59 results on '"Diana Naranjo"'
Search Results
2. Discontinued Use of the Loop Insulin Dosing System: A Mixed-Methods Investigation
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Sarah Hanes, John Lum, Brandon Arbiter, Ryan R. Bailey, Rayhan A. Lal, Korey K. Hood, Monica S. Lanning, Jessie J. Wong, Sakinah C. Suttiratana, Adrienne Dunlap, and Diana Naranjo
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Blood Glucose ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,MEDLINE ,Qualitative property ,Technical support ,Endocrinology ,Insulin Infusion Systems ,Pregnancy ,Medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Glycemic ,media_common ,business.industry ,Blood Glucose Self-Monitoring ,Original Articles ,Discontinuation ,Loop (topology) ,Medical Laboratory Technology ,Diabetes Mellitus, Type 1 ,Family medicine ,Observational study ,Female ,Worry ,business - Abstract
BACKGROUND: Loop is an open-source automated insulin dosing system that allows users unrivaled control over system settings that affect future glucose prediction. Thousands use Loop, but little is known about those who discontinue. METHODS: In a large observational study, 874 Loop participants completed surveys and provided glycemic data, 46 (5.3%) of those self-identified as discontinuing Loop use during the observation window, 45 completed a discontinued use survey, 22 provided system settings data, and 19 participated in semistructured interviews about their discontinuation. Qualitative data were transcribed, coded, and analyzed. RESULTS: Older age and not trusting Loop were associated with discontinued use, although no other demographic or clinical characteristics were significant correlates. The most endorsed reasons were “I decided to try something else” (27.8%) followed by “It just didn't help as much as I thought it would” (22.2%). Qualitative analyses revealed prominent themes centered upon mental and emotional burden and adjusting settings. Other reasons for discontinued use included fear of disapproval of Loop use from diabetes provider, barriers to acquiring component devices, a desire to try new/different technologies, concerns that Loop could not accommodate specific exercise or low insulin dose regimens, and worry about Loop use during pregnancy. It was noted that burdens might be alleviated by enhanced technical assistance and expert guidance. CONCLUSIONS: Although the majority of individuals in the Loop observational study continued use, those who discontinued reported similar challenges. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users. Clinical Trial Registration: clinicaltrials.gov (NCT03838900).
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- 2023
3. Stakeholders' perspectives on caregiver outcomes for health care transition for adolescents and young adults with special health care needs: A qualitative study
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Cynthia De Vane Fair, Cecily Betz, Diana Naranjo, Jerlym Porter, Elizabeth Caitlin Bailey, Hannah Korycinski, and Maria Ferris
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Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health ,Developmental and Educational Psychology - Published
- 2023
4. Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations
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Ananta Addala, Jessie J. Wong, Ricardo Medina Penaranda, Sarah J. Hanes, Hiba Abujaradeh, Rebecca N. Adams, Regan C. Barley, Esti Iturralde, Monica S. Lanning, Molly L. Tanenbaum, Diana Naranjo, and Korey K. Hood
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Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Published
- 2023
5. A Real-World Prospective Study of the Safety and Effectiveness of the Loop Open Source Automated Insulin Delivery System
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Brandon Arbiter, Korey K. Hood, Victoria Barnes-Lomen, Daniel J. DeSalvo, Roy W. Beck, Adam S. Brown, Ryan Bailey, Peter Calhoun, Diana Naranjo, Rayhan A. Lal, Jeremy Pettus, and John Lum
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Adult ,Blood Glucose ,Research design ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Insulin delivery ,MEDLINE ,030209 endocrinology & metabolism ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Endocrinology ,Physical medicine and rehabilitation ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Prospective Studies ,030212 general & internal medicine ,Child ,Prospective cohort study ,Type 1 diabetes ,business.industry ,Blood Glucose Self-Monitoring ,Infant ,Original Articles ,medicine.disease ,Loop (topology) ,Medical Laboratory Technology ,Diabetes Mellitus, Type 1 ,Closed-loop control ,Child, Preschool ,Automated insulin delivery ,Observational study ,Continuous glucose monitors ,Safety ,business - Abstract
Objective: To evaluate the safety and effectiveness of the Loop Do-It-Yourself automated insulin delivery system. Research Design and Methods: A prospective real-world observational study was conducted, which included 558 adults and children (age range 1–71 years, mean HbA1c 6.8% ± 1.0%) who initiated Loop either on their own or with community-developed resources and provided data for 6 months. Results: Mean time-in-range 70–180 mg/dL (TIR) increased from 67% ± 16% at baseline (before starting Loop) to 73% ± 13% during the 6 months (mean change from baseline 6.6%, 95% confidence interval [CI] 5.9%–7.4%; P
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- 2021
6. Provider Implicit Bias Impacts Pediatric Type 1 Diabetes Technology Recommendations in the United States: Findings from The Gatekeeper Study
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Sarah Hanes, David M. Maahs, Korey K. Hood, Diana Naranjo, and Ananta Addala
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Adult ,Male ,Technology ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,030209 endocrinology & metabolism ,Bioengineering ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Environmental health ,Diabetes mellitus ,Ethnicity ,Internal Medicine ,medicine ,Humans ,Special Section: Disparities in Diabetes Technology ,030212 general & internal medicine ,Child ,Proxy (statistics) ,Socioeconomic status ,Type 1 diabetes ,Public health insurance ,Middle Aged ,medicine.disease ,United States ,Health equity ,Diabetes Mellitus, Type 1 ,Minority health ,Female ,Implicit bias ,Psychology ,Prejudice - Abstract
Background: Diabetes technology use is associated with favorable type 1 diabetes (T1D) outcomes. American youth with public insurance, a proxy for low socioeconomic status, use less diabetes technology than those with private insurance. We aimed to evaluate the role of insurance-mediated provider implicit bias, defined as the systematic discrimination of youth with public insurance, on diabetes technology recommendations for youth with T1D in the United States. Methods: Multi-disciplinary pediatric diabetes providers completed a bias assessment comprised of a clinical vignette and ranking exercises ( n = 39). Provider bias was defined as providers: (1) recommending more technology for those on private insurance versus public insurance or (2) ranking insurance in the top 2 of 7 reasons to offer technology. Bias and provider characteristics were analyzed with descriptive statistics, group comparisons, and multivariate logistic regression. Results: The majority of providers [44.1 ± 10.0 years old, 83% female, 79% non-Hispanic white, 49% physician, 12.2 ± 10.0 practice-years] demonstrated bias ( n = 33/39, 84.6%). Compared to the group without bias, the group with bias had practiced longer (13.4±10.4 years vs 5.7 ± 3.6 years, P = .003) but otherwise had similar characteristics including age (44.4 ± 10.2 vs 42.6 ± 10.1, p = 0.701). In the logistic regression, practice-years remained significant (OR = 1.47, 95% CI [1.02,2.13]; P = .007) when age, sex, race/ethnicity, provider role, percent public insurance served, and workplace location were included. Conclusions: Provider bias to recommend technology based on insurance was common in our cohort and increased with years in practice. There are likely many reasons for this finding, including healthcare system drivers, yet as gatekeepers to diabetes technology, providers may be contributing to inequities in pediatric T1D in the United States.
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- 2021
7. 631-P: Youth with Type 1 Diabetes (T1D) and High Social Risk: Predictors of Glycemic Control
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DAVID V. WAGNER, MARK A. CLEMENTS, JENNIFER RAYMOND, JENISE C. WONG, ALISON REED, DIANA NARANJO, CELESTE JENISCH, CRISTIAN CRUZ, SUSANNE MITCHELL, LOREN YGLECIAS, JAQUELIN J. FLORES GARCIA, ELIZABETH SALCEDO-RODRIGUEZ, ALEJANDRA TORRES SANCHEZ, POOJITA DASIKA, JULIA VIANA, DAVID D. WILLIAMS, DIANA FERRO, and MICHAEL A. HARRIS
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Objective: A subset of youth with T1D experience ongoing challenges with diabetes self-management, often due to social risk. This 5-site study examined which social factors were associated with hemoglobin A1c (A1c) , specifically in youth with preexisting high A1c. Methods: Youth with T1D for more than 1 year were included if between 12-17 years old and with at least one A1c value ≥10% in the past year. Chart review captured A1c values, and caregivers reported on social risk- with 16 risk variables (e.g., housing security, employment status) in initial analyses. Multivariable linear regression model included A1c from 1 year prior to enrollment as an outcome and backwards stepwise procedure retained covariates with p Results: Participants (n=130) had a mean age of 14.4 (±1.6) years and mean A1c of 11.1 (±1.7) ; 49% reported male gender; 51% self-identified as Non-Hispanic White. A1c prior to study enrollment was predicted to be 0.68 lower in individuals whose caregiver had at least a college education and 0.65 higher when caregivers were divorced or separated. Conclusion: Findings suggest that, in youth with preexisting difficulty with glycemic variability, caregiver education level and marital status are associated with A1c - and, while not causal, may reflect unique value when screening for risk. This cohort will be followed to determine which factors predict future health concerns and associated need for intervention. Disclosure D.V.Wagner: None. L.Yglecias: None. J.J.Flores garcia: None. E.Salcedo-rodriguez: None. A.Torres sanchez: None. P.Dasika: None. J.Viana: None. D.D.Williams: None. D.Ferro: None. M.A.Harris: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.Raymond: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. D.Naranjo: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF
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- 2022
8. 284-OR: Diabetes Technology Access for Youth with T1D and High Social Risk: Comparing Intervention Outcomes
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JUSTINE LELY, MICHAEL A. HARRIS, DIANA NARANJO, CELESTE JENISCH, ANN JELINE F. MANABAT, CRISTIAN CRUZ, RACHEL BENSEN, ANDREA BONILLA OSPINA, and DAVID V. WAGNER
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
Objective: Health disparities exist in diabetes technology access for those youth with T1D who experience high social risk, despite likely benefits. Novel Interventions in Children’s Healthcare (NICH) , designed to improve health for youth with T1D experiencing such disparities, has previously been associated with improved diabetes technology access. This study compares diabetes technology use prior to and after NICH referral, and is the first such study to include a control group. Methods: Youth with T1D served by NICH (n=65) and referred youth (“controls”: n=73) across 3 sites were included. EHR data included DKAs, hospitalizations, ED visits, and presence of diabetes technology 1 year prior and 2 years after NICH initiation. No significant demographic differences. Results: Compared to the controls, NICH youth were significantly more likely to gain a CGM and experience significantly greater reductions in hospital admits, DKAs, and ED visits. After accounting for prior differences, only DKA event reduction and CGM access continued to be significant. Youth in NICH also averaged more years with tech access. Conclusion: This study demonstrates that while youth referred to NICH experience substantial barriers to accessing diabetes technology, youth in NICH were more likely to gain CGM access and have fewer DKA events than controls - and neither group approached national averages in technology access. Disclosure J.Lely: None. M.A.Harris: None. D.Naranjo: None. C.Jenisch: None. A.F.Manabat: None. C.Cruz: None. R.Bensen: None. A.Bonilla ospina: None. D.V.Wagner: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
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- 2022
9. Trends in Arterial Access Site Selection and Bleeding Outcomes Following Coronary Procedures, 2011-2018
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Jacob A. Doll, Kristine Beaver, Diana Naranjo, Stephen W. Waldo, Charles Maynard, Christian D. Helfrich, and Sunil V. Rao
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Cross-Sectional Studies ,Percutaneous Coronary Intervention ,Treatment Outcome ,Risk Factors ,Radial Artery ,Humans ,Hemorrhage ,Cardiology and Cardiovascular Medicine ,Coronary Angiography - Abstract
Background: Prior studies of radial access for cardiac catheterization have focused on early adopters of the technique, and some have described a risk/treatment paradox of low radial access use among high bleeding risk patients. This study aimed to determine (1) trends in radial access use over time, (2) if increasing use of radial access is driven by new invasive and interventional cardiologists (operators) or existing operators changing their practice, and (3) if increasing radial rates are associated with lower bleeding rates and elimination of the risk/treatment paradox. Methods: In this cross-sectional study using data from the Clinical Assessment, Reporting, and Tracking Program, we calculated radial access rates and risk-adjusted postprocedural bleeding rates of patients undergoing diagnostic angiography or percutaneous coronary intervention (PCI) between 2011 and 2018 in Veterans Affairs hospitals. We used separate bleeding risk models for diagnostic angiography and PCI and assessed temporal trends with the Kendall Tau-b test. Results: Among 253 179 diagnostic angiograms and 93 614 PCIs, radial access rates increased over time for both diagnostic (17.5%–60.4%; P P P =0.02) but not PCI (3.4%–2.5%, P =0.20). Femoral access patients had a higher predicted risk for bleeding. Conclusions: A steady rise in radial access for diagnostic angiography and PCI was driven by increasing use among existing operators and high use by new operators. While this was associated with decreasing bleeding rates, a risk/treatment paradox for access site selection persists; patients at higher bleeding risk were still more likely to receive femoral access.
