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1.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32778539

RESUMO

BACKGROUND: The optimal approach to screening and diagnosis of prediabetes and diabetes in youth is uncertain. METHODS: We conducted a cross-sectional analysis of 14 119 youth aged 10 to 19 years in the 1999-2016 NHANES. First, we examined the performance of American Diabetes Association risk-based screening criteria. Second, we evaluated the performance of current clinical definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. RESULTS: Overall, 25.5% of US youth (10.6 million in 2016) were eligible for screening. Sensitivity and specificity of the screening criteria for detecting any hyperglycemia were low for both HbA1c ≥5.7% (sensitivity = 55.5%, specificity = 76.3%) and FPG ≥100 mg/dL (sensitivity = 35.8%, specificity = 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was rare, <0.5% of youth. Most (>85%) cases of diabetes were diagnosed. Associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). CONCLUSIONS: One-quarter of US youth are eligible for screening for diabetes and prediabetes; however, few will test positive, especially for diabetes. Most cases of diabetes in US youth are diagnosed. Regardless of screening eligibility, we found that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.


Assuntos
Glicemia/análise , Diabetes Mellitus/diagnóstico , Jejum/sangue , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Criança , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etnologia , Programas de Rastreamento/estatística & dados numéricos , Síndrome Metabólica/diagnóstico , Inquéritos Nutricionais , Obesidade Pediátrica/epidemiologia , Guias de Prática Clínica como Assunto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Prevalência , Sensibilidade e Especificidade , Estados Unidos/epidemiologia , Adulto Jovem
2.
Brain Behav Immun ; 88: 44-49, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32497776

RESUMO

BACKGROUND: Differentials in COVID-19 hospitalisations and mortality according to ethnicity have been reported but their origin is uncertain. We examined the role of socioeconomic, mental health, and pro-inflammatory factors in a community-based sample. METHODS: We used data on 340,966 men and women (mean age 56.2 years) from the UK Biobank study, a prospective cohort study with linkage to hospitalisation for COVID-19. Logistic regression models were used to estimate associations between ethnicity and hospitalisation for COVID-19. RESULTS: There were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of COVID-19 infection (odds ratio; 95% confidence interval: 4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the 'other' non-white group (1.84; 1.13, 2.99). After controlling for potential explanatory factors which included neighbourhood deprivation, household crowding, smoking, body size, inflammation, glycated haemoglobin, and mental illness, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31). CONCLUSIONS: There were clear ethnic differences in risk of COVID-19 hospitalisation and these do not appear to be fully explained by measured factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/etnologia , Idoso , Betacoronavirus , Índice de Massa Corporal , Proteína C-Reativa/imunologia , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Inglaterra/epidemiologia , Feminino , Volume Expiratório Forçado , Hemoglobina A Glicada/metabolismo , Nível de Saúde , Humanos , Inflamação , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Questionário de Saúde do Paciente , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Fatores Socioeconômicos
3.
South Med J ; 113(6): 311-319, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483642

RESUMO

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Assuntos
Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Doenças Vasculares Periféricas/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etnologia , Americanos Asiáticos/estatística & dados numéricos , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Obesidade/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Doenças Vasculares Periféricas/etnologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/etnologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etnologia , Adulto Jovem
4.
Am J Clin Nutr ; 112(1): 57-65, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32469399

