Adherence to diabetes self care for white,African-American and Hispanic American telemedicine participants: 5 year results from the IDEATel project

Objectives. Adherence to diabetes self care is poor for Hispanic American and African-American patients. This study examined the change in adherence over time and in response to a telemedicine intervention for elderly diabetes patients in these groups compared to white diabetes patients. We also examined whether adherence mediated the effect of the intervention on glycemic control (A1c).

Design. The Informatics for Diabetes Education and Telemedicine project randomized medically underserved Medicare patients (n=1665) to telemedicine case management (televideo educator visits, individualized goal-setting/problem solving) or usual care. Hispanic and African-American educators delivered the intervention in Spanish if needed.

Main outcome measures. Annual assessment included A1c and self-reported adherence (Summary of Diabetes Self-Care Activities scale). A simple model (only time and group terms) and a model with covariates (e.g., age) were examined for baseline and 5 years of follow-up. SAS PROC Mixed was used with non-linear terms to examine mediating effects of adherence on A1c, by performing tests of the mediating path coefficients.

Results. Over time, self-reported adherence improved for the treatment group compared to usual care (p<0.001). There was no significant interaction with racial/ethnic group membership, i.e., all groups improved. However, minority subjects were consistently less adherent than whites. Also, greater comorbidity and diabetes symptoms predicted poorer adherence, greater duration of diabetes and more years of education predicted better adherence. Adherence was a significant mediator of A1c (p<0.001).

Conclusions. A unique, tailored telemedicine intervention was effective in achieving improved adherence to diabetes self care. However, African-American and Hispanic American participants were less adherent than white participants at all time points despite an individualized and accessible intervention. The finding that adherence did mediate glycemic control suggests that unique interventions for minority groups may be needed to overcome this disparity.     

Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center

ABSTRACT

Purpose: The purpose of this study is to examine the prevalence of depression and physical and psychosocial factors associated with depression among adults with Type 2 Diabetes Mellitus (T2DM).

Methods: The sample included 421 patients with T2DM at a Federally Qualified Healthcare Center in a southern state. The Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression.

Results: The multiple logistic regression analyses revealed that the likelihood of depression increased as the level of pain increased and as the level of ambulation difficulties increased. The likelihood of depression increased as the number of traumatic events increased and as the number of SES-related stressors increased. Expectedly, the likelihood of depression decreased as levels of self-esteem increased.

Conclusions: The findings support that health care providers developing care plans for individuals with diabetes need to include assessments and interventions that address both the physical and psychosocial needs of patients.     

2型糖尿病基础调查表的评价及其描述分析

目的评价自制2型糖尿病基础调查表并了解湛江地区2型糖尿病基本情况及流行现状。方法采用自制的2型糖尿病基础调查表和生活事件量表对确诊的2型糖尿病患者进行调查,并用SPSS统计软件进行统计分析。结果基础调查表三个指标的Kappa系数值均较大,并有较好的内容效度。定量指标中,2型糖尿病（DM2）组与2型糖尿病合并并发症（CDM2）组空腹血糖、餐后2 h血糖、生活事件得分、平均动脉压差异有统计学意义（P〈0.05）,体力活动量差异无统计学意义（P〉0.05）;分类指标中,水果、豆类、健康教育在两组间差异有统计学意义（P〈0.05）,其它指标差异均无统计学意义。结论基础调查表的信度和效度均较好。该调查能够为2型糖尿病的预防提供有效的借鉴与依据。     

Psycho-Social Problems Faced by “Frequent Flyers” in a Pediatric Diabetes Unit

SUMMARY

This article describes an exploratory study of psychosocial factors common to, and associated with, frequently readmitted pediatric patients diagnosed with Insulin Dependent Diabetes Mellitus (IDDM). This practice-based study was undertaken by a social worker providing clinical services within a tertiary health-care pediatric diabetes unit at the Royal Children's Hospital, Melbourne (RCH), Australia and utilises available data obtained through retrospective record review in order to better inform service delivery. The study identified thirteen psychosocial factors having multiple occurrences within a small, but resource intensive, sub-population of the diabetes unit. The author discusses the possible contribution of each of these factors to poor metabolic control and frequent read-mission to hospital, as well as the potential implications for future targeted prevention and treatment programs.     

A multi-group path analysis of the relationship between perceived racial discrimination and self-rated stress: how does it vary across racial/ethnic groups?

Objective: The objective of this study was to answer three questions: (1) Is perceived discrimination adversely related to self-rated stress via the social capital and health care system distrust pathways? (2) Does the relationship between perceived discrimination and self-rated stress vary across race/ethnicity groups? and (3) Do the two pathways differ by one’s race/ethnicity background?