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- 2022
10. Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use
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Monica S. Lanning, Jessie J. Wong, Regan C. Barley, Korey K. Hood, Diana Naranjo, Sarah Hanes, and Molly L. Tanenbaum
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Parents ,Insulin pump ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030209 endocrinology & metabolism ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Endocrinology ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Child ,Intensive care medicine ,Type 1 diabetes ,business.industry ,Blood Glucose Self-Monitoring ,Insulin ,Device use ,medicine.disease ,Medical Laboratory Technology ,Diabetes Mellitus, Type 1 ,Attitude ,Child, Preschool ,Glucose monitors ,business ,human activities - Abstract
Background: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles ...
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- 2020
11. An Intolerable Burden: Suicide, Intended Self-Injury and Diabetes
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Halis Kaan Akturk, Emilie Olié, Shideh Majidi, Philippe Courtet, Rayhan A. Lal, Eric Renard, Katharine D. Barnard-Kelly, Diana Naranjo, Marc D. Breton, Mark A. Atkinson, and Nicole Johnson
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Suicide Prevention ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,General Medicine ,Prognosis ,medicine.disease ,Article ,Suicide ,Endocrinology ,Diabetes mellitus ,Diabetes Mellitus ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,business ,Self-Injurious Behavior - Published
- 2020
12. RE-AIM Evaluation Plan for Washington State Innovation Models Project
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Norma B. Coe, Diana Naranjo, Janet G. Baseman, Suzanne J. Wood, Douglas A. Conrad, Tao Kwan-Gett, and David Grembowski
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education.field_of_study ,Health (social science) ,Leadership and Management ,business.industry ,030503 health policy & services ,Health Policy ,media_common.quotation_subject ,Population ,Plan (drawing) ,Population health ,03 medical and health sciences ,Intervention (law) ,Engineering management ,0302 clinical medicine ,Health care ,Conceptual model ,030212 general & internal medicine ,Business ,State (computer science) ,0305 other medical science ,education ,Care Planning ,Medicaid ,media_common - Abstract
The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
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- 2020
13. Exposure to Closed Loop Barriers Using Virtual Reality
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Jessica Shen, Diana Naranjo, Monica S. Lanning, Korey K. Hood, Daniel Wasser, Scott Riddle, and Bianca I Agustin
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Adult ,Blood Glucose ,Male ,Health Knowledge, Attitudes, Practice ,Adolescent ,Computer science ,Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,Insulin delivery ,Pilot Projects ,Bioengineering ,Glycemic Control ,Virtual reality ,Young Adult ,Insulin Infusion Systems ,Human–computer interaction ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Type 1 diabetes ,Attitude to Computers ,Virtual Reality ,Cognition ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Diabetes Mellitus, Type 1 ,Patient Satisfaction ,Feasibility Studies ,Female ,Closed loop ,Special Section: DIY Technical Factors ,Biomarkers - Abstract
Background: Closed loop (CL) automated insulin delivery systems are demonstrated to be safe and effective in regulating glucose levels and reducing cognitive burden in people with type 1 diabetes (T1D). However, given the limited market options and the do-it-yourself nature of most systems, it can be difficult for potential users to shape their expectations fitting them into daily lives and management routines. As such, we examined the potential feasibility of a virtual reality (VR) intervention. Methods: A four-part VR intervention was created to expose adults with T1D to expected CL system barriers: body image, perceived hassles of using CL, deskilling fears, and unwanted social attention. Goals of the pilot were to assess feasibility and expose patients to CL. Surveys were conducted pre- and postparticipating in the VR experience. Results: A total of 20 adults with T1D completed the pilot. Average time to complete the experience was 14.1 minutes (8.8-39.9). Reported VR sickness was low. Willingness to use VR was maintained in 90% ( n = 18) and did not change expectations of CL in 95% ( n = 19). Virtual reality changed perceived hassles of CL in 25% ( n = 5) with four concerned over alarms and one connectivity issues: positive diabetes technology attitudes, confidence in managing hypoglycemia, overall perceptions of appearance, and positive affect maintained after the VR intervention. Negative affect significantly decreased after exposure and perceptions of being overweight trended toward significance. Conclusion: This pilot VR intervention demonstrated high potential in addressing expected barriers to uptake and usage of CL systems without decreasing enthusiasm or changing expectations of CL.
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- 2020
14. Cost analysis of a coaching intervention to increase use of transradial percutaneous coronary intervention
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Edwin S. Wong, Christian D. Helfrich, Emily L. Neely, Kevin I Duan, Sunil V. Rao, Christine A. Sulc, and Diana Naranjo
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Marginal cost ,Medicine (General) ,Cost estimate ,business.industry ,Total cost ,Research ,Coaching ,Variable cost ,R5-920 ,Catheterization procedure ,Medicine ,Operations management ,Activity-based costing ,business ,Fixed cost ,health care economics and organizations - Abstract
Background The transradial approach (TRA) to cardiac catheterization is safer than the traditional transfemoral approach (TFA), with similar clinical effectiveness. However, adoption of TRA remains low, representing less than 50% of catheterization procedures in 2015. Peer coaching is one approach to facilitate implementation; however, the costs of this strategy for cardiac procedures such as TRA are unclear. Methods We conducted an activity-based costing analysis (ABC) of a multi-center, hybrid type III implementation trial of a coaching intervention designed to increase the use of TRA. We identified the key activities of the intervention and determined the personnel, resources, and time needed to complete each activity. The personnel cost per hour and the activity duration were then used to estimate the cost of each activity and the total variable cost of the implementation. Fixed costs related to designing and running the implementation were calculated separately. All costs are reported in 2019 constant US dollars. Results The total cost of the coaching intervention implementation was $374,863. Of the total cost, $367,752 were variable costs due to travel, preparatory work, in-person coaching, post-intervention evaluation, and administrative time. We estimated fixed costs of $7112. The mean marginal cost of implementing the intervention at only one additional medical center was $52,536. Conclusions We provide granular cost estimates of a conceptually rooted implementation strategy designed to increase the uptake of TRA for cardiac catheterization. We estimate that implementation costs stemming from the coaching approach would be offset after the conversion of approximately 409 to 1363 catheterizations from TFA to TRA. Our estimates provide benchmarks of the expected costs of implementing evidence-based, but expertise-intensive, cardiac procedures. Trial registration ISRCTN, ISRCTN66341299. Registered 7 July 2020—retrospectively registered
- Published
- 2021
15. State-Level Evaluation of Washington's State Innovation Models (SIM) Initiative
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Lingmei Zhou, Janet G. Baseman, Douglas A. Conrad, Jordan Banks, Diana Naranjo, Norma B. Coe, Suzanne J. Wood, David Grembowski, and Tao Kwan-Gett
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Washington ,Medicaid ,media_common.quotation_subject ,Public Health, Environmental and Occupational Health ,Social Welfare ,Population health ,Public administration ,Medicare ,United States ,Test (assessment) ,Intervention (law) ,State (polity) ,Conceptual model ,Humans ,Support system ,Business ,media_common ,Aged - Abstract
The Washington State Innovation Models (SIM) $65 million Test Award from the Center for Medicareamp; Medicaid Services' Innovation Center is a statewide intervention expected to improve population health, quality of care, and cost growth through four initiatives: 1) regional accountable communities of health linking health and social services to address local needs; 2) a practice transformation support hub; 3) four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and 4) data and analytic infrastructure development to support system transformation with common measures. We develop a conceptual model based on diffusion theory and apply the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to structure our evaluation. We find that in three years (2016-2018), SIM built the infrastructure for system transformation and increased Washington's readiness for health system change in the next decade. However, the initiatives have not spread statewide, which may take over 10 years.
