Telemedicine for the Underserved Racial and Ethnic Minorities During COVID-19 and Beyond.

Objective: To demonstrate that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients as an extension of regular clinical services and provide continuity of care. Methods: A telehealth platform was established during COVID-19 pandemic and from numerous telehealth encounters we sampled 498 patients who received telehealth intervention over a 12-month period for specific services: Rx refill, consultation for laboratory results, wellness evaluation and education, and acute or sick visits with appropriate referrals. This telehealth platform was integrated with a remote patient monitoring system utilizing a Bluetooth-enabled glucometer for patients with diabetes compared to their abnormal baseline hemoglobin A1C (HgA1C). The Blood sugar values were recorded at predefined intervals to monitor controls for diabetes. The ethnic diversity and level of education of patients required addressing the digital divide, language interpretation, and navigation at each monitoring step. Results: This method demonstrated that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients in an intervention group compared with a control group. Validation of the glycemic control was based on 70 patients identified as eligible for participation based on the inclusion criteria: a HgA1C level of 7% or higher obtained within the last 10 months. Informed consent was obtained for 42 participants based on patient participation constraints during the COVID-19 pandemic. Conclusions: We conclude that telemedicine procedures utilized for patients with little or no prior knowledge of remote self-monitoring methods can support their treatment of chronic diseases, such as diabetes. The outcomes from the implementation of telemedicine services were observed in a well-defined group of underserved racial and ethnic minority patients at our clinic. We now have a protocol to expand this to other chronic diseases and used as a regular clinical procedure.

Correlation of erythrocyte fatty acid composition and dietary intakes with markers of atherosclerosis in patients with myocardial infarction.

The purpose of this study was to examine the hypothesis that erythrocytes that are low in n-3 fatty acids and high in trans-fatty acids and nutrient intakes are associated with the risk of atherosclerosis. Fifty patients with acute nonfatal myocardial infarction were recruited to measure their dietary intake, erythrocyte fatty acid composition, intima medial thickness (IMT), and the Gensini score, which are markers of atherosclerosis. Trans-oleic acid of erythrocytes was positively (P = .05) correlated with the carotid IMT. After adjusting for age, sex, and energy intake, the IMT was negatively associated with the intake of protein, fat, phosphate, zinc, vitamin B(1), vitamin B(2), vitamin B(6), niacin, linoleic acid, linolenic acid, total fatty acids, total n-3 fatty acids, and total n-6 fatty acids. The Gensini score was also negatively associated with the intake of protein, fat, phosphate, sodium, zinc, vitamin E, vitamin B(1), vitamin B(2), vitamin B(6), niacin, linolenic acid, total fatty acids, and total n-3 fatty acids. In conclusion, lower levels of trans-oleic acid (elaidic acid) in erythrocytes and higher intakes of vitamins, minerals, and n-3 fatty acids were associated with the decreased risk of atherosclerosis. However, these findings need further investigation in randomized controlled clinical trials before public health recommendations for atherosclerosis prevention can be made.

Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction.

The risk of CHD has been linked to n-3 and trans-fatty acids. The purpose of the present study was to evaluate the hypothesis that lower n-3 fatty acids and higher trans-fatty acids in erythrocytes are associated with an increased risk of acute non-fatal myocardial infarction (MI), and that fatty acid profiles can discriminate MI cases from controls. Fifty cases with acute non-fatal MI and fifty age- and sex-matched controls without MI were recruited. The Omega-3 Index (the sum of EPA and DHA in erythrocytes) was significantly lower in cases than controls (9.57 (SEM 0.28) v. 11.81 (SEM 0.35) %; P < 0.001), while total trans-fatty acids were significantly higher (1.01 (SEM 0.04) v. 0.56 (SEM 0.03) %; P < 0.001). The Omega-3 Index was associated with decreased risk of MI (OR 0.08 (95 % CI 0.02, 0.38); P = 0.001), while total trans-fatty acids were associated with an increased risk of MI (OR 72.67 (95 % CI 6.68, 790.74); P < 0.001). The area under the receiver operating characteristic curve of fatty acid profiles was larger than that for traditional risk factors, suggesting that fatty acid profiles make a higher contribution to the discrimination of MI cases from controls compared with modified Framingham risk factors. In conclusion, a higher Omega-3 Index and lower trans-fatty acids in erythrocytes are associated with a decreased risk of MI. Furthermore, fatty acid profiles improve discrimination of acute non-fatal MI compared with established risk factors.