Design: Using the Philadelphia Health Management Corporation’s Southeastern Pennsylvania Household Survey, we classified 9831 respondents into 4 race/ethnicity groups: non-Hispanic White (n?=?6621), non-Hispanic Black (n?=?2359), Hispanic (n?=?505), and non-Hispanic other races (n?=?346). Structural equation modeling was employed to simultaneously estimate five sets of equations, including the confirmatory factor analysis for both social capital and health care distrust and both direct and indirect effects from perceived discrimination to self-rated stress.

Results: The key findings drawn from the analysis include the following: (1) in general, people who experienced racial discrimination have higher distrust and weaker social capital than those without perceived discrimination and both distrust and social capital are ultimately related to self-rated stress. (2) The direct relationship between perceived discrimination and self-rated stress is found for all race/ethnicity groups (except non-Hispanic other races) and it does not vary across groups. (3) The two pathways can be applied to non-Hispanic White and Black, but for Hispanic and non-Hispanic other races, we found little evidence for the social capital pathway.

Conclusions: For non-Hispanic White, non-Hispanic Black, and Hispanic, perceived discrimination is negatively related to self-rated stress. This finding highlights the importance of reducing interpersonal discriminatory behavior even for non-Hispanic White. The health care system distrust pathway can be used to address the racial health disparity in stress as it holds true for all four race/ethnicity groups. On the other hand, the social capital pathway seems to better help non-Hispanic White and Black to mediate the adverse effect of perceived discrimination on stress.     

Population-based case-control study of diabetes and breast cancer risk in Hispanic and non-Hispanic White women living in US southwestern states

Diabetes mellitus has been associated with breast cancer, although no studies appear to have adequately assessed the association in Hispanic women, a population with a high prevalence of diabetes. The authors investigated this association in a population-based case-control study of Hispanic and non-Hispanic White women living in the southwestern United States. Breast cancer cases diagnosed in 1999-2004 were identified through state cancer registries (1,526 non-Hispanic Whites, 798 Hispanics). Age- and ethnicity-matched controls (1,599 non-Hispanic Whites, 924 Hispanics) were selected from commercial mailing lists and driver's license and Social Security records. Diabetes history was assessed through interviewer-administered questionnaires. Odds ratios and 95% confidence intervals were calculated using logistic regression, adjusting for age, body mass index at age 15 years, and parity. Having any type of diabetes was not associated with breast cancer overall (odds ratio = 0.94, 95% confidence interval: 0.78, 1.12). Type 2 diabetes was observed among 19% of Hispanics and 9% of non-Hispanic Whites but was not associated with breast cancer in either group. Gestational diabetes was inversely associated with breast cancer in both ethnic groups, especially when first diagnosed at age < or =35 years (odds ratio = 0.54, 95% confidence interval: 0.37, 0.79). In this study, diabetes was not associated with breast cancer overall, although the inverse association with gestational diabetes warrants further investigation.     

Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study

ObjectivesType 2 diabetes is a risk factor for sarcopenia. Evidence on the prevention of sarcopenia using blood glucose–lowering therapy is limited. We aimed to examine the relationship between changes in glycemic control and sarcopenia and the effect of antidiabetic agents against sarcopenia in patients with type 2 diabetes.DesignWe conducted an observational longitudinal study.Setting and ParticipantsIn total, 588 Japanese patients with diabetes of an ongoing multicenter study completed 1-year follow-up measurements for sarcopenia and clinical data.MethodsThe data set of the Multicenter Study for Clarifying Evidence for Sarcopenia in patients with Diabetes Mellitus (the MUSCLES-DM study) was analyzed.ResultsDuring the follow-up period, the frequency of sarcopenia marginally increased, and the means of skeletal muscle mass index (SMI), handgrip strength, and gait speed did not show any changes. However, on dividing into 5 groups depending on the degree of changes in glycated hemoglobin (HbA_1c) value, the patients with a decrease of ≥1% in HbA_1c exhibited a significant increase in SMI. Our analysis revealed similar results for gait speed but not handgrip strength. Using the multiple linear regression model, we identified that a ≥1% decrease in HbA_1c value was an independent determinant of the changes in SMI and gait speed. We also determined that insulin use at baseline was an independent factor for the changes in SMI.Conclusions and ImplicationsCorrection of poor glycemic control and use of insulin were significantly associated with the increase in skeletal muscle mass or gait speed in Japanese patients with type 2 diabetes. The current finding increases our understanding of the importance of glycemic control for the prevention of cardiovascular diseases and sarcopenia.     

