1 of the special issue, we trace promotive, protective, and risk factors related to Indigenous health equity. Part 2 of the special issue describes interventions that address and promote wellness, providing promising pathways to achieving and transcending health equity.

5.
J Am Chem Soc ; 141(33): 13143-13147, 2019 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-31357860

RESUMEN

Singlet fission, the generation of two triplet excited states from the absorption of a single photon, may potentially increase solar energy conversion efficiency. A major roadblock in realizing this potential is the limited number of molecules available with high singlet fission yields and sufficient chemical stability. Here, we demonstrate a strategy for developing singlet fission materials in which we start with a stable molecular platform and use strain to tune the singlet and triplet energies. Using perylene diimide as a model system, we tune the singlet fission energetics from endoergic to exoergic or iso-energetic by straining the molecular backbone. The result is an increase in the singlet fission rate by 2 orders of magnitude. This demonstration opens a door to greatly expanding the molecular toolbox for singlet fission.

6.
Am J Community Psychol ; 64(1-2): 107-117, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31322733

RESUMEN

Although Hawai'i is often portrayed as an idyllic paradise and is recognized as one of the healthiest States in the United States, pervasive health disparities exist among Native Hawaiians. Similar to other indigenous populations across the globe, these disparities are linked to unjust social and economic policies rooted in colonization and historical trauma. Western-centric efforts to address these disparities have yielded limited results. Consequently, indigenous frameworks to decolonize western-centric research processes have emerged. The Waimanalo Pono Research Hui is an example of a community-academic partnership that uses indigenous methodologies and principles of community-based participatory research as the foundation to engage Native Hawaiian community members in research. Monthly gatherings are held where community members and academic researchers share a meal and discuss community priorities with the goal of shaping research and programming that are rooted in Native Hawaiian values. A mission for the group has been created as well as protocols for community engagement to ensure all projects that work with the Waimanalo Pono Research Hui are ethically sound and grounded in the community's preferences, cultural knowledge, and lived experiences. Our community members continually report that the Waimanalo Pono Research Hui has positively transformed their perception of and willingness to engage in research. Similarly, university students and academic researchers express how much their knowledge about working with communities has grown and inspired them. Creating spaces for communities and researchers to build authentic relationships and engage in ongoing conversations can promote culturally grounded and community-driven research and programming.


Asunto(s)
Investigación Participativa Basada en la Comunidad/métodos , Relaciones Comunidad-Institución , Competencia Cultural , Promoción de la Salud/métodos , Pueblos Indígenas , Investigación Participativa Basada en la Comunidad/organización & administración , Cultura , Hawaii , Promoción de la Salud/organización & administración , Humanos
7.
Faraday Discuss ; 197: 287-307, 2017 04 28.
Artículo en Inglés | MEDLINE | ID: mdl-28197597

RESUMEN

The effect of sodium species on the physical and catalytic properties of Cu/ZnO catalysts derived from zincian georgeite has been investigated. Catalysts prepared with <100 ppm to 2.1 wt% Na+, using a supercritical CO2 antisolvent technique, were characterised and tested for the low temperature water-gas shift reaction and also CO2 hydrogenation to methanol. It was found that zincian georgeite catalyst precursor stability was dependent on the Na+ concentration, with the 2.1 wt% Na+-containing sample uncontrollably ageing to malachite and sodium zinc carbonate. Samples with lower Na+ contents (<100-2500 ppm) remained as the amorphous zincian georgeite phase, which on calcination and reduction resulted in similar CuO/Cu particle sizes and Cu surface areas. The aged 2.1 wt% Na+ containing sample, after calcination and reduction, was found to comprise of larger CuO crystallites and a lower Cu surface area. However, calcination of the high Na+ sample immediately after precipitation (before ageing) resulted in a comparable CuO/Cu particle size to the lower (<100-2500 ppm) Na+ containing samples, but with a lower Cu surface area, which indicates that Na+ species block Cu sites. Activity of the catalysts for the water-gas shift reaction and methanol yields in the methanol synthesis reaction correlated with Na+ content, suggesting that Na+ directly poisons the catalyst. In situ XRD analysis showed that the ZnO crystallite size and consequently Cu crystallite size increased dramatically in the presence of water in a syn-gas reaction mixture, showing that stabilisation of nanocrystalline ZnO is required. Sodium species have a moderate effect on ZnO and Cu crystallite growth rate, with lower Na+ content resulting in slightly reduced rates of growth under reaction conditions.

8.
Ann Fam Med ; 13 Suppl 1: S27-35, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26304969

RESUMEN

PURPOSE: We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA1c). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support. METHODS: We randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months. RESULTS: No changes in HbA1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m(2), P = .032) than the DSME-alone group. CONCLUSIONS: In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.


