Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep.

BACKGROUND: Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. METHODS: Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). RESULTS: The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen's d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. CONCLUSIONS: CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02502929.

Community-based diabetes prevention randomized controlled trial in refugees with depression: effects on metabolic outcomes and depression.

Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either (a) antidepressant medication and/or (b) prolonged elevated depressive symptoms. Participants were randomized to one of three community health worker (CHW) interventions: (1) lifestyle intervention called Eat, Walk, Sleep (EWS), (2) EWS plus medication therapy management sessions with a pharmacist/CHW team to resolve drug therapy problems (EWS + MTM), or, (3) social services (SS; control). Assessments were at baseline, post-treatment (12 months), and follow-up (15 months). The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal educational attainment was 7.0 years. Compared to the other arms, EWS + MTM showed a significant decrease in HbA1c and a trend for reduced inflammation and stress hormones. Depressive symptoms improved for EWS and EWS + MTM relative to SS. There was no change in insulin resistance. Cardiometabolic and mental health can be improved in tandem among immigrant and refugee groups.

Prevalence of Face Mask Wearing in Northern Vermont in Response to the COVID-19 Pandemic.

OBJECTIVES: Information on the prevalence of face mask use to reduce the spread of SARS-CoV-2 is needed to model disease spread and to assess the effectiveness of policies that encourage face mask use. We sought to (1) estimate the prevalence of face mask use in northern Vermont and (2) assess the effect of age and sex on the likelihood of face mask use. METHODS: We monitored the entrances to public businesses and visually assessed age, sex, and face mask use. We collected 1004 observations during May 16-30, 2020. We calculated estimates of overall face mask use and odds ratios (ORs) for effects by age and sex. RESULTS: Of 1004 observations, 758 (75.5%) sampled people used a face mask. Our census-weighted estimate was 74.1%. A higher percentage of females than males wore face masks (83.8% vs 67.6%). The odds of face mask use were lower among males than among females (OR = 0.52; 95% CI, 0.37-0.73). Face mask use generally decreased with decreasing age: 91.4% among adults aged >60, 70.7% among adults aged 26-60, 74.8% among people aged 15-25, and 53.3% among people aged ≤14. The OR of an adult aged >60 wearing a face mask was 14.70 times higher, for young people aged 15-25 was 2.72 times higher, and for adults aged 26-60 was 2.99 times higher than for people aged ≤14. Females aged >60 had the highest percentage of face mask use (96.3%) and males aged ≤14 had the lowest (43.8%). CONCLUSIONS: Educational efforts promoting the use of face masks should be targeted at males and younger age groups to limit the spread of SARS-CoV-2.

Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic.

BACKGROUND: Pharmacists' responsibilities in caring for patients with diabetes mellitus are expanding. However, few data are available to support pharmacists optimizing therapy and improving outcomes in these patients. OBJECTIVE: To determine the effect of a clinical pharmacist-directed diabetes management clinic on glycemic control and cardiovascular and renal parameters in patients with type 2 diabetes. METHODS: A nonrandomized, prospective study was conducted in 70 Veterans Affairs patients. Patients met with the pharmacist every 6-8 weeks for approximately 30 minutes for education, medication counseling, monitoring, and management. The primary endpoint was the impact of 9-12 months of participation in the clinic on glycosylated hemoglobin (HbA1C). Secondarily, we evaluated body weight, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and level of microalbuminuria. All comparisons were made using a paired t-test at a significance level of p < or = 0.05. RESULTS: HbA1C significantly decreased from 10.3% +/- 2.2% at baseline to 6.9% +/- 1.1% (mean +/- SD) during the 9- to 12-month evaluation period (p < 0.001). The secondary endpoints including systolic (p < 0.001) and diastolic (p < 0.001) blood pressure, total cholesterol (p < 0.001), LDL-C (p < 0.001), triglycerides (p = 0.006), and level of microalbuminuria (p < 0.001) also were reduced at 9-12 months. CONCLUSIONS: This study demonstrated that a clinical pharmacist can effectively care for patients with diabetes referred by their primary care provider because of poor glycemic control.

Collaborative drug therapy management services and reimbursement in a family medicine clinic.

PURPOSE: The legislative and regulatory issues surrounding the reimbursement of pharmacists for cognitive services are reviewed and billing practices for a pharmacist-physician collaborative drug therapy management service (DTMS) in a family medicine clinic are examined. A case study is offered to illustrate the real-world application of these practices. SUMMARY: As regimens of prescription medications have become more complex and the potential for adverse drug reactions and interactions has increased, the need for individualized optimal drug therapy and drug-therapy experts has grown. Pharmacists, who are professionally trained to be an integral part of the medical team, are well prepared to ensure optimal drug therapy and medication safety for patients. Consequently, collaboration between physicians and pharmacists can lead to improved patient care and reduced medication errors. The following 10 steps are recommended for establishing a successful collaborative DTMS: (1) establish a working relationship with physician colleagues, (2) assess the needs of your patients, (3) draft collaborative DTMS protocols and agreements, (4) apply for credentialing status within your health organization, (5) consult the billing office staff at the clinic, (6) design a clinic-encounter form, (7) identify and train support personnel, (8) allocate resources, (9) advertise the DTMS, and (10) evaluate and improve your service. CONCLUSION: Establishing a DTMS presents many challenges and obstacles, but they should not lead to discouragement. Rather, pharmacists should be diligent and continue to explore ways in which they could provide optimal medication therapy to patients through appropriate channels that also facilitate reimbursement.