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- 2021
16. 565-P: Loop Automated Insulin Delivery System: Reasons for Discontinued Use
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Sakinah C. Suttiratana, Jessie J. Wong, Adrienne Dunlap, Rayhan A. Lal, Korey K. Hood, Monica S. Lanning, Sarah Hanes, and Diana Naranjo
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business.industry ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Insulin delivery ,Medicine ,Pharmacology ,business - Abstract
Background: Loop is an open-source do-it-yourself (DIY) automated insulin delivery system that allows users unrivaled control over physiologic settings that effect future glucose prediction. Over 9,000 individuals have adopted Loop, but little is known about those who discontinue. Methods: Twenty Loop users (14 adults and 6 caregivers; 60% female, 85% white, 75% household income >$100k/year, and HbA1c 6.7±1.0%) participated in semi-structured interviews about their experiences with Loop following discontinuation. Qualitative data were transcribed, coded, and analyzed. Results: Prominent themes reflected the perception that the stress, effort and/or time required to set up Loop and achieve management goals exceeded potential benefits. Two quotes: “I couldn’t spend any more time trying to work on my settings and trying to make it better,” and “I know I could get an improvement with it, but the problem was the cost of it⋯I couldn’t concentrate anymore at work⋯it felt like fog in my brain.” Technical issues with component devices, connectivity issues, lack of technical support, cost (time, energy, supplies), fear of provider disapproval, concerns related to pregnancy, exercise, hypoglycemia and managing low insulin doses, and desire to try other new technologies were among other reasons for ending use. Participants indicated that improved technical assistance and expert guidance might lead to them to use Loop again in the future. Conclusions: For those who manage to set up Loop there are additional challenges, even among individuals with adequate glycemic control and access to various financial, social, and personal resources. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users. Disclosure J. J. Wong: None. S. Suttiratana: Employee; Spouse/Partner; CVS Health. M. S. Lanning: None. A. Dunlap: None. S. Hanes: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. D. Naranjo: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
- Published
- 2021
17. 555-P: Leveling the Playing Field of Technology Access for Youth with T1D: NICH Helps, but Challenges Persist
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Winniebhelle C. Cadiz, Justine Lely, David V. Wagner, Rachel Bensen, Julia Viana, Michael Harris, Celeste Jenisch, and Diana Naranjo
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Type 1 diabetes ,business.industry ,Endocrinology, Diabetes and Metabolism ,Health care ,Internal Medicine ,Psychological intervention ,medicine ,Mean age ,medicine.disease ,business ,Demography ,Glycemic - Abstract
Objective: Advancements in technology (insulin pumps, CGMs) for youth with type 1 diabetes (T1D) hold promise for better outcomes, but multiple barriers to access exist, especially for underserved and underrepresented populations. Novel Interventions in Children’s Healthcare (NICH), was designed to improve health for youth with T1D and social vulnerabilities. NICH is associated with improvements in glycemic control and reductions in complications (DKA), but less is known regarding technology access for participating youth. This study aims to 1) identify prevalence of technology use prior to and after NICH initiation and 2) examine the relationship between technology access and NICH outcomes. Methods: Youth with T1D served by NICH (n=65) across three distinct geographical sites were included. EHR review included T1D complications (DKA), HbA1c values, and presence of T1D technology one year prior and two years following initiation of NICH services. Mean age was 15.0 years (SD=3.5); 52% female; 73% non-Hispanic White. Results: Ten percent of youth had access to technology prior to NICH (pump=8%; CGM=2%), and 22% had access to technology 2 years post NICH initiation (pump=17%; CGM=14%). Youth were significantly more likely to gain access to CGMs (p Conclusion: With rates of access hovering around 40% for CGMs and 50% for pumps, this study demonstrates that 1) youth referred to NICH experience substantial barriers to accessing T1D technology, 2) NICH participation is associated with increased access to T1D technology for socially vulnerable youth, and 3) despite program involvement, technology access inequities persist. Disclosure J. Lely: None. M. A. Harris: None. D. Naranjo: None. C. Jenisch: None. W. C. Cadiz: None. R. Bensen: None. J. Viana: None. D. V. Wagner: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust; BUILD EXITO Foundation; Central Oregon Health Council
- Published
- 2021
18. 518-P: User Experiences with Loop, an Open-Source Automated Insulin Delivery (AID) System
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Rayhan A. Lal, Sakinah C. Suttiratana, Jessie J. Wong, Korey K. Hood, Adrienne Dunlap, Sarah Hanes, Diana Naranjo, and Monica S. Lanning
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Focus group ,Technical support ,Quality of life (healthcare) ,Diabetes management ,Spouse ,Family medicine ,Internal Medicine ,medicine ,Observational study ,Disease management (health) ,Psychology ,Glycemic - Abstract
Background: Loop is an open-source AID system used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation. Methods: Focus groups illuminated 72 new and experienced users’ perspectives on Loop uptake, use and persistence. Participants were predominately white (95%), male (50%), privately insured (94%), reported annual household income ≥ $100K (73%) and education exceeding a bachelor’s degree (87%) with a mean HbA1c of 6.6±0.8%. Twenty discontinuers who stopped using Loop during the study (60% female, 85% white, 85% privately insured) completed interviews. Qualitative data, collected as part of the larger observational study, were analyzed and synthesized by a multidisciplinary team. Results: High frequency thematic content described experiences with: a) technical support and troubleshooting, b) decreased mental/behavioral burden, c) technical issues with parts of the system, d) glycemic control, e) personalizing settings, and f) providers while using Loop. Users also emphatically highlighted the effects of Loop on overnight experiences and the role that “Loop communities” played during use. Decreased burden was the most endorsed benefit characterized by less worry, stress, and cognitive effort; less time spent on diabetes management tasks, and more space to think about nondiabetes aspects of life. The most discussed drawback was having technical issues with any part of the system including challenges with insulin pumps, CGMs, infusion sites, signal loss, the app, and/or the algorithm. A range of provider attitudes and knowledge about Loop complicated users’ disclosure and experiences. Conclusions: This sample of Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components and adjusting settings. Users reported being empowered by the customizability and educational effects of the open-source AID system. Disclosure S. Suttiratana: Employee; Spouse/Partner; CVS Health. J. J. Wong: None. M. S. Lanning: None. A. Dunlap: None. S. Hanes: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. D. Naranjo: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
- Published
- 2021
19. 566-P: Is a Zoom, Family-Based Intervention Feasible during a Pandemic?
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Haley M. Linzmeyer, Jessica Ngo, Sarah Hanes, Christine A. Wu, Monica S. Lanning, Jessie J. Wong, Korey K. Hood, and Diana Naranjo
- Subjects
medicine.medical_specialty ,Type 1 diabetes ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.disease ,Focus group ,Distress ,Diabetes management ,Family medicine ,Intervention (counseling) ,Pandemic ,Internal Medicine ,medicine ,business ,Psychosocial ,Depression (differential diagnoses) - Abstract
Background: Access to psychosocial services is limited, especially during a pandemic. A Zoom-delivered family-based intervention for adolescents with type 1 diabetes has the potential to enhance access to psychosocial services. Methods: Nine families enrolled in a pilot of a 6-session online (Zoom) intervention for adolescents with type 1 diabetes and their parents during the COVID-19 pandemic. Qualitative and quantitative data were collected via online focus groups and surveys. Results: Teens’ ages ranged from 12-17 years (M=14.9, SD=1.76) and most self-identified as male (78%). All parents self-identified as female and most families self-identified as non-Hispanic white (78%). Qualitative results revealed that participants found the program to be generally helpful and would recommend the program to others. Perceived benefits included increased parental empathy toward teens, enhanced parental involvement in teens’ diabetes management, and decreased parent-teen conflict. Participants conveyed that these benefits were particularly impactful given increased family contact and tensions related to the COVID-19 pandemic. Identified areas for improvement included adding follow-up group sessions with parents to maintain program impact on parenting over time and to target teens in early adolescence, when family dynamics are more malleable. Quantitative results from paired t-tests of pre-post comparisons revealed no significant differences in teen or parental diabetes distress or depression (all p>0.05), but should be interpreted with caution due to small sample size. Conclusions: Adolescents with type 1 diabetes and their parents responded positively to this program and found it particularly relevant during the current pandemic. Zoom delivery of these programs may be instrumental in their feasibility, acceptability, and ultimately dissemination in the future. Disclosure J. J. Wong: None. M. S. Lanning: None. J. Ngo: None. C. A. Wu: None. S. Hanes: None. H. M. Linzmeyer: None. D. Naranjo: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK121771-01A1)
- Published
- 2021
20. 549-P: Understanding PCP Perspectives in a Project ECHO T1D Program Using the Consolidated Framework for Implementation Research
- Author
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Eleni Sheehan, Rayhan A. Lal, Linda G. Baer, Ashby F. Walker, Matthew J. Gurka, Brian C. Fitzgerald, Stephanie L. Filipp, Claudia Anez-Zabala, Sarah C. Westen, Marina Basina, Jessie J. Wong, Michael J. Haller, Gaia L. Zori, Xanadu Roque, Angelina Bernier, Kea Turner, David M. Maahs, Eugene Lewit, Jennifer Maizel, Nicolas Cuttriss, Lauren Figg, Korey K. Hood, Katarina Yabut, and Diana Naranjo
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Subspecialty ,Focus group ,Likert scale ,Qualitative analysis ,Family medicine ,Health care ,Internal Medicine ,medicine ,Intervention implementation ,Implementation research ,Thematic analysis ,Psychology ,business - Abstract
The Project Extension for Community Healthcare Outcomes (ECHO™) model addresses disparities by empowering primary care provider (PCPs), through tele-education, to meet the needs of underserved communities lacking access to subspecialty care. Given the rapid replication of this model, it is vital to understand the perspectives of participating PCPs to refine program implementation. Project ECHO™ Type 1 Diabetes (T1D) program was piloted in Florida and California with >15 Federally Qualified Health Centers (FQHC). PCPs completed pre/post-test surveys assessing knowledge and confidence in T1D care. Exit surveys and focus groups were conducted to understand their experiences (N=92 providers, 41 from FL and 51 from CA were queried). Qualitative analysis of open-ended survey feedback and thematic analysis of focus group data used the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies five domains that affect intervention implementation - including internal and external factors to the healthcare organization. Pre/post surveys demonstrated significant improvements in providers’ diabetes knowledge; mean ± SD change in score for an 11-item knowledge evaluation from pre/post: (1.0 ± 1.8, [Min: -2, Max: +5], p-value: 0.0003) and increase in overall confidence evaluated on a 4-point likert scale (0.6 ± 0.4 [Min: -0.1, Max: 1.6] p-value Disclosure A. F. Walker: None. S. L. Filipp: None. K. Turner: None. G. L. Zori: None. J. Maizel: None. N. Cuttriss: Consultant; Self; Cecelia Health. L. G. Baer: None. L. Figg: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. M. Basina: None. M. J. Haller: Board Member; Self; SAB Biotherapeutics, Inc., Consultant; Self; MannKind Corporation, Other Relationship; Self; Janssen Pharmaceuticals, Inc., Sanofi. J. J. Wong: None. K. Yabut: None. D. Naranjo: None. E. Lewit: None. D. M. Maahs: Advisory Panel; Self; Abbott Diabetes, Dompe, Eli Lilly and Company, Medtronic, Novo Nordisk, Consultant; Self; aditxt. E. Sheehan: None. S. C. Westen: None. C. Anez-zabala: None. X. Roque: None. B. C. Fitzgerald: None. A. Bernier: None. M. J. Gurka: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
- Published
- 2021
21. Cost considerations for adoption of diabetes technology are pervasive: A qualitative study of persons living with type 1 diabetes and their families
- Author
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Monica S. Lanning, Jessie J. Wong, Korey K. Hood, Jill Weissberg-Benchell, Diana Naranjo, Ananta Addala, Katharine D. Barnard, Sakinah C. Suttiratana, and Lori M. Laffel
- Subjects
Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,Decision Making ,030209 endocrinology & metabolism ,Interpersonal communication ,Frustration ,Insurance Coverage ,Article ,03 medical and health sciences ,Interpersonal relationship ,Insulin Infusion Systems ,0302 clinical medicine ,Endocrinology ,Cost of Illness ,Internal Medicine ,medicine ,Family ,Interpersonal Relations ,030212 general & internal medicine ,Qualitative Research ,health care economics and organizations ,media_common ,Type 1 diabetes ,business.industry ,Stakeholder ,Health Care Costs ,Public relations ,Morality ,medicine.disease ,Diabetes Mellitus, Type 1 ,Social ecological model ,business ,Psychosocial ,Qualitative research - Abstract
Background Cost is a major consideration in the uptake and continued use of diabetes technology. With increasing use of automated insulin delivery systems, it is important to understand the specific cost-related barriers to technology adoption. In this qualitative analysis, we were interested in understanding and examining the decision-making process around cost and diabetes technology use. Materials and methods Four raters coded transcripts of four stakeholder groups using inductive coding for each stakeholder group to establish relevant themes/nodes. We applied the Social Ecological Model in the interpretation of five thematic levels of cost. Results We identified five thematic levels of cost: policy, organizational, insurance, interpersonal, and individual. Equitable diabetes technology access was an important policy-level theme. The insurance-level theme had multiple sub-themes which predominantly carried a negative valence. Participants also emphasized the psychosocial burden of cost specifically identifying diabetes costs to their families, the guilt of diabetes related costs, and frustration in the time and involvement required to ensure insurance coverage. Conclusion We found broad consensus in how cost is experienced by stakeholder groups. Cost considerations for diabetes technology uptake extended beyond finances to include time, cost to society, morality, and interpersonal relationships. Cost also reflected an important moral principle tied to the shared desire for equitable access to diabetes technology. Knowledge of these considerations can help clinicians and researchers promote equitable device uptake while anticipating barriers for all persons living with type 1 diabetes and their families.
