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Clinician Educators' (CEs) focus on patient care and teaching, yet many academic institutions require dissemination of scholarly work for advancement. This can be difficult for CEs. Our division developed the Clinician-Educator Mentoring and Scholarship Program (CEMSP) in an effort to assist CEs with scholarship, national reputation, recognition, promotion and job satisfaction. The key components are salary-supported director and co-director who coordinate the program and serve as overall mentors and link CEs and senior faculty, and a full-time Senior Research Coordinator to assist with all aspects of scholarship, a close relationship with the General Internal Medicine (GIM) Methods Core provides advanced statistical support. Funding for the program comes from GIM divisional resources. Perceived value was evaluated by assessing the number of manuscripts published, survey of faculty regarding usage and opinion of CEMSP, and a review of faculty promotions. Although impossible to attribute the contributions of an individual component, a program specifically aimed at helping GIM CE faculty publish scholarly projects, increase participation in national organizations and focus on career progression can have a positive impact. [ABSTRACT FROM AUTHOR]

Objective: To identify patient characteristics related to intensity of weight reduction care provided in a primary care practice.Design: Cross-sectional study linking data from a patient survey and data from medical records.Setting: Internal medicine housestaff clinic in an urban university hospital.Participants: 321 outpatients who represented a systematic sample of all outpatients who had visited the clinic over one year.Measurements and Main Results: The patient population was largely black (86%) and female (65%). Most patients (54%) were overweight [body-mass index (BMI) > 85th percentile for the United States by gender]. Intensity of care was defined by a composite scale: points were awarded for actions documented in the medical chart or recalled by the patient. Factors independently associated with a higher intensity of care among the 161 overweight patients were: BMI [odds ratio (OR) = 1.13 per kg/m2; 95% confidence interval (95% CI) = 1.04, 122; p = 0.002], the patient's self-perception of being overweight (OR = 5.37; 95% CI = 1.99, 14.46; p = 0.001), and age of 64 years or younger (OR = 2.48; 95% CI = 1.12, 5.48; p = 0.02). Race, gender, and presence of hypertension or hypercholesterolemia were not associated with greater intensity of care.Conclusions: Patients with hypertension and hypercholesterolemia may be receiving suboptimal weight reduction care. Heightened awareness of being overweight may enhance the provision of weight reduction care. Prospective studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) disparities continue to have a negative impact on African Americans in the United States, largely because of uncontrolled hypertension. Despite the availability of evidence-based interventions, their use has not been translated into clinical and public health practice. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities is a new transdisciplinary research program with a stated goal to lower the impact of CVD disparities on vulnerable populations in Baltimore, Maryland. By targeting multiple levels of influence on the core problem of disparities in Baltimore, the center leverages academic, community, and national partnerships and a novel structure to support 3 research studies and to train the next generation of CVD researchers. We also share the early lessons learned in the center's design. [ABSTRACT FROM AUTHOR]