Asunto(s)
Negro o Afroamericano , Consejo/métodos , Diabetes Mellitus Tipo 2/terapia , Grupo Paritario , Autocuidado/métodos , Apoyo Social , Negro o Afroamericano/psicología , Anciano , Presión Sanguínea , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/psicología , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Poder Psicológico , Autocuidado/psicología
10.
Australas Psychiatry ; 23(6 Suppl): 45-7, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26634670

RESUMEN

OBJECTIVES: There is an increasing interest in conducting research within indigenous communities among indigenous and non-indigenous researchers alike. This paper offers the critical reflections of one Native Hawaiian researcher and the process of engaging in research as both an insider-outsider. CONCLUSIONS: Community-based, participatory research (CBPR) offers one model for outsiders to work effectively with indigenous communities, but CBPR also offers valuable principles for insiders who desire to work with their own communities.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Nativos de Hawái y Otras Islas del Pacífico/psicología , Investigadores/psicología , Humanos
11.
Prof Psychol Res Pr ; 45(3): 153-162, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26538802

RESUMEN

This study used qualitative methods and quantitative statistical analyses to examine whether race and gender are associated with reasons for which adults perceive a situation or object as fearful. The sample consists of 197 African-American and White adults (ages 18-85) recruited through a convenience sample and community sources in the Midwest. A cognitive interviewing instrument was utilized to examine respondents understanding of words and phrases from a mental health instrument. Using qualitative methods, free-response answers were content coded using 5 "fear-codes" (i.e., harm/danger, external locus of control, self-perception, and past experience), developed by the researchers. Results from logistic regression analyses indicate that race significantly predicts usage of specific fear codes (p<.05). In addition, a race by gender interaction was found.

12.
Prev Med Rep ; 39: 102658, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38380385

RESUMEN

Objectives: To describe the social drivers of health and health status of Native Hawaiian and Pacific Islander (NHPI) youth in the US. Methods: This is a cross-sectional analysis of the 2014 NHPI National Health Interview Survey (NHIS) which surveyed about 3,000 NHPI households, including 1,428 NHPI youth (884 0-12 yo, 421 13-17 yo, and 123 18-21 yo). We described domains of social drivers of health (SDoH), health conditions, and associations of income and food insecurity with body mass index (BMI) for NHPI youth. Results: NHPI youth come from households with a wide range in income. Approximately 20% of the cohort were food insecure. Among 18-21 yo, 10% report chronic medical conditions (5% with prediabetes). 33% of 13-17 yo and 52% of 18-21 yo were overweight/ obese. For 13-17 yo, lower income was associated with higher BMI. There was no association between food insecurity and BMI for any age group. Conclusions: Overweight/ obesity are highly prevalent among NHPI youth which is concerning for development of diabetes, hypertension, cardiovascular and kidney disease. Health efforts should focus on SDoH, obesity prevention and management for NHPI youth.

13.
Health Equity ; 6(1): 564-573, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36081882

RESUMEN

Introduction: Pasifika (Native Hawaiian and Pacific Islander) people living in the United States experience health, economic, and social inequities, and a disproportionate burden of COVID-19 cases and deaths. This study examines employment among Pasifika living in the 10 US states with the largest Pasifika populations during the COVID-19 pandemic. Methods: We use the Current Population Survey to examine racial differences in employment status, paid work from home (PWFH), and industry telework friendliness. We use data from the Washington Office of Fiscal Management and the Washington State (WA) Employment Security Department to examine county-level unemployment claims. Results: Nationally, Pasifika did not self-report unemployment significantly more than Black, Latino, Asian, and American Indian/Alaska Native respondents, but in WA counties with high Pasifika concentrations, unemployment insurance claim rates were higher compared with all other racial groups, particularly Whites and Asians. Surprisingly, Pasifika had more PWFH opportunities, but worked in less telework-friendly industries nationally. Discussion: This study demonstrates the complexity of employment among Pasifika during the COVID-19 pandemic. The findings correspond with national reports of racialized communities impacted by unemployment, including Pasifika. Marginally significant differences in unemployment nationally may be due to Pasifika working largely in essential industries requiring workplace attendance. Health Equity Implications: Although overlooked or overshadowed by size, our findings highlight the need for continued advocacy to support data disaggregation and Pasifika data sovereignty. This can be achieved through collaborations between researchers as well as local and community organizations to address data needs of Pasifika communities.

14.
Patient Educ Couns ; 105(7): 2166-2173, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-34903389

RESUMEN

OBJECTIVE: To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes. METHODS: The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c. RESULTS: The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress. CONCLUSIONS: Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os. PRACTICE IMPLICATIONS: Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.


Asunto(s)
Agentes Comunitarios de Salud , Diabetes Mellitus Tipo 2 , Adulto , Negro o Afroamericano , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/análisis , Hispánicos o Latinos , Humanos , Autocuidado
15.
Artículo en Inglés | MEDLINE | ID: mdl-36231282

RESUMEN

While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.