- Published
- 2021
22. Persons With Debt Burden Are More Likely to Report Suicide Attempt Than Those Without
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Joseph E. Glass, Emily C. Williams, and Diana Naranjo
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Adult ,Male ,Adolescent ,media_common.quotation_subject ,Suicide, Attempted ,Logistic regression ,Young Adult ,Intervention (counseling) ,Debt ,Prevalence ,Economic Status ,Humans ,Medicine ,Aged ,Retrospective Studies ,media_common ,Suicide attempt ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Health Surveys ,Obesity ,United States ,Psychiatry and Mental health ,Cross-Sectional Studies ,Mood disorders ,National study ,Female ,business ,Demography - Abstract
OBJECTIVE To assess the association between debt burden and self-reported suicide attempt among US adults. METHODS Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) were used to estimate the association between self-reported past-year debt burden and past-year and lifetime suicide attempt with logistic regression, controlling for sociodemographic characteristics with known associations with debt burden and suicide attempt. RESULTS Among 36,278 adults aged ≥ 18 years, 13.03% reported past-year debt burden, 0.37% reported past-year suicide attempt, and 5.16% reported lifetime suicide attempt. Self-reported attempt was more likely for persons reporting debt burden than for those without (eg, for past-year suicide attempt: odds ratio [OR] = 7.96 [95% CI, 5.45-11.64; P
- Published
- 2021
23. Evaluación de la calidad de la historia clínica en el servicio de consulta externa. Unidad Anidada Chunchi, Chimborazo 2018
- Author
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Andrés Fernando Alcocer Ortega, Lisseth Diana Naranjo Rosas, and Mauricio Gustavo Besantes Montoya
- Abstract
Determinando como piedra angular de todo el sistema de información en todos los niveles de atención de salud a una historia clínica de calidad, concordamos que es un tema esencial en nuestra práctica diaria, conceptualizando a una historia clínica adecuadamente confeccionada como la constancia escrita de todos los exámenes médicos, estudios realizados y tratamientos aplicados durante el transcurso de la enfermedad , el obtuvo principal del estudio fue conocer el grado de cumplimentación de la historia clínica en el Servicio de Consulta Externa de una Unidad de Primer Nivel de Atención, para evaluar áreas de mejora. Se realizó un Estudio descriptivo transversal, con análisis del porcentaje de cumplimentación de veinte variables en 147 ingresos atendidos en la consulta externa de la Unidad Anidad Chunchi durante 6 meses. Para el análisis de datos se creó una base de datos en Microsoft Excel 2016. De las 20 variables analizadas en el presente estudio se encontró que, en cuanto a la calidad de la documentación clínica utilizada, los datos clínico-estadísticos y la fecha de atención estaban presentes en el 100%, antecedentes familiares (73%), antecedentes personales de interés (82%), hábitos tóxicos (8%), motivo de consulta (95%), el diagnóstico, las órdenes terapéuticas y los signos vitales (100%). El 96% de las historias incluían las hojas de evolución. El 86% de las historias clínicas tenían realizadas el post consulta por parte de enfermería. El 59% de la documentación revisada es legible sin dificultad y el 41% es legible con alguna dificultad. El 68% de las historias clínicas poseían los formularos llenados de manera correcta de acuerdo con la edad. La calidad del registro es variable, aceptable en codificación diagnóstica, datos estadísticos y fecha de atención y deficitaria en antecedentes personales, hábitos, a pesar de la alta cumplimentación (>95%) de motivo de consulta y juicio clínico, se subraya la relevancia del incumplimiento del llenado documentario en un 41 % con datos legibles y comprensibles.
- Published
- 2019
24. Psychosocial Effects of the Loop Open-Source Automated Insulin Delivery System
- Author
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Jessie J. Wong, Korey K. Hood, Sarah J. Hanes, Rayhan A. Lal, and Diana Naranjo
- Subjects
Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,Internal Medicine ,Bioengineering - Abstract
Aims: This study examined the psychosocial impact of Loop, an open-source automated insulin dosing system that has emerged from the diabetes technology “Do-It-Yourself” (DIY) movement. Methods: Subsamples of 239 adults, 115 children, and 243 parents completed data collection at the time of Loop initiation and 3 and 6 months later. Surveys collected demographic and clinical information, percent time-in-range, HbA1c, and validated psychosocial measures. Analyses included paired t tests and McNemar’s tests to compare psychosocial functioning at 3 and 6 months and regression models to assess baseline predictors of psychosocial outcomes at 6 months. Results: Adults reported significant improvements in diabetes distress ( t = −7.20 P < .001; t = −8.01, P < .001), sleep quality ( t = 6.81, P < .001; t = 2.98, P = .003), fear of hypoglycemia ( t = −4.42, P < .001; t = −4.97, P < .001), and hypoglycemia confidence ( t = 8.68, P < .001; t = 7.96 P < .001) from baseline to 3 months and 6 months, respectively. Significant improvements in parents’ and children’s sleep quality and parents’ fear of hypoglycemia were also observed. Several baseline characteristics were associated with psychosocial outcomes at 6 months. Conclusions: The current findings support the broad and sustained benefits of Loop across multiple aspects of psychosocial well-being. Advancement and dissemination of such technologies has the potential to improve mental and physiological health among people living with type 1 diabetes.
- Published
- 2022
25. You, me, and diabetes: Intimacy and technology among adults with T1D and their partners
- Author
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Jill Weissberg-Benchell, Korey K. Hood, Lindsay M. Anderson, Katharine D. Barnard-Kelly, Lindsey E. G. Weil, Diana Naranjo, Lori M. Laffel, and Kimberly P. Garza
- Subjects
Gerontology ,Adult ,Male ,Type 1 diabetes ,Adolescent ,Biomedical Technology ,Context (language use) ,PsycINFO ,Focus Groups ,Patient Acceptance of Health Care ,medicine.disease ,Focus group ,Psychiatry and Mental health ,Interpersonal relationship ,Physical intimacy ,Diabetes Mellitus, Type 1 ,Sexual Partners ,Diabetes management ,medicine ,Humans ,Female ,Thematic analysis ,Psychology ,Applied Psychology ,Qualitative Research - Abstract
OBJECTIVE Limited research has examined the impact of technology on intimacy and relationships among individuals with type 1 diabetes (T1D). The current study examined the experiences of individuals with T1D and their partners and evaluated the expectations for how advances in technology such as automated insulin delivery systems may impact physical intimacy. METHOD The Insulin Delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) study is a multisite study examining expectations for automated insulin delivery systems among adults and youth with T1D as well as partners and caregivers. For the current analysis, data regarding the impact of diabetes on relationship intimacy were extracted from focus groups or individual semistructured interviews with adults with T1D (n = 113) and partners of individuals with T1D (n = 55). RESULTS Three independent coders conducted thematic analysis utilizing NVivo software. Two primary themes were identified: vulnerability in romantic relationships because of managing diabetes and the unique challenges of physical intimacy because of the use of diabetes technology. CONCLUSIONS Participants expressed the hope that diabetes technology, and automated insulin delivery systems in particular, will offer opportunities for flexibility in their diabetes management. These options may decrease their sense of vulnerability through provision of greater control over diabetes management and when/whether to disclose diabetes, minimizing discomforts in the context of sexual intimacy, and reduction of fear about diabetes complications. Patient-reported outcomes and expectations for diabetes technology should be incorporated into patient-provider conversations about sensitive issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
- Published
- 2021
26. Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability
- Author
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Monica S. Lanning, Sarah Hanes, Esti Iturralde, Jessie J. Wong, Molly L. Tanenbaum, Korey K. Hood, and Diana Naranjo
- Subjects
Adult ,Male ,Adolescent ,Emotions ,030209 endocrinology & metabolism ,Subspecialty ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Diabetes clinic ,Diabetes mellitus ,Surveys and Questionnaires ,Patient experience ,Developmental and Educational Psychology ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Child ,Depression (differential diagnoses) ,business.industry ,Depression ,medicine.disease ,Mental health ,Distress ,Diabetes Mellitus, Type 1 ,Pediatrics, Perinatology and Child Health ,Female ,business ,Psychosocial ,Clinical psychology - Abstract
Aims Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes. Methods A sample of 124 adolescents (57.7% female) ages 12–21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates. Results Adolescents with the most common profile (72.6%) placed high importance on medical providers’ awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not. Conclusions Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.