Reliability and validity of the DCP among hispanic veterans

The Diabetes Care Profile (DCP) was designed to measure psychosocial factors related to diabetes and its treatment. This study sought to determine the reliability and validity of the DCP in Hispanic veterans with Type 2 diabetes. Hispanic (n=81) and non-Hispanic White (n=238) patients were recruited at three southwestern VA hospitals. Scale reliabilities calculated by Cronbach's coefficient alpha revealed reliabilities ranging from .54 to .97 in Hispanics and .63 to .95 in non-Hispanic Whites. Only one scale, Monitoring Barriers, differed significantly between the two patient groups. Mean values on the DCP scales were consistent within and across ethnicities lending support for construct validity of the DCP in Hispanics. Convergent validity was also supported for DCP scales within the Hispanic patients as evidenced by correlations in expected directions with external measures.     

Racial and Ethnic Disparities in Diabetes Care Quality among Women of Reproductive Age in an Integrated Delivery System

BackgroundDiabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined.MethodsThis retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures—glycemic testing, glycemic control, and medication adherence—among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use.ResultsIn this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar.ConclusionsOur findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.     

The Association Between Exposure to Maternal Depression During Year 2 of a Child’s Life and Future Child Problem Behavior

Introduction

We examined the association of exposure to maternal depression during year 2 of a child’s life with future child problem behavior. We conducted a secondary analysis to investigate whether race/ethnicity is a moderator of this relationship.

Methods

We used Fragile Families and Child Well-Being Study data (age 3 N?=?3288 and 49% Black, 26% Hispanic, 22% non-Hispanic White; age 5 N?=?3001 and 51% Black, 25% Hispanic, 21% non-Hispanic White; age 9 N?=?3630 and 50% Black, 25% Hispanic, 21% non-Hispanic White) and ordinal logistic regression to model problem behavior at ages 3, 5, and 9 on maternal depression status during year 2.

Results

At age 9, children whose mother was depressed during year 2 were significantly more likely to have higher internalizing (AOR?=?1.92, 95% CI: 1.42,2.61) and externalizing (AOR?=?1.65, 95% CI: 1.10,2.48) problem behavior scores. In our secondary analysis, race/ethnicity did not have moderating effects, potentially due to a limitation of the data that required use of maternal self-reported race/ethnicity as a proxy for child race/ethnicity.

Discussion

Exposure to maternal depression after the prenatal and perinatal periods may have a negative association with children’s behavioral development through age 9. Interventions that directly target maternal depression during this time should be developed. Additional research is needed to further elucidate the role of race/ethnicity in the relationship between maternal depression and child problem behavior.

     

Alcohol misuse,depressive symptoms,and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study’s objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR?=?2.15) and better HIV/STI knowledge (β?=??.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR?=?1.76) and worse HIV/STI knowledge (β?=?.37).

Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women’s health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.     

Women’s beliefs about what causes obesity: variation by race/ethnicity and acculturation in a Washington State sample

ABSTRACT

Objective: Individuals’ beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State (n?=?1,002).

Design: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models.

Results: Hispanic women had a higher probability of not believing ‘at all’ in inheritance and physical activity as causes of obesity – an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing ‘at all’ in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women.

Conclusions: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.     

Computer Modeling of Diabetes and Its Complications: A Report on the Fifth Mount Hood Challenge Meeting

ObjectivesThe Mount Hood Challenge meetings provide a forum for computer modelers of diabetes to discuss and compare models, to assess predictions against data from clinical trials and other studies, and to identify key future developments in the field. This article reports the proceedings of the Fifth Mount Hood Challenge in 2010.MethodsEight modeling groups participated. Each group was given four modeling challenges to perform (in type 2 diabetes): to simulate a trial of a lipid-lowering intervention (The Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non-Insulin-Dependent Diabetes Mellitus [ASPEN]), to simulate a trial of a blood glucose–lowering intervention (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation [ADVANCE]), to simulate a trial of a blood pressure–lowering intervention (Cardiovascular Risk in Diabetes [ACCORD]), and (optional) to simulate a second trial of blood glucose–lowering therapy (ACCORD). Model outcomes for each challenge were compared with the published findings of the respective trials.ResultsThe results of the models varied from each other and, in some cases, from the published trial data in important ways. In general, the models performed well in terms of predicting the relative benefit of interventions, but performed less well in terms of quantifying the absolute risk of complications in patients with type 2 diabetes. Methodological challenges were highlighted including matching trial end-point definitions, the importance of assumptions concerning the progression of risk factors over time, and accurately matching the patient characteristics from each trial.ConclusionsThe Fifth Mount Hood Challenge allowed modelers, through systematic comparison and validation exercises, to identify important differences between models, address key methodological challenges, and discuss avenues of research to improve future diabetes models.     