Objectives To determine the degree to which hyperglycemia predicts the development of frailty and lower extremity mobility limitations. Design Secondary data analysis of longitudinal data collected in a prospective cohort study. Setting Baltimore, Maryland. Participants Three hundred twenty-nine women from the Women's Health and Aging Study II aged 70 to 79 at baseline who had all variables needed for analysis. Measurements Glycosylated hemoglobin ( Hb A1c) at baseline, categorized as less than 5.5%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 7.9%, and 8.0% and greater, was the independent variable. The incidence of frailty and lower extremity mobility limitations (based on self-reported walking difficulty, walking speed, and Short Performance Physical Battery score) was determined (follow-up ≈ 9 years). Frailty was assessed using the Cardiovascular Health Study criteria. Covariates included demographic characteristics, body mass index, interleukin-6 level, and clinical history of comorbidities. Statistical analyses included Kaplan-Meier survival curves and Cox regression models adjusted for important covariates. Results In time-to-event analyses, Hb A1c category was associated with incidence of walking difficulty ( P = .049) and low physical performance ( P = .001); association with incidence of frailty and low walking speed had a trend toward significance (both P = .10). In regression models adjusted for demographic characteristics, Hb A1c of 8.0% or greater (vs < 5.5%) was associated with an approximately three-times greater risk of incident frailty and three to five times greater risk of lower extremity mobility limitations (all P < .05). In fully adjusted models, Hb A1c of 8.0% or greater (vs < 5.5%) was associated with incident frailty (hazard ratio ( HR) = 3.33, 95% confidence interval ( CI) = 1.24-8.93), walking difficulty ( HR = 3.47, 95% CI = 1.26-9.55), low walking speed ( HR = 2.82, 95% CI = 1.19-6.71), and low physical performance ( HR = 3.60, 95% CI = 1.52-8.53). Conclusion Hyperglycemia is associated with the development of frailty and lower extremity mobility limitations in older women. Future studies should identify mediators of these relationships. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- The purpose of this study was to examine the association between parental history of type 2 diabetes and glycemic control among diabetic urban African Americans. RESEARCH DESIGN AND METHODS -- Study participants included 359 African Americans with type 2 diabetes from Baltimore, Maryland, enrolled in Project Sugar 2. Participants underwent an interview-administrated questionnaire that asked about family history, sociodemographics, clinical characteristics, and knowledge and perception of adequate glycemic control. Regression analysis was used to determine the association between parental history of diabetes and glycemic control, as measured by A1C. RESULTS -- In the comparisons between participants with and without a parental history of diabetes, those with a positive parental history tended to be younger, have higher glucose levels, and have higher blood glucose levels before calling a doctor (all P < 0.05). After adjustments for age, sex, and BMI, there was a significant association (P = 0.02) between A1C and parental history with the mean A1C difference between those with a positive and a negative parental history being 0.58%. However, after adjustment for duration of diabetes, the association was no longer significant (P = 0.11). However, there was a tendency for individuals with two diabetic parents to have higher A1C (P = 0.011). CONCLUSIONS -- From these results, we conclude that among the urban African American participants who were aware of their parental history of diabetes, a positive parental history was associated with worse glycemic control, partly due to longer duration of diabetes. Parental history did not appear to be associated with better knowledge or perception of adequate glycemic control. [ABSTRACT FROM AUTHOR]

Purpose. To identify pattern(s) of disability related to diabetes in older women and to determine the extent to which disability is mediated by selected diabetes complications. Methods. Cross-sectional analysis of data from a population-based study composed of a representative sample of 3570 noninstitutionalized women aged 65 years and older living in the Baltimore metropolitan area who agreed to be screened for the Women's Health and Aging Study. Results. 483 (13.5%) of the women reported physician-diagnosed diabetes. Compared to women without diabetes, women with diabetes were significantly more likely to report difficulty in 14 of 15 daily tasks, including walking 2-3 blocks, lifting 10 pounds, using the telephone, and bathing (range of odds ratios [OR] 1.5-2.8; all p < .01). After adjustment for age, race, and marital status, women with diabetes were about twice as likely to report difficulty in any one of four functioning groups (mobility, upper extremity, higher functioning tasks, or self-care) (OR 2.2; 95% confidence interval [CI] 1.8-2.7), and over three times as likely to report difficulty in a group combining higher functioning and self-care tasks (OR 3.2; 95% CI 2.4-4.1). Adjustment for self-reported heart disease, stroke, high blood pressure, and visual problems did not attenuate these associations. Conclusions. Diabetes is strongly associated with a wide range of disabilities in older women. This association does not appear to be mediated by prevalent diabetes complications and risks, heart disease, high blood pressure, stroke, or eye disease. Other complications of diabetes (e.g., neuropathy, peripheral vascular disease) may mediate diabetes-associated disability in older adults. [ABSTRACT FROM AUTHOR]

The article focuses on the prevalence of depressive symptoms and the relationship between depressive symptoms and metabolic control related to diabetes. Researchers conducted a cross-sectional study of 183 African-American adults aged 35-75 years with type 2 diabetes who were recruited from two primary care clinics in East Baltimore, Maryland. The main implication of this study is that depression may be an important contributor to suboptimal metabolic control in African-Americans with type 2 diabetes.