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Context Previous studies have demonstrated associations of endogenous thyroid hormones with diabetes; less is known about stages of diabetes development at which they are operative, mechanisms of associations, and the role of the hypothalamic-pituitary-thyroid axis. Objective This study examined associations of thyroid hormones with incident prediabetes and diabetes and with changes in glycemic traits in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort of Hispanic/Latino adults with diverse backgrounds in the United States. Methods The study includes 592 postmenopausal euthyroid women and 868 euthyroid men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Baseline hormones included thyrotropin (TSH), free thyroxine (FT4), total triiodothyronine (T3), and indices calculated from thyroid hormones evaluating pituitary sensitivity to thyroid hormone. Transitions to diabetes and prediabetes, and changes in glycemic traits determined at the 6-year follow-up visit, were examined using multivariable Poisson and linear regressions. Results Among women, T3 (incident rate ratio [IRR] = 1.65; 95% CI, 1.22-2.24; P =.001) and TSH (IRR = 2.09; 95% CI, 1.01-4.33; P =.047) were positively, while FT4 (IRR = 0.59; 95% CI, 0.39-0.88; P =.011) was inversely, associated with transition from prediabetes to diabetes. Among men, the T3/FT4 ratio was positively associated with transition from normoglycemia to prediabetes but not from prediabetes to diabetes. Indices measuring sensitivity of the pituitary to thyroid hormone suggested increased sensitivity in men who transitioned from prediabetes to diabetes. Conclusion Positive associations in women of T3 and TSH and inverse associations of FT4, as well as inverse associations of thyroid indices in men with transition from prediabetes to diabetes, but not from normoglycemia to diabetes, suggest decreased pituitary sensitivity to thyroid hormones in women and increased sensitivity in men later in the development of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Psychological evaluation is required by insurance companies in the United States prior to proceeding with a spinal cord stimulation or a dorsal root ganglion stimulation trial. Since January 2017, we implemented a Multidisciplinary Team Conference for Neuromodulation in our center to facilitate the collaboration between pain physicians and psychologists and to optimize screening of neuromodulation candidates. This study aims to report the impact of this team conference on improvement of neuromodulation outcome in our center. Methods: Appropriateness of neuromodulation were discussed in the team conference after initial visit with the pain specialist and psychological evaluation. For this study, we prospectively and retrospectively collected data on neuromodulation candidates who went through the team conference and those who did not as controls. Results: We discussed 461 patients in the team conference sessions from January 2017 to July 2023. Out of these, a spinal cord stimulator or a dorsal root ganglion stimulator trial was performed in 164 patients with 80.5% (132 cases) trial success rate leading to 140 implants. Out of these implants, 26 (18.6%) explanted and 21 (15%) required revision in 41 (29.3%) patients. We performed neuraxial neuromodulation trial for 70 patients without going through the team conference from January 2016 to July 2023 with a trial success rate of 45.7% (32 cases). In this group, 7 (21.9%) and 6 (18.8%) patients underwent explant and revision. The differences between the groups were statistically significant for trial success rate (odds ratio of 4.9 with p-value of <0.01) but not for explant (odds ratio of 0.8 with p-value of 0.627) or revision (odds ratio of 0.8 with p-value of 0.595). Conclusion: Implementing Multidisciplinary Team Conference increased trial success rate in our center. Team conference provides therapeutic benefit for patients, and also provides the opportunity for an educational discussion for trainees. [ABSTRACT FROM AUTHOR]

Objective: To examine purpose in life (PIL) and ethnic identity (EI) as buffers to suicide ideation for Asian American, Hispanic, and Black emerging adults who perceive racial discrimination. Method: Two-hundred eighty-nine undergraduate students enrolled at a large university in the southwestern region of the United States (40.8% Asian American, 32.5% Hispanic, 26.6% Black; 61.2% women; mean age = 20.47, SD = 1.83) reported on experiences of racial discrimination, PIL, EI, and suicidal thoughts. Covariates were intrinsic religiosity, gender, and age. Results: Regression analysis showed that EI was not a significant moderator for the association between perceived racial discrimination (PRD) and suicidal ideation (β = −.08, p =.13; 95% confidence interval (CI) [−.19,.03]). However, PIL was a significant moderator (β = −.11, p =.025; CI [−.20, −.01]). A hierarchical regression showed that PIL as a moderator explained additional variance (ΔR2 = 0.11, p <.001) in suicide ideation above and beyond EI. Conclusions: These findings provide some insight into how life purpose might ameliorate the impact of social stressors above and beyond a positive cultural identity for young racial/ethnic minority adults. [ABSTRACT FROM AUTHOR]

