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The authors trialed a mobile application, DiabetesXcel, which included type 2 diabetes–focused educational videos and modules, in 50 adults of Bronx, NY, a region with a high prevalence of diabetes and diabetes complications. From baseline to 4 months and from baseline to 6 months, there was significantly improved quality of life, self-management, knowledge, self-efficacy, depression, A1C, and LDL cholesterol among those who used DiabetesXcel. There was also a significant decrease in diabetes-related emergency department visits and hospital admissions from baseline to 6 months. This study demonstrates that DiabetesXcel could be beneficial for type 2 diabetes management. [ABSTRACT FROM AUTHOR]

Aim: Undiagnosed diabetes is more prevalent among racial/ethnic minorities in the United States (U.S.). Despite the proliferation of risk scores, few have been validated in Hispanics populations. The aim of this study is to systematically review published studies that developed risk scores to identify undiagnosed Type 2 Diabetes Mellitus based on self-reported information that were validated for Hispanics in the U.S.Methods: The search included PubMed, EMBASE, Cochrane and CINAHL from inception to 2016 without language restrictions. Risk scores whose main outcome was undiagnosed Type 2 diabetes reporting performance measures for Hispanics were included.Results: We identified three studies that developed and validated risk scores for undiagnosed diabetes based on questionnaire data. Two studies were conducted in Latin America and one in the U.S. All three studies reported adequate performance (area under the receiving curve (AUC) range between0.68and 0.78). The study conducted in the U.S. reported a higher sensitivity of their risk score for Hispanics than whites. The limited number of studies, small size and heterogeneity of the combined cohorts provide limited evidence of the validity of risk scores for Hispanics.Conclusions: Efforts to develop and validate risk prediction models in Hispanic populations in the U.S are needed, particularly given the diversity of thisfast growing population. Healthcare professionals should be aware of the limitations of applying risk scores developed for the general population on Hispanics. [ABSTRACT FROM AUTHOR]

Women in the US continue to be affected by HIV through heterosexual contact. Sexual risk behaviors among women have been associated with a syndemic, or a mutually reinforcing set of conditions, including childhood sexual abuse (CSA), depression, substance use, violence, and financial hardship. Baseline data from a cohort of women with and at-risk for HIV (N = 620; 52% HIV+) were analyzed with Poisson regression to assess evidence for additive, independent and interactive effects among syndemic conditions in relation to reported sexual risk behaviors (e.g., unprotected and transactional sex) over the past 6 months, controlling for age and HIV status. The number of syndemic conditions was incrementally associated with more types of sexual risk behaviors. For example, women with all five syndemic conditions reported 72% more types of risk behaviors over 6 months, as compared to women without any syndemic conditions. Compared to women with no syndemic conditions, women with three syndemic conditions reported 34% more and women with one syndemic condition reported 13% more types of risk behaviors. Endorsing substance use in the past 6 months, reporting CSA, and experiencing violence as an adult were independently associated with 49%, 12%, and 8% more types of risk behaviors, respectively compared to women without these conditions. Endorsing both substance use and violence was associated with 27% more types of risk behaviors. These associations were not moderated by HIV status. Understanding specific relationships and interactions are needed to more effectively prioritize limited resources in addressing the psychosocial syndemic associated with sexual risk behavior among women with and at-risk for HIV. Our results identify interrelated psychosocial factors that could be targeted by intervention studies aiming to reduce high-risk sex in this population. [ABSTRACT FROM AUTHOR]

Introduction: Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships., Materials and Methods: Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships., Results: Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs., Conclusions: In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Racial-ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. Methods: We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. Results: We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Discussion: Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.

Background: Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of prediabetes and dyslipidemia. Differences in parent and child acculturation related to language use and preference (i.e., language acculturation) are associated with adverse cardiometabolic health behaviors, but no study has examined associations with cardiometabolic markers., Purpose: To determine whether discordance in parent-child language acculturation (parent-child acculturation gap) was associated with poor youth cardiometabolic health., Methods: Hispanic/Latino 8-16-year-olds (n = 1,466) and parents from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores for the Brief ARSMA-II's Anglo (AOS) and Latino (LOS) Orientation Scales represented language acculturation. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, and dysglycemia and hyperlipidemia measures. Missing data were imputed. Survey-weighted multivariable linear regression examined the association of youth, parent, and youth × parent (the acculturation gap) AOS and LOS scores separately with each cardiometabolic marker., Results: Youth reported greater English and lower Spanish use than parents. Greater discordance in AOS scores was associated with elevated BMI percentile only (p-for-interaction < .01). The LOS acculturation gap was not associated with any outcome. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth's diet and physical activity did not alter findings. Removal of nonsignificant acculturation gaps did not indicate an association between individual youth or parent AOS or LOS scores and any cardiometabolic marker., Conclusions: Discordance in Hispanic/Latino parent-child dyads' English use may relate to increased risk for childhood obesity. Future studies should identify mediators of this association., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Diabetic foot amputation is a preventable complication that is increasing in incidence in the United States, with disparities across geography, race, ethnicity, and income. This qualitative study explored the experiences of people in a low-income urban area in the United States in preventing and obtaining care for foot ulcers. Sixteen adults with foot ulcers were identified through purposive sampling based on records of hospital stays and primary care visits. Semi-structured interviews were transcribed and analyzed for key themes. Participants described inadequate understanding of diabetic foot disease: many sought care only after developing advanced symptoms. They identified social and health system factors as barriers to timely access to care. Some participants described a realization of the seriousness of their condition and an ability to improve self-care after developing an ulcer. Patients' experiences can inform the design of amputation-reduction initiatives to achieve more desirable results, including enhanced self-management capabilities, timely access, and attention to social determinants.

Introduction: Suboptimal or partial adherence to antiepileptic drugs (AEDs) is an avoidable cause of seizures and deleterious outcomes in epilepsy. As self-rated adherence may be unreliable, suboptimal adherence may go undetected. This study assessed generalizability of a performance-based measure of medication management to patients with intractable epilepsy., Materials and Methods: Participants were 50 adults (age = 42 ± 14 years, 60% female, 82% Black, 20% Hispanic/Latino) with ≥2 seizures in the preceding 6 months. Antiepileptic drug adherence was electronically monitored for one month via Medication Event Monitoring Systems (MEMS) and self-rated (1 = very poor to 6 = excellent). The Medication Management Ability Assessment (MMAA) was administered at follow-up and scored by raters blind to adherence results. Spearman correlations and Poisson regressions assessed their associations., Results: On average, participants self-reported good-to-very good adherence. According to MEMS, participants took AEDs as prescribed 73% of the time; most participants (58%) missed ≥3 doses. The MMAA demonstrated strong internal consistency (Kuder-Richardson 20 = 0.81) and was associated with MEMS: percentage of days doses were taken correctly (r s  = 0.29, p = 0.04) and frequency of missed doses (r s  = -0.31, p = 0.03). The MMAA was not associated with self-rated adherence. Poisson regressions showed that self-ratings and MMAA performance accounted for unique variance in frequency of missed AED doses., Conclusions: These findings provide evidence of the MMAA's criterion validity as a measure of capacity to manage AEDs. It may prove useful in cases where suboptimal adherence is suspected but unreported by patients. Its lack of significant association with self-rated adherence is consistent with prior reports; however, future studies should replicate these findings with larger samples., (Copyright © 2018 Elsevier Inc. All rights reserved.)