RESUMO

BACKGROUND: Genetic or pharmacological inhibition of de novo sphingolipid synthases prevented diabetes in animal studies. OBJECTIVES: We sought to evaluate prospective associations of serum sphingolipids with incident diabetes in a population-based cohort. METHODS: We included 2010 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) aged 18-74 y who were free of diabetes and other major chronic diseases at baseline (2008-2011). Metabolomic profiling of fasting serum was performed using a global, untargeted approach. A total of 43 sphingolipids were quantified and, considering subclasses and chemical structures of individual species, 6 sphingolipid scores were constructed. Diabetes status was assessed using standard procedures including blood tests. Multivariable survey Poisson regressions were applied to estimate RR and 95% CI of incident diabetes associated with individual sphingolipids or sphingolipid scores. RESULTS: There were 224 incident cases of diabetes identified during, on average, 6 y of follow-up. After adjustment for socioeconomic and lifestyle factors, a ceramide score (RR Q4 versus Q1 = 2.40; 95% CI: 1.24, 4.65; P-trend = 0.003) and a score of sphingomyelins with fully saturated sphingoid-fatty acid pairs (RR Q4 versus Q1 = 3.15; 95% CI: 1.75, 5.67; P-trend <0.001) both were positively associated with risk of diabetes, whereas scores of glycosylceramides, lactosylceramides, or other unsaturated sphingomyelins (even if having an SFA base) were not associated with risk of diabetes. After additional adjustment for numerous traditional risk factors (especially triglycerides), both associations were attenuated and only the saturated-sphingomyelin score remained associated with risk of diabetes (RR Q4 versus Q1 = 1.98; 95% CI: 1.09, 3.59; P-trend = 0.031). CONCLUSIONS: Our findings suggest that a cluster of saturated sphingomyelins may be associated with elevated risk of diabetes beyond traditional risk factors, which needs to be verified in other population studies. This study was registered at clinicaltrials.gov as NCT02060344.


Assuntos
Diabetes Mellitus/sangue , Diabetes Mellitus/etnologia , Esfingolipídeos/sangue , Adolescente , Adulto , Idoso , Diabetes Mellitus/epidemiologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto Jovem
5.
BMC Public Health ; 20(1): 566, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345300

RESUMO

BACKGROUND: Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS: Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS: After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS: Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.


Assuntos
Afeto , Afro-Americanos/psicologia , Doenças Cardiovasculares/psicologia , Adulto , Idoso , Ira , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Depressão/etnologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/psicologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etnologia , Hipertensão/psicologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade/psicologia , Distribuição de Poisson , Prevalência , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Classe Social , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Estresse Psicológico/etnologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-32325783

RESUMO

: Objective: To determine the characteristics of members of online diabetes communities as well as those factors affecting the provision and acceptance of social support. Methods: A cross-sectional STAR questionnaire survey was conducted among patients with diabetes who were members of online diabetes groups. Univariate and multivariate binary logistic regression analysis were adopted to explore the relative analysis of providing and accepting social support compared with the characteristics of members in virtual diabetics' groups. Results: A total of 1297 respondents were collected. The map distribution of patients in China was mainly located in the Guangdong, Jiangsu, Shandong, Henan, and Hebei provinces. As for their demographic characteristics, respondents had diabetes or prediabetes and were between the ages of 21 and 50 years (Median age was 35.0 (interquartile range from 28.0 to 44.0)). Most respondents were married and lived in cities. The education level of patients was mainly distributed throughout junior high, technical secondary, high school, junior college, and undergraduate levels. Age, marital status, and education level varied by gender, and the total score of the patients aged 41 to 50 for social support had a statistical significance between male and female. In addition, when group members were in junior high school or below, or were undergraduate students, their total social support scores varied by gender. Binary logistic regression showed that in 21 independent variables the total score and the total score grade of relationship intensity in the online group and reorganize of age were significant. The patients' social support acceptance of the map of respondents score grading of relationship intensity in the online group was 5.420 times higher than that of the lower score grading of relationship intensity in the group. At the same time, the patients' social support acceptance of the patients at the age of less than or equal to 31 years old was 19.608 times higher than that of group members aged more than 31 years old. Conclusion: Age and education background of the patients affects scores of social supports between males and females. The higher the total score and the score grade of relationship intensity in the online group, the higher the patients' social support acceptance. The younger patients had a better utilization of social support.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Diabetes Mellitus/etnologia , Apoio Social , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
7.
CMAJ ; 192(6): E128-E135, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041696

RESUMO

BACKGROUND: Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. METHODS: Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. RESULTS: Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. INTERPRETATION: Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.