We aimed to examine the retention of Hispanics/Latinos participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective cohort study of 16,415 adults in 4 US cities who were enrolled between 2008 and 2011. We summarized retention strategies and examined contact, response, and participation rates over 5 years of annual follow-up interviews. We then evaluated motivations for participation and satisfaction with retention efforts among participants who completed a second in-person interview approximately 6 years after their baseline interview. Finally, we conducted logistic regression analyses estimating associations of demographic, health, and interview characteristics at study visit 1 (baseline) with participation, high motivation, and high satisfaction at visit 2. Across 5 years, the HCHS/SOL maintained contact, response, and participation rates over 80%. The most difficult Hispanic/Latino populations to retain included young, single, US-born males with less than a high school education. At visit 2, we found high rates of motivation and satisfaction. HCHS/SOL participants primarily sought to help their community and learn more about their health. High rates of retention of Hispanics/Latinos can be facilitated through the employment of bilingual/bicultural staff and the development of culturally tailored retention materials. [ABSTRACT FROM AUTHOR]

Background: Color groups of fruits and vegetables (FV) are part of a healthy diet, but evidence for an association with cardiometabolic outcomes is inconsistent. Objective: To examine the association between intake of FV of different colors with incident diabetes and cardiometabolic risk biomarkers among U.S. Hispanics/Latinos. Subjects/methods: We used data from 9206 adults ages 18–74 years who were free of diabetes at baseline (2008–2011) and had follow-up data at visit 2 (2014–2017) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter, prospective cohort study of self-identified Hispanics/Latinos. Dietary intake was assessed using two 24 h recalls at baseline. FV were categorized into five color groups: green, white, yellow/orange, red/purple, and uncategorized. Diabetes was defined based on laboratory measures and self-reported antihyperglycemic medication. We used survey logistic regression models to evaluate the association between FV color groups and incident diabetes and survey linear regression models to evaluate the association of FV color groups with cardiometabolic risk biomarkers at visit 2. Results: During ~6 years of follow-up, 970 incident cases of diabetes were documented. The red/purple FV color group was the least consumed (0.21 servings/day), whereas white FV were the most consumed (0.92 servings/day). For each serving of total FV intake, body mass index (BMI) was lower by 0.24% (p = 0.03) and insulin by 0.69% (p = 0.03). For each serving of red/purple FV intake, HDL was 1.59% higher (p = 0.04). For each serving of white FV intake (with potato), post-OGTT was 0.83% lower (p = 0.04) and triglycerides 1.43% lower (p = 0.04). There was no association between FV intake and incident diabetes. Conclusions: Specific FV colors were associated with cardiometabolic benefits though the associations were of relatively small magnitudes. Dietary recommendations could consider varying colors of FV intake, especially white and red/purple color groups, for a healthy diet. [ABSTRACT FROM AUTHOR]