Targeting Hispanic adolescents with outdoor food & beverage advertising around schools

Objectives: Although some research has focused on the food environment and food marketing, little has examined outdoor food and beverage (FB) advertising, particularly its relationship to the Hispanic composition in schools. Therefore, the purpose of this study was to determine if the prevalence of outdoor FB advertising was greater around middle and high schools with a majority Hispanic population as compared to schools with a lower Hispanic population.

Design: All FB advertisements located within a half-mile of 47 schools in Central Texas were documented. Advertisements were coded as free standing or on establishments. Advertisements were coded for theme including price (emphasizing price) and deals/value meals (promoting discounted price/meal deals). These two themes were combined to create an overall price promotion variable. In order to determine if the prevalence of FB advertising varied by the Hispanic composition of the students in the school, data from the Texas Education Agency was used to create a variable which dichotomized the schools into two groups: schools that reported ≥60% Hispanic students or ‘Hispanic schools’ (n?=?21) and schools that reported <60% Hispanic students or ‘non-Hispanic schools’ (n?=?26). Linear regression analyses were conducted to determine if the prevalence of outdoor FB advertising was greater around Hispanic schools as compared to non-Hispanic schools.

Results: Hispanic schools had more overall outdoor FB advertisements as compared to non-Hispanic schools (p?=?0.02). Similarly, we found significantly more outdoor FB establishment (p?=?0.02) and price promotion (p?=?0.05) around Hispanic schools as compared to non-Hispanic schools. Differences in freestanding advertisements by school type approached significance (p?=?0.07) with Hispanic schools having more freestanding FB advertisements on average.

Conclusion: Further research is needed that documents the content of these advertisements and determines the extent to which these advertisements affect Hispanic and other racial/ethnic minority youth’s attitudes and behaviors toward the consumption of these products.     

Racial/ethnic variation in the prevalence of vaccine-related human papillomavirus genotypes

Objective: There are currently three licensed human papillomavirus (HPV) vaccines that protect against cervical cancer. Here we compare the prevalence of bi-, quadri-, and nonavalent vaccine-related HPV genotypes in a multi-ethnic sample of non-Hispanic white, non-Hispanic black, Hispanic, and Asian women.

Design: Patients in this analysis (n?=?419) represent a subset of women with a previous abnormal Pap test participating in a clinical trial. HPV genotyping was conducted using the Roche Linear Array. Prevalent HPV genotypes were grouped according to their inclusion in each of the vaccines: bivalent (16, 18), quadrivalent (16, 18, 6, 11), and nonavalent (16, 18, 31, 33, 45, 52, 58, 6, 11).

Results: The prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines was lowest among non-Hispanic black (15%) and Hispanic women (20%), compared to non-Hispanic white (38%) and Asian women (38%). Across all racial/ethnic groups, a large proportion of infections (38%–49%) were with genotypes included in the nonavalent vaccine. However, the prevalence of HPV genotypes not covered by any vaccine was significantly higher among non-Hispanic black (36%) and Hispanic women (42%), compared to non-Hispanic white (24%) and Asian women (16%) (p?<?0.001). Racial/ethnic differences in HPV genotype prevalence were observed when controlling for demographic and sexual behavior characteristics, as well as when restricting the analysis to women with CIN?2+.

Conclusion: Our data suggest racial/ethnic differences in the prevalence of vaccine-related HPV genotypes. In particular, non-Hispanic black and Hispanic women had the lowest prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines. While a large proportion of their infections were covered by the nonavalent vaccine, non-Hispanic black and Hispanic women also had the highest prevalence of HPV genotypes not covered by any vaccine.     

Association between satisfaction and participation in everyday occupations after stroke

Background: Within occupational therapy, it is assumed that individuals are satisfied when participating in everyday occupations that they want to do. However, there is little empirical evidence to show this.

Aims: The aim of this study is to explore and describe the relation between satisfaction and participation in everyday occupations in a Swedish cohort, 5 years post stroke.

Methods: Sixty-nine persons responded to the Occupational Gaps Questionnaire (OGQ). The questionnaire measures subjective restrictions in participation, i.e. the discrepancy between doing and wanting to do 30 different occupations in everyday life, and satisfaction per activity. Results were analysed with McNemar/chi-square.