Assuntos
Diabetes Mellitus/etnologia , Diabetes Mellitus/mortalidade , Índios Norte-Americanos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Distribuição por Sexo , Adulto Jovem
8.
Gac Med Mex ; 156(1): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32026882

RESUMO

Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade Abdominal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etnologia , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hipercolesterolemia/etnologia , Hipertensão/etnologia , Estudos Longitudinais , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Obesidade Abdominal/etnologia , Fatores de Risco , Distribuição por Sexo , Estados Unidos/epidemiologia
9.
Circ Cardiovasc Qual Outcomes ; 13(2): e006139, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32069093

RESUMO

BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]). CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Financiamento Pessoal/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Adolescente , Adulto , Afro-Americanos , Fatores Etários , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Abastecimento de Alimentos/economia , Pesquisas sobre Serviços de Saúde , Humanos , Renda , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Cooperação do Paciente , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
10.
BMC Health Serv Res ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914997

RESUMO

BACKGROUND: Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS: Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS: Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION: The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION: clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).


Assuntos
Nativos do Alasca/psicologia , Atitude Frente a Saúde/etnologia , Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus/etnologia , Índios Norte-Americanos/psicologia , Nativos do Alasca/estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Relações Comunidade-Instituição , Comportamento Cooperativo , Diabetes Mellitus/terapia , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos/organização & administração , Participação do Paciente , Relações Profissional-Paciente , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados Unidos
11.
Curr Diabetes Rev ; 16(8): 833-850, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971112

RESUMO

BACKGROUND: The modern society is extremely prone to many life-threatening diseases, which can be easily controlled as well as cured if diagnosed at an early stage. The development and implementation of a disease diagnostic system have gained huge popularity over the years. In the current scenario, there are certain factors such as environment, sedentary lifestyle, genetic (hereditary) are the major factors behind the life threatening diseases such as 'diabetes.' Moreover, diabetes has achieved the status of the modern man's leading chronic disease. So one of the prime needs of this generation is to develop a state-of-the-art expert system which can predict diabetes at a very early stage with a minimum of complexity and in an expedited manner. The primary objective of this work is to develop an indigenous and efficient diagnostic technique for detection of diabetes. Method & Discussion: The proposed methodology comprises of two phases: In the first phase The Pima Indian Diabetes Dataset (PIDD) has been collected from the UCI machine learning repository databases and Localized Diabetes Dataset (LDD) has been gathered from Bombay Medical Hall, Upper Bazar Ranchi, Jharkhand, India. In the second phase, the dataset has been processed through two different approaches. The first approach entails classification through Adaboost, Classification via Regression (CVR), Radial Basis Function Network (RBFN), K-Nearest Neighbor (KNN) on Pima Indian Diabetes Dataset and Localized Diabetes Dataset. In the second approach, Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA) have been applied as a feature reduction method followed by using the same set of classification methods used in the first approach. Among all of the implemented classification methods, PCA_CVR achieves the maximum performance for both the above mentioned datasets. CONCLUSION: In this article, comparative analysis of outcomes obtained by with and without the use of PCA and LDA for the same set of classification method has been done w.r.t performance assessment. Finally, it has been concluded that PCA & LDA both are useful to remove the insignificant features, decreasing the expense and computation time while improving the ROC and accuracy. The used methodology may similarly be applied to other medical diseases.


Assuntos
Algoritmos , Diabetes Mellitus/classificação , Diabetes Mellitus/diagnóstico , Biomarcadores/análise , Conjuntos de Dados como Assunto , Diabetes Mellitus/etnologia , Análise Discriminante , Humanos , Povos Indígenas , Aprendizado de Máquina , Análise de Componente Principal , Fatores de Risco , Estatística como Assunto
12.
JAMA ; 322(24): 2389-2398, 2019 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-31860047