Introduction: Non‐alcoholic fatty liver disease (NAFLD) has been associated with increased risk of incident diabetes. But such evidence is lacking in the Hispanic/Latino population, which has high prevalence of obesity and NAFLD. Methods: We conducted a prospective cohort study of 6,928 adults of Hispanic/Latino background who had no diabetes, did not report excessive alcohol use, and no hepatitis B and C infection at baseline (2008–2011). We estimated risk ratios (RR) for incident diabetes, identified from visit 2 examination by glucose measurements or antidiabetic medication use, with baseline liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma‐glutamyl transpeptidase (GGT)). Results: A total of 738 adults developed diabetes during 6 years of follow‐up. After adjusting for participant characteristics at baseline, versus the lowest quartile, highest quartiles of ALT and GGT were associated with risks for incident diabetes (RR for ALT: 1.51 [95% CI 1.03–2.22], p‐trend = 0.006; RR for GGT: 2.39 [1.60–3.55], p‐trend = 0.001). Higher GGT levels predicted increased risk of incident diabetes even among those with ALT or AST below the median levels. The associations of ALT and GGT with incident diabetes were similar among most Hispanic background but were not seen among Dominicans (p for interaction <0.05). The association of AST with incident diabetes was found only among light‐to‐moderate alcohol drinkers (RR = 1.50 [1.20–1.86]) but not abstainers (RR = 0.91 [0.69–1.20], p for interaction = 0.006). Conclusion: Higher ALT and GGT levels are associated with increased risk of developing diabetes among Latinos. Liver enzyme tests might aid in diabetes prevention by identifying high‐risk individuals. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model. Methods: A community-based cross-sectional probability sample (2008–2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy's education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually. Results: In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P <.001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps <.001). The income-MetSyn association was only significant for women and those with current health insurance. Conclusions: Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population. [ABSTRACT FROM AUTHOR]

Background: U.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities.Purpose: Informed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study.Methods: Participants were 5,247 Latino adults, aged 18-74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms.Results: Household income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80).Conclusion: Low household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death for vulnerable ethnic minority emerging adults in the United States (Web-based injury statistics query and reporting system [WISQARS], 2015). Perceived discrimination (Journal of Youth and Adolescence, 40, 2011, 1465) and anxiety symptoms (Asian American Journal of Psychology, 1, 2010, 18) are two predictors that are theoretically and conceptually related, but have yet to be examined in a simultaneous model for suicide ideation. Existing theory and research suggest that these variables activate similar pathways (American Behavioral Scientist, 51, 2007, 551). This study sought to address this gap in the literature by examining the simultaneous relationship between perceived discrimination and anxiety symptoms as predictors of suicide ideation. The moderating effect of anxiety symptoms on the relationship between perceived discrimination and suicide ideation was examined in a multiethnic sample of emerging adults. Results indicated that anxiety symptoms moderated the perceived discrimination-suicide ideation relationship for Hispanic emerging adults, but not for their Asian American and African American counterparts. Furthermore, ethnic identity has been shown to mitigate suicide risk in the face of other stressors (Cultural Diversity and Ethnic Minority Psychology, 14, 2008, 75). Ethnic identity emerged as a protective factor for Hispanic emerging adults by further interacting with perceived discrimination and anxiety symptoms to negatively predict suicide ideation. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Introduction Obesity rates among US Hispanic women and children are high. Childhood obesity prevention beginning prenatally is desirable, but studies show mixed results. Methods We tested a pilot intervention to promote optimal gestational and infant weight with primigravid Hispanic women at a Federally Qualified Health Center (FQHC) on the U.S.-Mexico border. The intervention included promotora-led exercise, nutrition, breastfeeding activities (n = 23), supported by text/social media messaging (text messaging prenatally, private Facebook page postnatally). Measures included demographics, BMI, weight gain/retention, infant feeding, and attendance. Results Most women were U.S. born (73%), Spanish-language dominant (83%), with ≤ high school education (65%), and overweight/obese (56%). Retention rates were modest for the prenatal component (50%), supported by an SMS text-messaging program. Retention of the remaining postnatal sample, supported by a private Facebook® page, was 100%. Of women who regularly attended group sessions pre and postpartum, over 70% were within 5 lbs of pre-pregnancy weight at 6 months postpartum. A private Facebook® group was feasible for out-of-class support, including among women with regular cross-border mobility. Discussion While the intervention was well-received, almost 2/3 of the original participants did not follow up postpartum. Importantly, the findings indicate the use of social media (private Facebook® page) was more feasible than the SMS text-messaging program and may be a successful approach to reach and engage women living in mobile and transnational settings. Future studies should examine social media as an intervention tool to influence optimal weight and encourage healthy behaviors in primigravidas living near the U.S.-Mexico border. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic‐based approaches in this population. Objective: The purpose of this study was to test the efficacy of a clinic‐based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. Methods: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5–10 years old) and their parents. The 12‐month family‐based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid‐level providers. The primary study outcome was child BMI (kg m−2) assessed at baseline, 6‐month (n = 191) and 12‐month (n = 201) post‐baseline. A subsample of the children was examined for overall and site‐specific adiposity using dual‐energy X‐ray absorptiometry (n = 79). Results: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. Conclusions: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families. [ABSTRACT FROM AUTHOR]