Results: Seventy percent of the persons perceived participation restrictions. Individuals that did not perceive restrictions in their participation had a significantly higher level of satisfaction (p?=?.002) compared to those that had restrictions. Participants that performed activities that they wanted to do report between 79 and 100% satisfaction per activity.

Conclusion: In this cohort, there was a significant association between satisfaction and participating in everyday occupations one wants to do, showing that satisfaction is an important aspect of participation and substantiates a basic assumption within occupational therapy. The complexity of measuring satisfaction and participation in everyday occupations is discussed.     

Adolescent decision making about participation in a hypothetical HIV vaccine trial

PurposeThe purpose of this study was to examine the process of adolescent decision-making about participation in an HIV vaccine clinical trial, comparing it to adult models of informed consent with attention to developmental differences.MethodsAs part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their decision making process when deciding whether or not to enroll in and HIV vaccine trial. An ethnographic content analysis approach was utilized.ResultsTwelve concepts related to adolescents’ decision-making about participation in an HIV vaccine trial were identified and mapped onto Appelbaum and Grisso's four components of decision making capacity including understanding of vaccines and how they work, the purpose of the study, trial procedures, and perceived trial risks and benefits, an appreciation of their own situation, the discussion and weighing of risks and benefits, discussing the need to consult with others about participation, motivations for participation, and their choice to participate.ConclusionThe results of this study suggest that most adolescents at high risk for HIV demonstrate the key abilities needed to make meaningful decisions about HIV vaccine clinical trial participation.     

Antimicrobial Resistance in Hispanic Patients Hospitalized in San Antonio,TX with Community-Acquired Pneumonia

Abstract

Limited information is available on the antimicrobial resistance of patients with community-acquired pneumonia (CAP) depending on their ethnicity. Our aim was to compare the clinical characteristics, etiology, and microbiological resistance of Hispanic versus non-Hispanic white patients. A retrospective cohort of 601 patients with a diagnosis of CAP included 288 non-Hispanic whites and 313 Hispanics. Penicillin-resistant Streptococcus pneumoniae was more common among Hispanic patients (21.7% vs 0%; P = 0.03) but there were no significant differences in macrolide-resistant S pneumoniae, drug-resistant S pneumoniae, or potential or actual multidrug-resistant pathogens (eg, drug-resistant S pneumoniae, methicillin-resistant Staphylococcus aureus, Pseudomonas spp., and Acinetobacter spp.). There were no differences among groups in length of hospital stay, intensive care unit (ICU) admission, or 30-day mortality. This study suggests that Hispanic patients with CAP have a higher rate of penicillin-resistant S pneumoniae, but no differences in antimicrobial resistance, 30-day mortality, ICU admission, or length of stay when compared with non-Hispanic white patients.     

Prevalence of obesity and diabetes in the socioeconomic transition of rural Mayas of Yucatan from 1962 to 2000

ABSTRACT

Background: The Mayas of the State of Yucatan in Mexico are the only aboriginal group with obesity and diabetes data before 1997.

Objective: To analyze socioeconomic trends associated with the increase in obesity and diabetes seen in rural Yucatan from 1962 to 2000.

Methods: Body weight, height and venous Fasting Blood Glucose (FBG) were measured in 263 rural Maya adults participating in a 2000 nutrition survey.

Results: Diabetes (FBG?>?125?mg/dL) and obesity (BMI?≥?30?kg/m²) were 10.6% and 35.7%, respectively. These results contrast with those of a 1962 survey where diabetic prevalence was 2.3% and 0% in women and men respectively, with widespread adult pellagra and malnutrition. An important socioeconomic transition that took place in Yucatan during this lapse appeared to be associated to the obesity and diabetes increase.

Conclusions: Rural Yucatan evolved from malnutrition conditions to high prevalence of obesity and diabetes in less than 40 years. This change was associated with the transition from an agroindustry-based economy, characterized by high-energy expenditure and low protein intake, to lower energy requirements of a Government-subsidized economy with larger food supply.     

对糖尿病病人进行健康教育的效果评价

目的：使病人认识和了解自身的疾病情况,发挥患者的主观能动性,并从中了解健康教育对糖尿病治疗效果的作用。方法：2000年收治无并发症糖尿病患者130例,为教育组;1999年收治无并发症糖尿病患者132例为对照组。对教育组进行健康教育,教育方法采用多样化,如讲座、放糖尿病科普录像等;教育内容主要为糖尿病的基本知识、饮食控制、运动和自我监测尿糖等。2组在药物相同的条件下进行比较。结果：2入院时平均血糖无差异,但空腹血糖降至7．2mmol/L以下的天数和住院天数均有显著差异。结论：健康教育对糖尿病的治疗有重要作用。