Search

Objective: The objective of this study was to develop ANcam, a novel method for identifying acanthosis nigricans (AN) using a smartphone camera and computer-aided color analysis for noninvasive screening of people with impaired glucose tolerance (IGT). Research Design and Methods: Adult and juvenile participants with or without diagnosed type 2 diabetes were recruited in Trinidad and Tobago. After obtaining informed consent, participants' history, demographics, anthropometrics, and A1C were collected and recorded. Three subject matter experts independently graded pictures of the posterior neck and upper back using the ANcam smartphone application and Burke methods. A correlation matrix investigated 25 color channels for association with hyperpigmentation, and the diagnostic thresholds were determined with a receiver operating characteristic curve analysis. Results: For the 227 participants with captured images and A1C values, the cyan/magenta/yellow/black (CMYK) model color channel CMYK_K was best correlated with IGT at an A1C cutoff of 5.7% (39 mmol/mol) (R = 0.45, P <0.001). With high predictive accuracy (area under the curve = 0.854), the cutoff of 7.67 CMYK_K units was chosen, with a sensitivity of 81.1% and a specificity of 70.3%. ANcam had low interrater variance (F = 1.99, P = 0.137) compared with Burke grading (F = 105.71, P <0.001). ANcam detected hyperpigmentation on the neck at double the self-reported frequency. Elevated BMI was 2.9 (95% CI 1.9–4.3) times more likely, elevated blood pressure was 1.7 (95% CI 1.2–2.4) times more likely, and greater waist-to-hip ratio was 2.3 (95% CI 1.4–3.6) times more likely with AN present. Conclusion: ANcam offers a sensitive, reproducible, and user-friendly IGT screening tool to any smartphone user that performs well with most skin tones and lighting conditions. [ABSTRACT FROM AUTHOR]

To guide effective planning and decision-making regarding strategies to address adverse social determinants of health (SDOH) in diabetes, an understanding of upstream drivers and root causes is imperative. The World Health Organization SDOH framework includes socioeconomic and political systems and racism as upstream drivers of SDOH. These factors are not currently included in the Healthy People 2030 framework or other commonly used U.S. SDOH frameworks. This review gives an overview of the socioeconomic status SDOH and race and ethnicity in diabetes prevalence and incidence, discusses socioeconomic and political contexts and racism as upstream drivers and root causes of SDOH that necessitate attention in the U.S., illustrates the role of these drivers in the entrenched nature of SDOH within racial and ethnic minoritized and marginalized populations, and examines current and emerging actions within and beyond the health care sector to mitigate adverse SDOH. The incorporation of socioeconomic and political systems and racism as root causes and current drivers of adverse SDOH into U.S. SDOH frameworks enables an emphasis shift from primary individual- and neighborhood-level time-limited solutions to multisector and all-of-government initiatives that bring requisite policy change and permanent structural change. 6331876271112 dci230001video1 Video 1. Dr. Felicia Hill-Briggs, American Diabetes Association 83rd Scientific Sessions Diabetes Care Symposium–Social Determinants of Health: Impact on Diabetes Development and Care. [ABSTRACT FROM AUTHOR]

Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with progressive chronic kidney disease in a recent randomized controlled trial: Patients and their families were invited to meet twice with a social worker to discuss their self-identified barriers to seeking LKT and to identify solutions to barriers. The authors audio recorded and transcribed all social worker visits to assess implementation of the TALK SWI and its acceptability to patients and families. The study social worker adhered to the TALK SWI protocol more than 90 percent of the time. Patients and families discussed medical (for example, long-term risks of transplant), psychological (for example, patients' denial of the severity of their disease), and economic (for example, impact of donation on family finances) concerns regarding LKT. Most patients and families felt that the intervention was helpful. Consistently high adherence to the TALK SWI protocol and acceptability of the intervention among patients and families suggest that the TALK SWI can be feasibly implemented in clinical practice.

Identification of patients with poor chronic disease self-management skills can facilitate treatment planning, determine effectiveness of interventions, and reduce disease complications. This paper describes the use of a Rasch model, the Rating Scale Model, to examine psychometric properties of the 50-item Health Problem-Solving Scale (HPSS) among 320 African American patients with high risk for cardiovascular disease. Items on the positive/effective HPSS subscales targeted patients at low, moderate, and high levels of positive/effective problem solving, whereas items on the negative/ineffective problem solving subscales mostly targeted those at moderate or high levels of ineffective problem solving. Validity was examined by correlating factor scores on the measure with clinical and behavioral measures. Items on the HPSS show promise in the ability to assess health-related problem solving among high risk patients. However, further revisions of the scale are needed to increase its usability and validity with large, diverse patient populations in the future., Author(s): Stephanie L. Fitzpatrick[sup.1] , Felicia Hill-Briggs[sup.2] Author Affiliations: (1) Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Room 478A, 60607, Chicago, IL, USA (2) [...]