- Published
- 2020
27. 58-LB: Barriers to Technology Use for Underserved Communities with Type 1 Diabetes
- Author
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Korey K. Hood, Katarina Yabut, Matthew J. Gurka, Gina Aulisio, Diana Naranjo, Stephanie L. Filipp, Xanadu Roque, Nicolas Cuttriss, Ashby F. Walker, Ananta Addala, David M. Maahs, Claudia Anez-Zabala, Sydney Look, and Michael J. Haller
- Subjects
0301 basic medicine ,Type 1 diabetes ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Psychological intervention ,Ethnic group ,030209 endocrinology & metabolism ,medicine.disease ,Focus group ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Family medicine ,Internal Medicine ,medicine ,business ,Location ,Socioeconomic status - Abstract
Disparities in the use of CGMs and insulin pumps in T1D based on socioeconomic status (SES) and race/ethnicity are pronounced. However, systematic reports of perspectives from patients in vulnerable communities are limited. To better understand barriers, focus groups were conducted in Florida and California with adults with T1D. Selection criteria included hospitalization for DKA, HbA1C >9%, or receiving care at a Federally Qualified Health Center. A total of 16 focus groups were conducted in English or Spanish with 86 adults (Table 1). Transcript themes and pre-focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology included: (1) provider-level (overtly blocked/discouraged by provider) (2) system-level (financial barriers related to coverage) and (3) individual-level (difficulty with use or preference issues). In Florida there was less technology use overall (38% had used CGMs in FL, 63% in CA; 43% had used pumps in FL, 69% in CA) and significant differences in pump use by SES (P=0.02 in FL, P=0.08 in CA) and race/ethnicity (P=0.01 in FL, P=0.80 in CA). In California there were significant differences in CGM use by race/ethnicity (P=0.05 in CA, P=0.56 in FL) and education level (P=0.02 in CA, P=0.90 in FL). These findings provide novel insights and demonstrate the need for multi-level interventions and further research on variations in technology use based on geographic location. Disclosure A.F. Walker: None. N. Cuttriss: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc. S.L. Filipp: None. K. Yabut: None. C. Anez-Zabala: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. X. Roque: None. D. Naranjo: None. G. Aulisio: None. A. Addala: None. S. Look: None. M.J. Gurka: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. Funding The Leona M. and Harry B. Helmsley Charitable Trust
- Published
- 2020
28. 1307-P: Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability
- Author
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Molly L. Tanenbaum, Diana Naranjo, Korey K. Hood, Sarah Hanes, Monica S. Lanning, and Jessie J. Wong
- Subjects
business.industry ,Endocrinology, Diabetes and Metabolism ,Ethnic group ,medicine.disease ,Mental health ,Distress ,Diabetes mellitus ,Internal Medicine ,Global health ,medicine ,Anxiety ,medicine.symptom ,business ,Psychosocial ,Depression (differential diagnoses) ,Clinical psychology - Abstract
Background: Psychosocial screening is recommended and increasingly common, but little is known about youths’ perspectives on screenings. Methods: One hundred and twenty-four adolescents (57.7% female) ages 12-21 years (M=16.2±2.3) completed routine, clinic-integrated screenings. K-means clustering derived profiles and ANOVA assessed correlates profiles. Results: Four distinct profiles emerged (Table 1). Profiles varied by depression (F=3.54, p=0.017), diabetes distress (F=3.27, p=0.036), and A1c values (F=4.03, p=0.009). Majority (72.6%) placed high importance on diabetes teams awareness about their emotions and reported no difficulties/discomfort (Embracers). Those uncomfortable with screening (Avoiders) were most depressed and had lowest A1C. Youth who endorsed difficulties with tablet and placed low importance about team awareness about their emotions (Skeptics) had relatively high depression but least diabetes distress. A small fourth group (Strugglers; n=3) must be interpreted with caution due to size. No differences were found for age, gender, diabetes duration/type, race/ethnicity, self-rated global health, or anxiety. Conclusions: Most youth responded favorably to in-clinic psychosocial screenings. Those less satisfied may have increased mental health risk and may benefit from technical support and an emphasized rationale for screenings. Disclosure J.J. Wong: None. S. Hanes: None. M.S. Lanning: None. M.L. Tanenbaum: None. D. Naranjo: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ.
- Published
- 2020
29. RE-AIM Evaluation Plan for Washington State Innovation Models Project
- Author
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David, Grembowski, Douglas A, Conrad, Diana, Naranjo, Suzanne, Wood, Norma B, Coe, Tao, Kwan-Gett, and Janet, Baseman
- Subjects
Washington ,Humans ,Delivery of Health Care ,Centers for Medicare and Medicaid Services, U.S ,United States ,Program Evaluation ,Quality of Health Care - Abstract
The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for MedicareMedicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
- Published
- 2020
30. Suicide and Self-inflicted Injury in Diabetes: A Balancing Act
- Author
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Katharine D. Barnard-Kelly, Shideh Majidi, Nicole Johnson, Philippe Courtet, Halis Kaan Akturk, Eric Renard, Emilie Olié, Marc D. Breton, Rayhan A. Lal, Diana Naranjo, Bournemouth University [Poole] (BU), University of New Hampshire (UNH), Department of Psychiatry and Behavioral Sciences [Stanford], Stanford Medicine, Stanford University-Stanford University, University of Colorado Anschutz [Aurora], Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Institut National de la Recherche Agronomique (INRA)-Centre National de la Recherche Scientifique (CNRS), University of Virginia [Charlottesville], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Stanford University, Greater NYC Chapter (JDRF), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Université de Lille-Centre National de la Recherche Scientifique (CNRS), University of Virginia, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Male ,Suicide Prevention ,Health Knowledge, Attitudes, Practice ,Endocrinology, Diabetes and Metabolism ,Health Behavior ,0302 clinical medicine ,MESH: Diabetes Mellitus, Type 1 / therapy ,Female ,Humans ,Risk Assessment ,Cost of Illness ,Risk Factors ,MESH: Risk Factors ,Self Care / psychology ,Self-Injurious Behavior / diagnosis ,Self-Injurious Behavior / prevention & control ,Self-Injurious Behavior / psychology ,Suicide / prevention & control ,Suicide / psychology ,Young Adult ,Adaptation, Psychological ,030212 general & internal medicine ,Suicidal ideation ,Depression (differential diagnoses) ,education.field_of_study ,Diabetes ,Age Factors ,[SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism ,3. Good health ,Distress ,Suicide ,Self-inflicted injury ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,medicine.symptom ,Psychosocial ,Adult ,MESH: Adaptation, Psychological ,Adolescent ,Diabetes Mellitus, Type 1 / diagnosis ,Diabetes Mellitus, Type 1 / psychology ,Population ,Biomedical Engineering ,030209 endocrinology & metabolism ,Bioengineering ,03 medical and health sciences ,Diabetes mellitus ,Internal Medicine ,medicine ,Self-harm ,education ,Glycemic ,Type 1 diabetes ,business.industry ,medicine.disease ,Self Care ,Diabetes Mellitus, Type 1 ,business ,Special Section: DIY Clinical Factors ,Self-Injurious Behavior ,Demography - Abstract
International audience; Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.
- Published
- 2019
31. From Wary Wearers to d-Embracers: Personas of Readiness to Use Diabetes Devices
- Author
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Sarah Hanes, Molly L. Tanenbaum, Korey K. Hood, Diana Naranjo, Regan C. Barley, Esti Iturralde, and Rebecca N. Adams
- Subjects
Adult ,Male ,Gerontology ,endocrine system diseases ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Information Seeking Behavior ,Biomedical Engineering ,030209 endocrinology & metabolism ,Bioengineering ,Persona ,Disease cluster ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Special Section: Improving Usability of Diabetes Devices ,Cost of Illness ,Inventions ,Quality of life ,Diabetes mellitus ,Diabetes Mellitus ,Internal Medicine ,medicine ,Humans ,Insulin ,030212 general & internal medicine ,Type 1 diabetes ,Continuous glucose monitoring ,business.industry ,Blood Glucose Self-Monitoring ,Communication Barriers ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Distress ,Equipment and Supplies ,Female ,Patient Participation ,business ,Attitude to Health ,Psychosocial ,Personality - Abstract
Background: Diabetes devices such as insulin pumps and continuous glucose monitoring (CGM) are associated with improved health and quality of life in adults with type 1 diabetes (T1D). However, uptake remains low. The aim of this study was to develop different “personas” of adults with T1D in relation to readiness to adopt new diabetes technology. Methods: Participants were 1498 T1D Exchange participants who completed surveys on barriers to uptake, technology attitudes, and other psychosocial variables. HbA1c data was available from the T1D Exchange for 30% of the sample. K-means cluster analyses grouped the sample by device barriers and attitudes. The authors assigned descriptive labels based on cluster characteristics. ANOVAs and chi-square tests assessed group differences by demographic and psychosocial variables (eg, diabetes duration, diabetes distress). Results: Analyses yielded five distinct personas. The d-Embracers (54% of participants) endorsed few barriers to device use and had the highest rates of device use, lowest HbA1c, and were the least distressed. The Free Rangers (23%) had the most negative technology attitudes. The Data Minimalists (10%) used pumps but had lower CGM use and did not want more diabetes information. The Wary Wearers (11%) had lower overall device use, were younger, more distressed, endorsed many barriers, and had higher HbA1c. The High Distress (3%) group members were the youngest, had the shortest diabetes duration, reported the most barriers, and were the most distressed. Conclusion: These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.
- Published
- 2018
32. Diabetes and cardiometabolic risk factors in Cambodia: Results from two screening studies
- Author
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Diana Naranjo, Ien Srey Horn, Sakinah C. Suttiratana, Touch Khun, Lim Keuky, Serey Seng, and Julie Wagner
- Subjects
Gerontology ,medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Prevalence ,030209 endocrinology & metabolism ,Anthropometry ,Overweight ,medicine.disease ,Obesity ,Impaired glucose tolerance ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Environmental health ,Epidemiology ,Medicine ,030212 general & internal medicine ,Rural area ,medicine.symptom ,business - Abstract
Background Despite growing attention to diabetes throughout Asia, data from Southeast Asia are limited. This article reports rates of diabetes, hypertension and obesity in Cambodia. Methods Two studies were conducted across different regions of Cambodia: a 2012 screening study across urban, semi-urban and rural areas that used point of care capillary glucose for determination of diabetes (n = 13,997) and a 2005 epidemiological study with random selection from two main urban areas that used oral glucose tolerance tests for determination of diabetes (n = 1,863). Blood pressure and anthropometrics were also measured. Results In the screening study, urban sites showed significantly higher rates of diabetes than rural sites; semi-urban rates were intermediate. There was a significant dose–response effect for urbanicity on overweight, obesity, and waist-to-hip ratio with higher rates for urban vs semi-urban and semi-urban vs rural locales. Rural sites had the lowest hypertension rates followed by urban and then semi-urban. Among persons who screened positive for diabetes, there was a dose–response effect for urbanicity on undiagnosed diabetes; rates of previously undiagnosed diabetes were lowest in urban (51%) vs semi-urban (55%) vs rural locales (67%). Rural participants reported the highest rates of smoking and alcohol use. In the urban epidemiological study, prevalence rates of diabetes and impaired glucose tolerance were approximately 10%, indicating a prevalence of total glucose intolerance of approximately 20%. Conclusions Diabetes rates in Cambodia are high and disproportionately affect urban residents. A public health response is urgently needed; as development continues, rates of diabetes are expected to rise.
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- 2017
33. Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users
- Author
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Esti Iturralde, Stuart A. Weinzimer, Diana Naranjo, Sarah Hanes, Bruce A. Buckingham, Jodie M. Ambrosino, Sakinah C. Suttiratana, Natalie Walders-Abramson, Korey K. Hood, Trang T. Ly, David M. Maahs, and Molly L. Tanenbaum
- Subjects
Adult ,Male ,Decreased stress ,050103 clinical psychology ,050109 social psychology ,Context (language use) ,Trust ,Article ,Change Type ,Diabetes management ,Diabetes mellitus ,medicine ,Humans ,0501 psychology and cognitive sciences ,Qualitative Research ,Applied Psychology ,Self-Management ,05 social sciences ,Patient Acceptance of Health Care ,medicine.disease ,Diabetes Mellitus, Type 1 ,Female ,Psychology ,Social psychology ,Closed loop ,Qualitative research - Abstract
Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.