Background: Current evidence suggests that periodontal disease (PD) is associated with a significant increased risk of atherosclerotic cardiovascular disease (CVD) independent of known confounders. PD is a chronic oral disease with significant variation in prevalence demonstrated among Hispanic/Latino subgroups. The purpose of this study was to investigate the associations between PD and CVD risk and variations with sex, age, and Hispanic/Latino background.Methods: The sample included 7379 participants aged 30 to 74 years, from the Hispanic Community Health Study/Study of Latinos (2008 to 2011). We assessed CVD risk by the Framingham 10-year general CVD risk score (FGRS). PD severity classification was based on calibrated measurements of gingival recession and probing depth. Multivariable sequential linear models for complex sample design assessed FGRS by PD severity, Hispanic/Latino background, and covariates.Results: The prevalence of moderate and severe PD combined was 46%. For women and men with severe PD, the combined prevalence of moderate and high CVD risk was 44% and 85%, respectively. The FGRS observed for women (5.1% [95% CI: 4.1%, 6.0%], p < 0.001) and men 10.8% (95% CI [9.2%, 12.3%], p < 0.001) with severe PD were 56% and 134% greater than those without PD, respectively. Dominican women and men with moderate or severe PD, aged 60 to 69 years, exhibited the greatest CVD risks (FGRS = 15.1%, 95% CI [7.8%, 22.5%]) and (FGRS = 40.2%, 95% CI [30.2%, 50.3%]), respectively.Conclusions: Moderate and severe PD were associated with significant CVD risk with marked sex disparity and heterogeneity by Hispanic/Latino background. [ABSTRACT FROM AUTHOR]

Hispanic and Black adults are disproportionately affected by HIV and experience poorer HIV-related health outcomes relative to non-Hispanic White adults. The current study adopted Sørensen's integrated model to test the hypothesis that lower functional and critical health literacy competencies contribute to poorer HIV-related health and CD4 cell count for Hispanic and Black individuals. Eighty-one non-Hispanic White, Hispanic, and Black HIV seropositive individuals from a large, Southwestern metropolitan area were administered measures of health literacy, including the Expanded Numeracy Scale, Newest Vital Sign, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy (TOHFLA)-numeracy, and TOHFLA-reading. Hispanic and Black individuals demonstrated less HIV knowledge than non-Hispanic White individuals. Black participants demonstrated fewer health literacy appraisal skills. Importantly, lower levels of health literacy were linked to poorer CD4 cell count (an index of immune functioning) for Hispanic and Black individuals and not for non-Hispanic White individuals. These findings suggest race group differences for health literacy on current CD4 cell count such as very specific dimensions of low health literacy (e.g. poorer judgment of health-related information), but not other presumed deficits (e.g. motivation, access), play an important role in clinical health outcomes in HIV. [ABSTRACT FROM AUTHOR]