Researchers have established the long-term negative impact of adverse childhood experiences (ACEs) on mental health. Evidence also shows that different types of ACEs often co-occur and that ACEs profiles have differential impact on mental health. However, this prior research has often omitted first-generation Latino immigrants—a growing segment of the population, with potentially higher risk for ACEs, decreased access to mental health services, and increased risk for remaining in poor mental health. In this study, we conducted a cluster analysis using a sample of 336 Latina immigrant to examine: (1) patterns of ACEs, and (2) the mediating role of social problem-solving in the association between ACEs and mental health (depression, anxiety, and post-traumatic stress disorder symptoms [PTSD]) and life satisfaction. We identified 5 clusters: (a) Global ACEs (n = 52, 15.5%), (b) Community Violence and Physical Abuse (n = 80, 23.8%), (c) Physical and Emotional Abuse (n = 72, 21.4%), (d) Household Dysfunction with Physical and Emotional Abuse (n = 56, 16.7%), and (e) Low ACEs (n = 76, 22.6%). The clusters differed by social problem-solving, chronic life burden, mental health, and life satisfaction. Compared to the Low Abuse cluster, the Community Violence and Physical Abuse, and Global ACEs clusters were significantly more likely to have higher depression, anxiety, and PTSD symptoms. Social problem-solving was independently associated with all mental health variables and life satisfaction, and mediated the association between ACEs and depression and anxiety for those in the Community Violence and Physical Abuse cluster. Our study sheds light on how ACEs are experienced by Latina immigrants. Social problem-solving also emerged as a significant determinant of mental health and life satisfaction, and may be a point of intervention for improving mental health in this population. [ABSTRACT FROM AUTHOR]

Summary: Adults with sickle cell disease (SCD) are at risk for cognitive impairment, which causes significant morbidity. Guidelines support routine cognitive screening, but no screening test is validated in this population. We explored the Montreal Cognitive Assessment (MoCA) as a possible screening test in SCD. We administered the MoCA; a literacy test, the Wide Range Achievement Test, fourth edition (WRAT‐4); and a health literacy test, the Shortened Test of Functional Health Literacy in Adults (S‐TOFHLA) to adults with SCD and gathered clinical variables through chart review. Spearman's rho, Mann–Whitney, and Kruskal–Wallis tests and quantile regression models were used. Among our sample of 49 adults with SCD, the median MoCA score was 25.0 [interquartile range (IQR) 22.0–28.0]. Higher educational attainment was associated with MoCA scores (p = 0.001). In multivariable models, MoCA scores were associated with S‐TOFHLA (p = 0.001) and WRAT‐4 Reading (p = 0.002) scores, and overt stroke (p = 0.03) at the median. This pilot study adds to the limited literature of cognitive screening tests in adults with SCD and demonstrates a relationship between MoCA scores and measures of literacy and health literacy. The MoCA is a promising option for briefly screening for cognitive impairment in adults with SCD, though further study is needed to confirm its validity. [ABSTRACT FROM AUTHOR]

Social needs contribute to persistent diabetes disparities; thus, it is imperative to address social needs to optimize diabetes management. The purpose of this study was to determine determine the feasibility and acceptability of health system-based social care versus social care + behavioral intervention to address social needs and improve diabetes self-management among patients with type 2 diabetes. Black/African American, Hispanic/Latino, and low-income White patients with recent hemoglobin A1C (A1C) ≥ 8%, and ≥1 social need were recruited from an integrated health system. Patients were randomized to one-of-two 6-month interventions: (a) navigation to resources (NAV) facilitated by a Patient Navigator; or (b) NAV + evidence-based nine-session diabetes self-management support (DSMS) program facilitated by a community health worker (CHW). A1C was extracted from the electronic health record. We successfully recruited 110 eligible patients (54 NAV; 56 NAV + DSMS). During the trial, 78% NAV and 80% NAV + DSMS participants successfully connected to a navigator; 84% NAV + DSMS connected to a CHW. At 6-month follow-up, 33% of NAV and 34% of NAV + DSMS participants had an A1C < 8%. Mean reduction in A1C was clinically significant in NAV (−0.65%) and NAV + DSMS (−0.72%). By follow-up, 89% of NAV and 87% of NAV + DSMS were successfully connected to resources to address at least one need. Findings suggest that it is feasible to implement a health system-based social care intervention, separately or in combination, with a behavioral intervention to improve diabetes management among a high-risk, socially complex patient population. A larger, pragmatic trial is needed to test the comparative effectiveness of each approach on diabetes-related outcomes. [ABSTRACT FROM AUTHOR]

This paper aims to elucidate the need for counseling services among clients with diabetes, clarify common adjustment and diabetes self-care issues, and suggest counseling strategies for this population. We suggest that counselors increase their competencies in diabetes counseling, and strive to help traditional members of the diabetes care team (e.g., physicians) to recognize the benefits of routinely including counseling in diabetes care. This paper also explains the medical, psychosocial, and vocational aspects and implications of diabetes., In the United States, 14.6 million people have been diagnosed with diabetes and an estimated 6.2 million more people have the disease but are undiagnosed. In addition, 54 million adults [...]

Byline: Felicia Hill-Briggs, PhD (Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, fbriggs3@jhmi.edu); [...]

Purpose The purpose of this pilot study was to examine psychometric properties of the Diabetes Problem-Solving Scale (DPSS), which was designed to assess how adults with type 2 diabetes approach [...]

Purpose Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. Methods The authors describe [...]

Purpose of Review: To summarize evidence of impact of social determinants of health (SDOH) on diabetes risk, morbidity, and mortality and to illustrate this impact in a population context. Recent Findings: Key findings from the American Diabetes Association's scientific review of five SDOH domains (socioeconomic status, neighborhood and physical environment, food environment, health care, social context) are highlighted. Population-based data on Black/African American adults illustrate persisting diabetes disparities and inequities in the SDOH conditions in which this population is born, grows, lives, and ages, with historical contributors. SDOH recommendations from US national committees largely address a health sector response, including health professional education, SDOH measurement, and patient referral to services for social needs. Fewer recommendations address solutions for systemic racism and socioeconomic discrimination as root causes. Summary: SDOH are systemic, population-based, cyclical, and intergenerational, requiring extension beyond health care solutions to multi-sector and multi-policy approaches to achieve future population health improvement. [ABSTRACT FROM AUTHOR]