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- 2017
34. Expectations and Attitudes of Individuals With Type 1 Diabetes After Using a Hybrid Closed Loop System
- Author
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Korey K. Hood, Natalie Walders-Abramson, Sakinah C. Suttiratana, Molly L. Tanenbaum, Trang T. Ly, David M. Maahs, Bruce A. Buckingham, Esti Iturralde, Sarah Hanes, Stuart A. Weinzimer, Diana Naranjo, and Jodie M. Ambrosino
- Subjects
Adult ,Blood Glucose ,Male ,Pancreas, Artificial ,Health Knowledge, Attitudes, Practice ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Control (management) ,030209 endocrinology & metabolism ,Health Professions (miscellaneous) ,Artificial pancreas ,Article ,Young Adult ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,030212 general & internal medicine ,Young adult ,Glycemic ,Type 1 diabetes ,Blood Glucose Self-Monitoring ,medicine.disease ,Focus group ,Clinical trial ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Female ,Psychology ,Clinical psychology - Abstract
Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as “closed loop” and “artificial pancreas,” which seemed to imply a more “hands-off” experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.
- Published
- 2017
35. Pilot evaluation of a brief intervention to improve nicotine patch adherence among smokers living with HIV/AIDS
- Author
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Joan S. Tucker, William G. Shadel, Claude Messan Setodji, Frank H. Galvan, Diana Naranjo, and Christian Lopez
- Subjects
Adult ,Male ,medicine.medical_specialty ,media_common.quotation_subject ,Nicotine patch ,medicine.medical_treatment ,Population ,Medicine (miscellaneous) ,Pilot Projects ,Article ,Nicotine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,media_common ,Acquired Immunodeficiency Syndrome ,education.field_of_study ,Hispanic or Latino ,Middle Aged ,Abstinence ,Nicotine replacement therapy ,Tobacco Use Cessation Devices ,Psychiatry and Mental health ,Clinical Psychology ,Treatment Outcome ,030220 oncology & carcinogenesis ,Physical therapy ,Patient Compliance ,Psychotherapy, Brief ,Smoking cessation ,Female ,Smoking Cessation ,Brief intervention ,Breath carbon monoxide ,Psychology ,medicine.drug - Abstract
Nicotine replacement therapy is an effective intervention for smoking cessation, but adherence tends to be low. This article presents results from a pilot evaluation of a brief smoking cessation treatment to improve adherence to the nicotine patch among Latino smokers living with HIV/AIDS. Forty smokers were randomized to receive either a standard 5 As counseling session and 8-week treatment of nicotine patch, or a similar intervention that added a 10-min module to the 5 As counseling that focused on improving adherence to the nicotine patch. Smoking outcomes (breath carbon monoxide monitoring verified 7-day point prevalence and continuous abstinence) were evaluated through a 3-month follow-up. Patch usage during the follow-up period was also assessed. Intention to treat analyses indicated that abstinence rates were 2 to 3 times higher in the adherence condition compared with the standard condition (7-day point prevalence abstinence: 35.0% vs. 15.0%; continuous abstinence: 30.0% vs. 10.0%). Nicotine patch compliance over an 8-week period was also higher in the adherence condition than in the standard condition (44% vs. 25%). Although this small pilot was conducted to estimate effect sizes and was not powered to detect group differences, results are promising and suggest that adding a 10-min module focused on nicotine patch adherence to a standard 5 As protocol can increase abstinence rates. Given that this smoking cessation treatment was not specifically tailored to either HIV-positive smokers or Latino smokers, future research should examine whether it may be a promising approach for improving nicotine patch adherence in the general population of smokers. (PsycINFO Database Record
- Published
- 2017
36. Diabetes Device Use in Adults With Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets
- Author
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Molly L. Tanenbaum, Korey K. Hood, Sarah Hanes, Diana Naranjo, Kellee M. Miller, and Rachel Bensen
- Subjects
Adult ,Blood Glucose ,Male ,Insulin pump ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Psychological intervention ,030209 endocrinology & metabolism ,Young Adult ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Surveys and Questionnaires ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,Aged ,Glycemic ,Aged, 80 and over ,Glycated Hemoglobin ,Advanced and Specialized Nursing ,Type 1 diabetes ,business.industry ,Blood Glucose Self-Monitoring ,Clinical Care/Education/Nutrition/Psychosocial Research ,Middle Aged ,medicine.disease ,Distress ,Diabetes Mellitus, Type 1 ,Physical therapy ,Female ,business ,Psychosocial - Abstract
OBJECTIVE Diabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target. RESEARCH DESIGN AND METHODS We surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20.4 [SD 12.5] years) to investigate barriers to device uptake, understand profiles of device users versus nonusers, and explore differences by age and sex. Scales used were the Diabetes Distress Scale, Technology Use Attitudes (General and Diabetes-Specific), and Barriers to Device Use and Reasons for Discontinuing Devices. RESULTS Most commonly endorsed modifiable barriers were related to the hassle of wearing devices (47%) and disliking devices on one’s body (35%). CGM users (37%) were older than nonusers (mean 38.3 vs. 33.5 years), had diabetes for longer (22.9 vs. 18.8 years), had more positive technology attitudes (22.6–26.0 vs. 21.4–24.8), and reported fewer barriers to using diabetes technology than nonusers (3.3 vs. 4.3). The youngest age-group (18–25 years) had the lowest CGM (26% vs. 40–48%) and insulin pump (64% vs. 69–77%) uptake, highest diabetes distress (2.2 vs. 1.8–2.1), and highest HbA1c levels (8.3% [67 mmol/mol] vs. 7.2–7.4% [55–57 mmol/mol]). CONCLUSIONS Efforts to increase device use need to target physical barriers to wearing devices. Because young adults had the lowest device uptake rates, highest distress, and highest HbA1c compared with older age-groups, they should be the focus of future interventions to increase device use.
- Published
- 2016
37. Depression in context: Important considerations for youth with type 1 vs type 2 diabetes
- Author
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Esti Iturralde, Ananta Addala, Jessie J. Wong, Monica S. Lanning, Sarah Hanes, Diana Naranjo, Korey K. Hood, Hiba Abujaradeh, Regan C. Barley, Molly L. Tanenbaum, and Rebecca N. Adams
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Context (language use) ,Type 2 diabetes ,Patient Health Questionnaire ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Sex Factors ,Risk Factors ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Global health ,Humans ,030212 general & internal medicine ,Child ,Depression (differential diagnoses) ,Type 1 diabetes ,business.industry ,Depression ,Age Factors ,medicine.disease ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Pediatrics, Perinatology and Child Health ,Regression Analysis ,Female ,business ,Psychosocial ,Adolescent health - Abstract
BACKGROUND Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type. OBJECTIVE Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes. METHODS A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type. RESULTS Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P
- Published
- 2019
38. 856-P: Can Monetary-Based Reinforcement for Self-Monitoring Blood Glucose (SMBG) Impact Psychosocial Outcomes? A Randomized Controlled Trial
- Author
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Korey K. Hood, Jessie J. Wong, Eda Cengiz, Kate Weyman, Diana Naranjo, Ananta Addala, Julie Wagner, and Eileen M. Tichy
- Subjects
Type 1 diabetes ,Endocrinology, Diabetes and Metabolism ,medicine.disease ,law.invention ,Randomized controlled trial ,Spouse ,law ,Intervention (counseling) ,Diabetes mellitus ,Internal Medicine ,medicine ,Self-monitoring ,Reinforcement ,Psychology ,Psychosocial ,Clinical psychology - Abstract
Background: Members of our group previously reported that monetary reinforcement of SMBG related behaviors shows robust increases in frequency of SMBG and modest decreases in A1c among youth with type 1 diabetes (T1D). In these secondary data analyses, we explored effects on psychosocial functioning. Methods: Sixty youth ages 12-21 (Mage=15.58, SD=2.31) with T1D, A1c 7.5-13%, and Results: Generalized linear models showed no significant time x condition effects. In t-tests at discrete follow-ups, compared to the control group, the reinforce group had significantly lower youth-reported diabetes related family conflict at 12 weeks (22.39 vs. 25.11, p=.043) and significantly higher negative affective responses to out-of-range glucose results at 24 weeks (13.62 vs. 11.71, p=.047). Conclusion: Monetary reinforcers targeting SMBG behaviors may produce transitory decreases in youth perceptions of family conflict and transitory iatrogenic increases in youth’s negative affective responses to out-of-range glucose results. The timing of changes in family conflict, negative affect, and previously reported changes in A1c suggest that psychosocial changes may reflect youth responses to A1c as well as to reinforcers per se. For broader effects, the intervention could include psychosocial components that seek to directly maintain decreased family conflict and mitigate negative affect related to increased awareness of glucose control. Disclosure J.J. Wong: None. A. Addala: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. J. Wagner: None. E. Cengiz: Advisory Panel; Self; Abvance, ADOCIA, MannKind Corporation, Novo Nordisk Inc. Speaker's Bureau; Self; Novo Nordisk Inc. E.M. Tichy: None. K. Weyman: None. D. Naranjo: Advisory Panel; Spouse/Partner; Eli Lilly and Company. Speaker's Bureau; Spouse/Partner; Johnson & Johnson Diabetes Institute. Other Relationship; Self; Abbott. Funding National Institutes of Health
- Published
- 2019
39. Psychosocial and Human Factors During a Trial of a Hybrid Closed Loop System for Type 1 Diabetes Management
- Author
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Korey K. Hood, Natalie Walders-Abramson, Jodie M. Ambrosino, Molly L. Tanenbaum, Bruce A. Buckingham, Rebecca N. Adams, Stuart A. Weinzimer, Diana Naranjo, Trang T. Ly, David M. Maahs, and Sarah Hanes
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Hypoglycemia ,Artificial pancreas ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Endocrinology ,Insulin Infusion Systems ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,030212 general & internal medicine ,Intensive care medicine ,Depression (differential diagnoses) ,Type 1 diabetes ,business.industry ,Fear ,medicine.disease ,Medical Laboratory Technology ,Distress ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Attitude ,Female ,business ,Psychosocial ,Closed loop ,Stress, Psychological - Abstract
Hybrid closed loop (HCL) systems are designed to automate insulin delivery to improve type 1 diabetes (T1D) outcomes and reduce user burden and distress. Because the systems only automate some aspects of diabetes care, psychosocial and human factors remain an important consideration in their use. Thus, we examined whether psychosocial and human factors (i.e., distress related to diabetes management, fear of hypoglycemia, and technology attitudes) would (1) change after using the system and (2) predict glycemic outcomes during the trial.Fourteen adults and 15 adolescents with T1D participated in a multisite clinical trial of an investigational version of the MiniMed™ 670G system (Medtronic, Northridge, CA) over 4 to 5 days in a semisupervised outpatient setting. Users completed surveys assessing psychosocial and human factors before beginning the HCL system and at the conclusion of the study. t-Tests and regression analyses were conducted to examine whether these factors changed following trial exposure to the HCL system and predicted glycemic outcomes during the trial.Diabetes management distress decreased and diabetes technology attitudes became more positive over the trial period. Fear of hypoglycemia did not change over the trial period. There was a trend toward greater pretrial management distress predicting less time in range during the trial, controlling for time in range before the trial.Results suggest that this system is promising for enhancing technology attitudes and reducing management distress. Psychosocial factors, such as management distress, may negatively impact glycemic outcomes and should be a priority area for further investigation.