Asunto(s)
Diabetes Mellitus Tipo 2 , Agentes Comunitarios de Salud , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/análisis , Hispánicos o Latinos , Humanos , Modelos Lineales
16.
Am J Public Health ; 101(12): 2253-60, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21680932

RESUMEN

OBJECTIVES: We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control. METHODS: We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. RESULTS: Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P < .01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. CONCLUSIONS: This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery.


Asunto(s)
Negro o Afroamericano , Agentes Comunitarios de Salud , Diabetes Mellitus Tipo 2/etnología , Hispánicos o Latinos , Educación del Paciente como Asunto , Autocuidado , Adulto , Investigación Participativa Basada en la Comunidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Michigan , Persona de Mediana Edad , Pobreza , Población Urbana
17.
Subst Use Misuse ; 46(10): 1256-64, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21619444

RESUMEN

Filipino American drinkers (N = 1,443) in Honolulu and San Francisco were selected from the 1998-1999 Filipino American Community Epidemiological Survey to examine the association between perceived discrimination and heavy drinking behavior by immigration status. Results indicate that living in San Francisco, lower religious participation, and higher perceived discrimination were associated with increased odds for heavy drinking among US-born individuals, whereas being male was a risk factor among foreign-born individuals. Thus, perceived discrimination and immigration status should be considered when designing prevention and intervention strategies to address heavy drinking behavior in this population.


Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Intoxicación Alcohólica/etnología , Asiático/psicología , Emigración e Inmigración , Prejuicio , Consumo de Bebidas Alcohólicas/psicología , Intoxicación Alcohólica/psicología , Femenino , Humanos , Masculino , Filipinas/etnología , Factores de Riesgo , Percepción Social , Estados Unidos
18.
Sch Psychol ; 36(6): 546-554, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34766816

RESUMEN

As schools physically closed across the country to protect against the spread of the COVID-19 pandemic, it became clear early on that the burden on students will not be equally shared. Structural racism patterns the lives of people of color that, in turn, increases their exposure to the effects of the pandemic further impacting the quality of education the students of color have access to. It is critical to examine the ways in which racial disparities in social emotional and educational outcomes have the potential to increase as a result of the pandemic. To that end, using a content analysis of an open-ended survey, this study examines (a) how teachers and school staff experienced the pandemic, (b) their perception of student experiences during the transition to remote learning, and (c) school staff's perceptions of how racial inequities may be increased as a result of the pandemic. Our findings highlight the deep, but unequal impact of the pandemic on school staff, students, and their families. Teachers are overwhelmed and overworked, struggling to manage multiple roles while working at home. They also have tremendous empathy for the weight of the losses that students have experienced, and concern for the well-being of students in difficult living or family situations. However, most school staff maintained a colorblind analysis of the way the pandemic is affecting their students and did not recognize the role of systemic racism or potential for racial disparities to be increased. Implications and limitations are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
COVID-19 , Pandemias , Humanos , Percepción , SARS-CoV-2 , Instituciones Académicas
19.
Sci Adv ; 7(49): eabj7667, 2021 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-34851673

RESUMEN

Spin-orbit coupling (SOC) is responsible for a range of spintronic and topological processes in condensed matter. Here, we show photonic analogs of SOCs in exciton-polaritons and their condensates in microcavities composed of birefringent lead halide perovskite single crystals. The presence of crystalline anisotropy coupled with splitting in the optical cavity of the transverse electric and transverse magnetic modes gives rise to a non-Abelian gauge field, which can be described by the Rashba-Dresselhaus Hamiltonian near the degenerate points of the two polarization modes. With increasing density, the exciton-polaritons with pseudospin textures undergo phase transitions to competing condensates with orthogonal polarizations. Unlike their pure photonic counterparts, these exciton-polaritons and condensates inherit nonlinearity from their excitonic components and may serve as quantum simulators of many-body SOC processes.

20.
Diabetes Care ; 44(5): 1108-1115, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33958424

RESUMEN

OBJECTIVE: To simulate the long-term cost-effectiveness of a peer leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program in reducing risks of complications in people with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: The trial randomized 222 Latino adults with T2D to 1) enhanced usual care (EUC); 2) a CHW-led, 6-month DSME program and 6 months of CHW-delivered monthly telephone outreach (CHW only); or 3) a CHW-led, 6-month DSME program and 12 months of PL-delivered weekly group sessions with telephone outreach to those unable to attend (CHW + PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a health care sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS: Over 20 years, the CHW + PL intervention had an ICER of $28,800 and $5,900 per quality-adjusted life-year (QALY) gained compared with the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared with the EUC intervention. In sensitivity analyses, the results comparing the CHW + PL with EUC and CHW-only interventions were robust to changes in intervention effects and costs. CONCLUSIONS: The CHW + PL-led DSME/DSMS intervention improved health and provided good value compared with the EUC intervention. The 6-month CHW-led DSME intervention without further postintervention CHW support was not cost effective in Latino adults with T2D.


Asunto(s)
Diabetes Mellitus Tipo 2 , Automanejo , Agentes Comunitarios de Salud , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/terapia , Humanos , Salud Pública
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