RESUMO

Importance: The prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown. Objective: To estimate racial/ethnic differences in the prevalence of diabetes among US adults 20 years or older by major race/ethnicity groups and selected Hispanic and non-Hispanic Asian subpopulations. Design, Setting, and Participants: National Health and Nutrition Examination Surveys, 2011-2016, cross-sectional samples representing the noninstitutionalized, civilian, US population. The sample included adults 20 years or older who had self-reported diagnosed diabetes during the interview or measurements of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG). Exposures: Race/ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic and Hispanic subgroups (Mexican, Puerto Rican, Cuban/Dominican, Central American, and South American), non-Hispanic Asian and non-Hispanic Asian subgroups (East, South, and Southeast Asian), and non-Hispanic other. Main Outcomes and Measures: Diagnosed diabetes was based on self-reported prior diagnosis. Undiagnosed diabetes was defined as HbA1c 6.5% or greater, FPG 126 mg/dL or greater, or 2hPG 200 mg/dL or greater in participants without diagnosed diabetes. Total diabetes was defined as diagnosed or undiagnosed diabetes. Results: The study sample included 7575 US adults (mean age, 47.5 years; 52% women; 2866 [65%] non-Hispanic white, 1636 [11%] non-Hispanic black, 1952 [15%] Hispanic, 909 [6%] non-Hispanic Asian, and 212 [3%] non-Hispanic other). A total of 2266 individuals had diagnosed diabetes; 377 had undiagnosed diabetes. Weighted age- and sex-adjusted prevalence of total diabetes was 12.1% (95% CI, 11.0%-13.4%) for non-Hispanic white, 20.4% (95% CI, 18.8%-22.1%) for non-Hispanic black, 22.1% (95% CI, 19.6%-24.7%) for Hispanic, and 19.1% (95% CI, 16.0%-22.1%) for non-Hispanic Asian adults (overall P < .001). Among Hispanic adults, the prevalence of total diabetes was 24.6% (95% CI, 21.6%-27.6%) for Mexican, 21.7% (95% CI, 14.6%-28.8%) for Puerto Rican, 20.5% (95% CI, 13.7%-27.3%) for Cuban/Dominican, 19.3% (95% CI, 12.4%-26.1%) for Central American, and 12.3% (95% CI, 8.5%-16.2%) for South American subgroups (overall P < .001). Among non-Hispanic Asian adults, the prevalence of total diabetes was 14.0% (95% CI, 9.5%-18.4%) for East Asian, 23.3% (95% CI, 15.6%-30.9%) for South Asian, and 22.4% (95% CI, 15.9%-28.9%) for Southeast Asian subgroups (overall P = .02). The prevalence of undiagnosed diabetes was 3.9% (95% CI, 3.0%-4.8%) for non-Hispanic white, 5.2% (95% CI, 3.9%-6.4%) for non-Hispanic black, 7.5% (95% CI, 5.9%-9.1%) for Hispanic, and 7.5% (95% CI, 4.9%-10.0%) for non-Hispanic Asian adults (overall P < .001). Conclusions and Relevance: In this nationally representative survey of US adults from 2011 to 2016, the prevalence of diabetes and undiagnosed diabetes varied by race/ethnicity and among subgroups identified within the Hispanic and non-Hispanic Asian populations.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Diabetes Mellitus/etnologia , Grupos Étnicos/estatística & dados numéricos , Adulto , Americanos Asiáticos , Estudos Transversais , Feminino , Hispano-Americanos , Humanos , Masculino , Inquéritos Nutricionais , Prevalência , Fatores Socioeconômicos , Estados Unidos/epidemiologia
13.
Int J Equity Health ; 18(1): 183, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771603

RESUMO

BACKGROUND: We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. METHODS: We abstracted routine clinical data from the Indian Health Service's information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. RESULTS: Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (- 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (- 10.58 mg/dl) compared to the non-COPE group (- 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. CONCLUSION: Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. TRIAL REGISTRATION: Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus/etnologia , Diabetes Mellitus/terapia , Índios Norte-Americanos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico , Resultado do Tratamento , Utah
15.
Saudi J Kidney Dis Transpl ; 30(5): 1084-1096, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696847