- Published
- 2018
40. Using Cluster Analysis to Understand Clinician Readiness to Promote Continuous Glucose Monitoring Adoption
- Author
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Rebecca N. Adams, Monica S. Lanning, Bianca I Agustin, Sarah Hanes, Diana Naranjo, Molly L. Tanenbaum, and Korey K. Hood
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,endocrine system diseases ,Attitude of Health Personnel ,Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,Directive Counseling ,030209 endocrinology & metabolism ,Bioengineering ,Disease cluster ,03 medical and health sciences ,0302 clinical medicine ,Insulin Infusion Systems ,Patient Education as Topic ,Special Section: Improving Usability of Diabetes Devices ,Diabetes mellitus ,Physicians ,Surveys and Questionnaires ,Internal Medicine ,medicine ,Cluster Analysis ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Type 1 diabetes ,Motivation ,Physician-Patient Relations ,Continuous glucose monitoring ,business.industry ,Blood Glucose Self-Monitoring ,nutritional and metabolic diseases ,Middle Aged ,medicine.disease ,Diabetes Mellitus, Type 1 ,Caregivers ,Equipment and Supplies ,Female ,business ,Comprehension ,Personality - Abstract
Background:Many people with type 1 diabetes (T1D) report barriers to using continuous glucose monitoring (CGM). Diabetes care providers may have their own barriers to promoting CGM uptake. The goal of this study was to develop clinician “personas” with regard to readiness to promote CGM uptake.Methods:Diabetes care providers who treat people with T1D (N = 209) completed a survey on perceived patient barriers to device uptake, technology attitudes, and characteristics and barriers specific to their clinical practice. K-means cluster analyses grouped the sample by CGM barriers and attitudes. ANOVAs and chi-square tests assessed group differences on provider and patient characteristics. The authors assigned descriptive names for each persona.Results:Analyses yielded three clinician personas regarding readiness to promote CGM uptake. Ready clinicians (20% of sample; 24% physicians, 38% certified diabetes educators/CDEs) had positive technology attitudes, had clinic time to work with patients using CGM, and found it easy to keep up with technology advances. In comparison, Cautious clinicians (41% of sample; 17% physicians, 53% CDEs) perceived that their patients had many barriers to adopting CGM and had less time than the Ready group to work with patients using CGM data. Not Yet Ready clinicians (40% of sample; 9% physicians; 79% CDEs) had negative technology attitudes and the least clinic time to work with CGM data. They found it difficult to keep up with technology advances.Conclusion:Some diabetes clinicians may benefit from tailored interventions and additional time and resources to empower them to help facilitate increased uptake of CGM technology.
- Published
- 2018
41. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes
- Author
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Timothy W. Jones, Beate Karges, Diana Naranjo, Mary B Abraham, AO Oduwole, Martin Tauschmann, and David M. Maahs
- Subjects
Pediatrics ,medicine.medical_specialty ,Consensus ,Adolescent ,Endocrinology, Diabetes and Metabolism ,International Cooperation ,MEDLINE ,030209 endocrinology & metabolism ,Hypoglycemia ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Diabetes mellitus ,Internal Medicine ,medicine ,Diabetes Mellitus ,Humans ,Hypoglycemic Agents ,030212 general & internal medicine ,Age of Onset ,Practice Patterns, Physicians' ,Child ,Societies, Medical ,Type 1 diabetes ,Practice patterns ,business.industry ,medicine.disease ,Clinical Practice ,Pediatrics, Perinatology and Child Health ,Age of onset ,business - Published
- 2018
42. Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics
- Author
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Sruthi Veeravalli, Esti Iturralde, Rachel Bensen, Regan C. Barley, K.T. Park, Diana Naranjo, Carlos Milla, Megan Christofferson, David M. Maahs, Avni Shah, Molly L. Tanenbaum, Rebecca N. Adams, Korey K. Hood, and Sarah Hanes
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Health Status ,Subspecialty ,Ambulatory Care Facilities ,Pediatrics ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Surveys and Questionnaires ,medicine ,Global health ,Humans ,Mass Screening ,030212 general & internal medicine ,Disease management (health) ,Depression (differential diagnoses) ,business.industry ,Depression ,Public Health, Environmental and Occupational Health ,Mental health ,Patient Health Questionnaire ,Psychiatry and Mental health ,Health assessment ,Family medicine ,Pediatrics, Perinatology and Child Health ,Chronic Disease ,Physical therapy ,Female ,business ,Psychosocial - Abstract
Purpose Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics. Methods A total of 109 patients aged 12–22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care. Results Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening. Conclusions A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.
- Published
- 2017
43. Diabetes and cardiometabolic risk factors in Cambodia: Results from two screening studies
- Author
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Julie, Wagner, Diana, Naranjo, Touch, Khun, Serey, Seng, Ien S, Horn, Sakinah C, Suttiratana, and Lim, Keuky
- Subjects
Adult ,Blood Glucose ,Glycated Hemoglobin ,Male ,Rural Population ,Urban Population ,Glucose Tolerance Test ,Middle Aged ,Prognosis ,Body Mass Index ,Metabolic Diseases ,Cardiovascular Diseases ,Risk Factors ,Hypertension ,Diabetes Mellitus ,Prevalence ,Humans ,Female ,Obesity ,Cambodia ,Biomarkers ,Aged ,Follow-Up Studies - Abstract
Despite growing attention to diabetes throughout Asia, data from Southeast Asia are limited. This article reports rates of diabetes, hypertension, and obesity in Cambodia.Two studies were conducted across different regions of Cambodia: (i) a 2012 screening study across urban, semi-urban, and rural areas that used point-of-care capillary glucose for determination of diabetes (n = 13 997); and (ii) a 2005 epidemiological study with random selection from two main urban areas that used oral glucose tolerance tests for determination of diabetes (n = 1863). Blood pressure and anthropometrics were also measured.In the screening study, rates of diabetes were significantly higher in urban than rural sites, with intermediate rates in semi-urban areas. There was a significant dose-response effect for urbanicity on overweight, obesity, and waist:hip ratio, with higher rates for urban versus semi-urban and for semi-urban versus rural locales. Rural sites had the lowest rates of hypertension, followed by urban and semi-urban sites. Among people who screened positive for diabetes, there was a dose-response effect for urbanicity on undiagnosed diabetes; rates of previously undiagnosed diabetes were lowest in urban (51%), followed by semi-urban (55%) and rural (67%) locales. Rural participants reported the highest rates of smoking and alcohol use. In the urban epidemiological study, prevalence rates of diabetes and impaired glucose tolerance were approximately 10%, indicating a prevalence of total glucose intolerance of approximately 20%.In Cambodia, diabetes rates are high among urban residents and undiagnosed diabetes is highest among rural residents. A country-wide public health response is urgently needed; as development continues, rates of diabetes are expected to rise.
- Published
- 2017
44. Pre-earthquake Burden of Illness and Postearthquake Health and Preparedness in Veterans
- Author
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Elizabeth M. Yano, Deborah Riopelle, Lisa V. Rubenstein, Claudia Der-Martirosian, Aram Dobalian, and Diana Naranjo
- Subjects
Male ,Activities of daily living ,Medical equipment ,Disaster Planning ,Emergency Nursing ,Vulnerable Populations ,Interviews as Topic ,Cost of Illness ,Nursing ,Surveys and Questionnaires ,Activities of Daily Living ,Health care ,Earthquakes ,Humans ,Medicine ,Medical prescription ,Veterans Affairs ,Aged ,Demography ,Veterans ,Health Services Needs and Demand ,Emergency management ,business.industry ,Middle Aged ,medicine.disease ,Los Angeles ,United States ,Preparedness ,Chronic Disease ,Cohort ,Emergency Medicine ,Medical emergency ,business - Abstract
BackgroundDuring an earthquake, vulnerable populations, especially those with chronic conditions, are more susceptible to adverse, event-induced exacerbation of chronic conditions such as limited access to food and water, extreme weather temperatures, and injury. These circumstances merit special attention when health care facilities and organizations prepare for and respond to disasters.MethodsThis study explores the relationship between pre-earthquake burden of illness and postearthquake health-related and preparedness factors in the US. Data from a cohort of male veterans who were receiving care at the Sepulveda Veterans Affairs Medical Center (VAMC) in Los Angeles, California USA during the 1994 Northridge earthquake were analyzed.ResultsVeterans with one or more chronic conditions were more likely to report pain lasting two or more days, severe mental/emotional stress for more than two weeks, broken/lost medical equipment, having difficulty refilling prescriptions, and being unable to get medical help following the quake compared to veterans without chronic conditions. In terms of personal emergency preparedness, however, there was no association between burden of illness and having enough food or water for at least 24 hours after the earthquake.ConclusionThe relationship that exists between health care providers, including both individual providers and organizations like the US Department of Veterans Affairs (VA), and their vulnerable, chronically-ill patients affords providers the unique opportunity to deliver critical assistance that could make this vulnerable population better prepared to meet their postdisaster health-related needs. This can be accomplished through education about preparedness and the provision of easier access to medical supplies. Disaster plans for those who are burdened with chronic conditions should meet their social needs in addition to their psychological and physical needs.Der-MartirosianC, RiopelleD, NaranjoD, YanoE, RubensteinL, DobalianA. Pre-earthquake burden of illness and postearthquake health and preparedness in veterans. Prehosp Disaster Med. 2014;29(3):1-7.
- Published
- 2014
45. REDEEM: A Pragmatic Trial to Reduce Diabetes Distress
- Author
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Russell E. Glasgow, Patricia A. Areán, Danielle Hessler, Lawrence Fisher, Diana Naranjo, Umesh Masharani, and Lisa A. Strycker
- Subjects
Adult ,Male ,Research design ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Psychological intervention ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Diabetes mellitus ,Internal Medicine ,Humans ,Medicine ,Young adult ,Original Research ,Aged ,Advanced and Specialized Nursing ,business.industry ,Clinical Care/Education/Nutrition/Psychosocial Research ,nutritional and metabolic diseases ,Type 2 Diabetes Mellitus ,Middle Aged ,medicine.disease ,Self Care ,Regimen ,Distress ,Diabetes Mellitus, Type 2 ,Physical therapy ,Female ,business - Abstract
OBJECTIVE To compare three interventions to reduce diabetes distress (DD) and improve self-management among non–clinically depressed adults with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS In REDEEM, 392 adults with T2DM and DD were randomized to computer-assisted self-management (CASM), CASM plus DD-specific problem solving (CAPS), or a computer-administered minimal supportive intervention. Primary outcomes were Diabetes Distress Scale (DDS) total, the Emotional Burden (EB) and Regimen Distress (RD) DDS subscales, and diet, exercise, and medication adherence. RESULTS Significant and clinically meaningful reductions in DD (DDS, EB, and RD) and self-management behaviors occurred in all three conditions (P < 0.001), with no significant between-group differences. There was, however, a significant group × baseline distress interaction (P < 0.02), in which patients with high baseline RD in the CAPS condition displayed significantly larger RD reductions than those in the other two conditions. RD generated the most distress and displayed the greatest distress reduction as a result of intervention. The pace of DD reduction varied by patient age: older patients demonstrated significant reductions in DD early in the intervention, whereas younger adults displayed similar reductions later. Reductions in DD were accompanied by significant improvements in healthy eating, physical activity, and medication adherence, although not by change in HbA1c. CONCLUSIONS DD is malleable and highly responsive to intervention. Interventions that enhance self-management also reduce DD significantly, but DD-specific interventions may be necessary for patients with high initial levels of DD. Future research should identify the minimal, most cost-effective interventions to reduce DD and improve self-management.