RESUMO

Nontransmissible chronic diseases (NTCDs) are the leading causes of death worldwide, causing serious social and economic consequences in all societies and economies and emerging as a major public health problem. One of the ways of coping the social and economic impact caused by the NTCDs is the elaboration of effective public policies; one of the instruments used for the elaboration of public policies is the social indicators. The most popular indicator at present is the Human Development Index (HDI), which covers the dimensions of longevity, education, and income. The Inequality-adjusted HDI (IHDI) was implemented that quantifies the effects of inequality in development, measured in terms of HDI. The objective of the present study was to analyze the impact of income, education, and ethnicity in hypertension, diabetes mellitus (DM), and chronic kidney disease (CKD) in the world, through the narrative review of the literature and analyzing the social indicators HDI and IHDI of the countries analyzed. After analyzing 161 studies from 96 countries, we identified that income, education, and color impact on the prevalence, incidence, diagnosis, treatment, progression, and mortality of hypertension, DM, and CKD in both low- and middle-income countries' development, as well as high and very high human development. The HDI data for all countries change when adjusted for inequality. The theme related to social factors needs to be a constant in the elaboration of health policies, as well as present in the professional doing.


Assuntos
Diabetes Mellitus/epidemiologia , Escolaridade , Saúde Global , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/epidemiologia , Renda , Insuficiência Renal Crônica/epidemiologia , Determinantes Sociais da Saúde , Países Desenvolvidos , Países em Desenvolvimento , Diabetes Mellitus/etnologia , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde , Humanos , Hipertensão/etnologia , Hipertensão/mortalidade , Hipertensão/terapia , Incidência , Prevalência , Prognóstico , Insuficiência Renal Crônica/etnologia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde/etnologia
16.
Med Care ; 57(12): 960-967, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31730568

RESUMO

OBJECTIVES: Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. METHODS: We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. RESULTS: Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). CONCLUSIONS: We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.


Assuntos
Grupos de Populações Continentais/psicologia , Acesso aos Serviços de Saúde , Nível de Saúde , Saúde Mental/etnologia , Estigma Social , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Depressão/etnologia , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Socioeconômicos , Adulto Jovem
17.
Ann Epidemiol ; 40: 8-12.e1, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708406

RESUMO

PURPOSE: Cardiovascular diseases (CVDs) are a leading cause of death among Latinos in the United States. The present study examines the prevalence of four CVD risk factors (diabetes, hypertension, hypercholesterolemia, and obesity) in a large sample of Latino farmworkers in Oregon. METHODS: We pooled secondary, cross-sectional data from Latino vineyard and winery farmworkers (n = 3382), in the north Willamette valley, Oregon, between 2004 and 2012. Prevalence was estimated for the four CVD risk factors under study. Multivariable logistic regression analyses were conducted to examine the association between CVD risk factors, sex, and other sociodemographic factors. RESULTS: Hypercholesterolemia (21.6%) and obesity (22.8%) were the most prevalent CVD risk factors among Latino farmworker participants. In multivariable analyses, men and women, aged 45-64 years, were more likely to have all four CVD risk factors than those aged 18-44. Living in the United States for ten years or more was associated with higher odds of hypertension (OR = 1.72, 95% CI: 1.17-2.54), and obesity (OR = 2.08, 95% CI: 1.57-2.76) among Latino farmworker men. Among Latino farmworker women, living in the United States for ten years or more increased the odds of obesity (OR = 1.81, 95% CI: 1.07-3.06). CONCLUSIONS: Our findings highlight the higher prevalence of CVD risk factors among Latino farmworkers and the need to address CVD risk factors in this population.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus/epidemiologia , Fazendeiros/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , População Rural/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adulto , Doenças dos Trabalhadores Agrícolas/etnologia , Doenças dos Trabalhadores Agrícolas/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Humanos , Hipercolesterolemia/etnologia , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Oregon/epidemiologia , Prevalência , Fatores de Risco
18.
Diabetes Educ ; 45(6): 642-651, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31725364

RESUMO

PURPOSE: The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. METHODS: Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. RESULTS: Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. DISCUSSION: Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.


Assuntos
Grupos de Populações Continentais/psicologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/psicologia , Emigrantes e Imigrantes/psicologia , Grupos Étnicos/psicologia , Grupos Minoritários/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Percepção , Medição de Risco , Fatores de Risco , Estados Unidos
19.
J Glob Health ; 9(2): 020401, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673335

RESUMO

Background: Atypical presentations of diabetes mellitus (DM) have been reported in non-European ethnic populations under various names. It is unclear whether those names are used for the same or different clinical phenotypes. Unclear terminology may lead to inappropriate treatment and an underestimation of the burden caused by atypical diabetes phenotypes overlapping with classic types of diabetes. This review aimed to describe the terms used for atypical forms of diabetes and to investigate whether the terms are used for similar or different phenotypes. Methods: PubMed and Scopus were searched for relevant publications in French or English available before 15 September 2015 using the terms: "Atypical diabetes", "Malnutrition Related Diabetes Mellitus (MRDM)", "Fibro-calculus pancreatic diabetes (FCPD)", Protein deficient Pancreatic Diabetes (PDPD)", "African diabetes", "Ketosis prone-type 2 diabetes", "tropical diabetes", "Flatbush diabetes", "J-type diabetes". Titles, abstracts screening and quality assessment were performed by two independent authors. Observational studies addressing atypical diabetes in humans aged 14 years and above were included. One author extracted data from selected articles. Results: 22 articles among 350 identified articles were retained for data extraction. Two atypical diabetes phenotypes were identified, each of them with a variety of names but similar definitions. One phenotype occurred in very thin people less than 30 years of age, typically from poor socio-economic backgrounds and requires insulin for life. It differs from type 1 diabetes in the tolerance of high blood glucose without ketosis in the absence of exogenous insulin. The second phenotype resembles type1 diabetes as it presents with ketosis at onset but responds well, as type2 diabetes, to oral hypoglycemic drugs after initial stabilization with insulin. It occurs in individuals who are usually over 30 years of age, with normal or overweight and absence of auto antibodies mainly found in type 1 diabetes. Conclusion: The scarce existing literature used various terms for similar diabetes phenotypes. Agreement on nomenclature for the various forms of diabetes using the above reported characteristics are needed in populations where atypical forms of diabetes exist as well as better characterization of phenotypes and genotypes to inform evidence based treatment.


Assuntos
Grupo com Ancestrais do Continente Africano , Diabetes Mellitus/classificação , Diabetes Mellitus/etnologia , Grupos Étnicos , Países em Desenvolvimento , Humanos , Fenótipo , Terminologia como Assunto
20.
Medicine (Baltimore) ; 98(44): e17519, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689753

RESUMO

BACKGROUND: Accumulated evidence has indicated the associations between single-nucleotide polymorphisms (SNPs) in microRNAs (miRNAs) and the susceptibility to diabetes mellitus (DM), but the conclusions remain controversial. This study was to investigate the true contribution of miRNA SNPs to the risk of DM by using a meta-analysis of all the published studies. METHODS: Relevant studies were identified in the databases of PubMed and the Cochrane Library databases. The strength of associations between miRNA polymorphisms and DM risk was assessed by odds ratios (ORs) and 95% confidence intervals (95% CIs) under five genetic models using the STATA software. RESULTS: Six studies, containing 2773 cases and 2632 controls, were enrolled, 5 of which evaluated miR-146a (rs2910164), 4 for miR-27a (rs895819), and 3 for miR-124 (rs531564) and 2 for miR-375 (rs6715345), miR-128a (rs11888095), miR-194a (rs3820455). The meta-analysis indicated that the G allele or GG genotype of miR-146a rs2910164 was associated with a significantly increased risk for DM compared with C allele or GC/CC genotype in Latin American population; CC genotype of miR-27a rs895819 polymorphism was associated with a significantly decreased risk for DM in Asian population compared with the TT genotype; patients carrying with CC genotype of miR-124 rs531564 had a lower probability to develop DM regardless of ethnicity; no associations were identified between polymorphisms in miR-375, miR-128a, miR-194a and the susceptibility to DM. CONCLUSION: Our study suggests that miR-146a/miR-27a and miR-124 polymorphisms may be ethnicity-dependent or -independent susceptibility factors to DM, respectively.


Assuntos
Diabetes Mellitus/etnologia , Diabetes Mellitus/genética , MicroRNAs/genética , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Genótipo , Hispano-Americanos/genética , Humanos , Razão de Chances , Polimorfismo de Nucleotídeo Único
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