- Published
- 2013
46. Diabetes Technology: Uptake, Outcomes, Barriers, and the Intersection With Distress
- Author
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Esti Iturralde, Diana Naranjo, Molly L. Tanenbaum, and Korey K. Hood
- Subjects
Gerontology ,Male ,Pancreas, Artificial ,Emerging technologies ,Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,Biomedical Technology ,030209 endocrinology & metabolism ,Bioengineering ,03 medical and health sciences ,0302 clinical medicine ,Insulin Infusion Systems ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Biomedical technology ,Special Section: Psychological Factors for Diabetes Technology, Part II ,Type 1 diabetes ,business.industry ,Blood Glucose Self-Monitoring ,medicine.disease ,Clinical Practice ,Distress ,Diabetes Mellitus, Type 1 ,Female ,Medical emergency ,business ,Psychosocial ,Meaning (linguistics) - Abstract
Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.
- Published
- 2016
47. Partner Perspectives on Closed Loop Systems
- Author
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Molly L. Tanenbaum, Korey K. Hood, Diana Naranjo, and Esti Iturralde
- Subjects
Research design ,Engineering ,business.industry ,Applied psychology ,Hypoglycemia ,medicine.disease ,Affect (psychology) ,Focus group ,Clinical trial ,Distress ,Diabetes management ,medicine ,Operations management ,business ,Closed loop - Abstract
Objective : Closed loop automated insulin delivery systems have the potential to transform diabetes management. Partners and relationships will be increasingly affected by these innovations. We examine current understanding of the partner’s role in type 1 diabetes (T1D) management and technology, and provide an example of how to elicit partners’ perspectives in technology research. Research Design and Methods : We conducted a literature review and a small focus group with the partners of participants enrolled in a 5-day hybrid closed loop (HCL) clinical trial. Couples’ questionnaire ratings of diabetes-related distress and hypoglycemia concerns were described. Results : Partners play an integral and often helpful role in managing diabetes. They also report significant diabetes-related distress and fear of hypoglycemia, which have implications for relationships. Closed loop systems offer potential benefits such as hypoglycemia prevention and partners’ online access to glucose data (“remote monitoring”). However, disruptive alerts, technical glitches, maintenance tasks, device size, and other drawbacks may strain partners and relationships. A partner focus group elicited several novel themes. Partners gained valuable insights about T1D from remote monitoring and identified hypoglycemia prevention as a major benefit. For all partners, hypoglycemia worries decreased during system use. However, partners also cited vicarious frustrations with the system, concerns about remote monitoring disrupting couple communication, and needs for technology-specific partner education. Conclusion : Closed loop systems stand to affect partners and relationships. As researchers continue to design closed loop systems and devise their integration into standard clinical care, it will be vital to assess partner perspectives to increase satisfaction and success with this technology.
- Published
- 2016
48. International and Interdisciplinary Identification of Health Care Transition Outcomes
- Author
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Cynthia, Fair, Jessica, Cuttance, Niraj, Sharma, Gary, Maslow, Lori, Wiener, Cecily, Betz, Jerlym, Porter, Suzanne, McLaughlin, Jordan, Gilleland-Marchak, Amy, Renwick, Diana, Naranjo, Sophia, Jan, Karina, Javalkar, Maria, Ferris, and Valerie, Bowman
- Subjects
Medical home ,Male ,medicine.medical_specialty ,Canada ,Transition to Adult Care ,Adolescent ,Delphi Technique ,International Cooperation ,Delphi method ,MEDLINE ,Likert scale ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Quality of life (healthcare) ,030225 pediatrics ,Surveys and Questionnaires ,Health care ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Chronic care ,Self-management ,business.industry ,United States ,Europe ,Family medicine ,Pediatrics, Perinatology and Child Health ,Quality of Life ,Female ,Interdisciplinary Communication ,business - Abstract
IMPORTANCE: There is a lack of agreement on what constitutes successful outcomes for the process of health care transition (HCT) among adolescent and young adults with special health care needs. OBJECTIVE: To present HCT outcomes identified by a Delphi process with an interdisciplinary group of participants. DESIGN, SETTING, AND PARTICIPANTS: A Delphi method involving 3 stages was deployed to refine a list of HCT outcomes. This 18-month study (from January 5, 2013, of stage 1 to July 3, 2014, of stage 3) included an initial literature search, expert interviews, and then 2 waves of a web-based survey. On this survey, 93 participants from outpatient, community-based, and primary care clinics rated the importance of the top HCT outcomes identified by the Delphi process. Analyses were performed from July 5, 2014, to December 5, 2014. EXPOSURES: Health care transition outcomes of adolescents and young adults with special health care needs. MAIN OUTCOMES AND MEASURES: Importance ratings of identified HCT outcomes rated on a Likert scale from 1 (not important) to 9 (very important). RESULTS: The 2 waves of surveys included 117 and 93 participants as the list of outcomes was refined. Transition outcomes were refined by the 3 waves of the Delphi process, with quality of life being the highest-rated outcome with broad agreement. The 10 final outcomes identified included individual outcomes (quality of life, understanding the characteristics of conditions and complications, knowledge of medication, self-management, adherence to medication, and understanding health insurance), health services outcomes (attending medical appointments, having a medical home, and avoidance of unnecessary hospitalization), and a social outcome (having a social network). Participants indicated that different outcomes were likely needed for individuals with cognitive disabilities. CONCLUSIONS AND RELEVANCE: Quality of life is an important construct relevant to HCT. Future research should identify valid measures associated with each outcome and further explore the role that quality of life plays in the HCT process. Achieving consensus is a critical step toward the development of reliable and objective comparisons of HCT outcomes across clinical conditions and care delivery locations.
- Published
- 2015
49. Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time
- Author
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Lawrence Fisher, Danielle Hessler, Joseph T. Mullan, Patricia A. Areán, and Diana Naranjo
- Subjects
Adult ,Male ,Time Factors ,Psychometrics ,Context (language use) ,Type 2 diabetes ,behavioral disciplines and activities ,Body Mass Index ,chemistry.chemical_compound ,Risk Factors ,Surveys and Questionnaires ,Diabetes mellitus ,mental disorders ,Health Status Indicators ,Humans ,Medicine ,Longitudinal Studies ,Aged ,Original Research ,Glycated Hemoglobin ,Depressive Disorder, Major ,business.industry ,Middle Aged ,medicine.disease ,Self Care ,Logistic Models ,Diabetes Mellitus, Type 2 ,chemistry ,Major depressive disorder ,Female ,Glycated hemoglobin ,Family Practice ,business ,Psychosocial ,Body mass index ,Clinical psychology - Abstract
PURPOSE We wanted to identify risk factors associated with the development of major depressive disorder (MDD) among patients with type 2 diabetes over time. METHODS In a noninterventional study, 338 adult patients with type 2 diabetes and no MDD diagnosis at baseline were assessed 3 times during 18 months (9-month intervals) to ascertain predictors of MDD. We tested a model incorporating personal, behavioral, biologic, and psychosocial variables to identify predictors of MDD. Exploratory analyses tested whether current negative affect mediated the relationship between predictors and subsequent MDD. We also conducted a stratified analysis of moderate vs high negative affect to explore whether level of baseline negative affect mediated the relationship between specific predictors and MDD. RESULTS Prior MDD and negative affect predicted future development of MDD. In subpopulations stratified by moderate negative affect, negative life events, an elevated body mass index (BMI), prior MDD, and poor control of glycated hemoglobin (hemoglobin A1c) each predicted MDD. In subpopulations stratified by elevated negative affect, negative life events and poor control of hemoglobin A1c predicted MDD. Current negative affect partially mediated the relationship between prior MDD and subsequent MDD, as well as the relationship between negative life events and subsequent MDD. CONCLUSIONS Although negative affect at baseline was the primary predictor of subsequent MDD, when stratified by negative affect, negative life events, BMI, and poor control of hemoglobin A1c also predicted MDD. Thus, life stresses and patients’ disease-related concerns are important when understanding what predicts subsequent MDD. Addressing depressive symptoms and broader life context issues expands the scope of a potential intervention to reduce the risk of developing MDD in persons with type 2 diabetes.
- Published
- 2011
50. Cultural Traditions as 'Protective Factors' Among Latino Children of Illicit Drug Users
- Author
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Maria Rollins, Diana Naranjo, Julie Garfinkle, David W. Brook, Judith S. Brook, and Felipe González Castro
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Health (social science) ,Adolescent ,Substance-Related Disorders ,Community organization ,Culture ,Protective factor ,Ethnic group ,Medicine (miscellaneous) ,Surveys and Questionnaires ,Southwestern United States ,Humans ,Family traditions ,Child ,Father-Child Relations ,Family values ,Public Health, Environmental and Occupational Health ,Hispanic or Latino ,Object Attachment ,Acculturation ,Psychiatry and Mental health ,Prosocial behavior ,Family Relations ,Psychology ,Social responsibility ,Social psychology - Abstract
Family bonding was examined among Hispanic adolescents whose fathers are illicit drug users to ascertain whether such adolescents maintain close affective family ties or alienate themselves from their families given their father's use of illicit drugs and referral to a drug screening and treatment program. It was hypothesized that high levels of paternal drug use would be associated with the youth's alienation from the family. In addition, it was postulated that the adolescent's endorsement of traditional cultural values and social responsibility would protect her or him against this effect in relation to family bonding. These hypotheses are based on prior research that suggests that youth bonding to prosocial institutions, such as family, school, church, and community organizations, can be "protective" against drug use. More specifically, our analyses examined the role of level of acculturation in middle school, family traditionalism, American orientation, Latino orientation, and social responsibility in predicting adolescents' family bonding. Results indicated that the father's level of marijuana and/or methamphetamine use was unrelated to youth family bonding. Additionally, Latino and American cultural orientations and level of acculturation in middle school were not associated with family bonding. By contrast, social responsibility (the youth's citizenship and responsibility to the community) and family traditionalism (endorsing conservative cultural values regarding the maintenance of family traditions and respect for elders and family) were significantly associated with family bonding. In other words, among children of Latino illicit drug users, the youth's conservative family values and a responsible attitude toward community traditions were dual factors related to family bonding, perhaps operating also as sources of "protection" against youth problem behaviors.
- Published
- 2007
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