Rationale: Accurate reference values for spirometry are important because the results are used for diagnosing common chronic lung diseases such as asthma and chronic obstructive pulmonary disease, estimating physiologic impairment, and predicting all-cause mortality. Reference equations have been established for Mexican Americans but not for others with Hispanic/Latino backgrounds.Objectives: To develop spirometry reference equations for adult Hispanic/Latino background groups in the United States.Methods: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) recruited a population-based probability sample of 16,415 Hispanics/Latinos aged 18-74 years living in the Bronx, Chicago, Miami, and San Diego. Participants self-identified as being of Puerto Rican, Cuban, Dominican, Mexican, or Central or South American background. Spirometry was performed using standardized methods with central quality control monitoring. Spirometric measures from a subset of 6,425 never-smoking participants without respiratory symptoms or disease were modeled as a function of sex, age, height, and Hispanic/Latino background to produce background-specific reference equations for the predicted value and lower limit of normal.Measurements and Main Results: Dominican and Puerto Rican Americans had substantially lower predicted and lower limit of normal values for FVC and FEV1 than those in other Hispanic/Latino background groups and also than Mexican American values from NHANES III (Third National Health and Nutrition Examination Survey).Conclusions: For patients of Dominican and Puerto Rican background who present with pulmonary symptoms in clinical practice, use of background-specific spirometry reference equations may provide more appropriate predicted and lower limit of normal values, enabling more accurate diagnoses of abnormality and physiologic impairment. [ABSTRACT FROM AUTHOR]

We document basic facts about prices in online markets in the United States and Canada, which is a rapidly growing segment of the retail sector. Relative to prices in regular stores, prices in online markets are more flexible and exhibit stronger pass-through (60-75 percent) and faster convergence (half-life less than two months) in response to movements of the nominal exchange rate. Multiple margins of adjustment are active in the process of responding to nominal exchange rate shocks. Properties of goods, sellers, and markets are systematically related to pass-through and the speed of price adjustment for international price differentials. (JEL F31, F41, L11, L81) [ABSTRACT FROM AUTHOR]

The objective of this study was to further develop an existing lexicon for use in describing the flavor characteristics of a wide variety of artisan goat cheeses made in diverse geographic locations throughout of the United States. Highly trained sensory panelists reviewed published lexicons for cheese before establishing a lexicon of 39 flavor attributes to represent sensory characteristics for 47 artisan goat cheeses manufactured in different parts of the United States. Twenty-eight attributes were present in a majority of samples and were able to describe most flavor characteristics. Other attributes were used occasionally to describe specific characteristics of certain cheeses. A large number of attributes were needed to describe flavor characteristics of cheese samples with more complex flavors (i.e., mold-ripened samples). Samples with milder characteristics (chèvre-style) needed a reduced number of terms and had lower intensities for most attributes. Feta-style cheeses generally were more salty and cheddar-style cheeses were mostly nutty, waxy, and sweet. Mold-ripened cheeses had musty-like characteristics and were more pungent and sharp. These attributes had higher intensities specifically for blue-type cheeses. The goaty flavor attribute was higher for mold-ripened cheeses but was characteristic of all the goat cheeses. Practical applications This study gathers previously developed flavor terms and combines them with new terms to describe the flavor characteristics of a broad variety of artisan cheeses made with goat's milk produced in different parts of the United States. This work can be a valuable resource for goat cheese producers. Any producer can use this study as a tool for learning, benchmarking, development, and quality control of goat cheese as it shows the types of flavors typical in a wide variety of goat cheeses. [ABSTRACT FROM AUTHOR]

Objective: This study examined perceived satisfaction among Hispanic/Latino individuals who participated in a baseline examination for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large cohort study of 16,415 adults living in four selected communities.Method: An estimated 22% (n= 3,584) of participants completed a questionnaire regarding satisfaction with staff attention, the overall experience during the study examination, and the influence of the informed consent digital video disc (DVD).Results: The majority of participants who completed the questionnaire expressed overall satisfaction with the study. Most participants reported that staff were friendly, courteous and respectful and study test procedures were clearly explained. Participants who preferred to complete the interview in Spanish felt that the informed consent DVD positively influenced their ability to make an informed decision to enroll in the study. Participants who preferred to complete the interview in English tended to report that the baseline examination was longer than expected compared with participants who completed the interview in Spanish.Conclusion: Results demonstrate that culturally and linguistically trained staff and the use of the study's informed consent DVD were effective in explaining study procedures and positively influenced decisions to participate in the HCHS/SOL study. These results can inform recruitment and enrollment strategies for future participation of minority groups into longitudinal cohort studies. [ABSTRACT FROM AUTHOR]

Background: Certolizumab pegol, a PEGylated tumour necrosis factor (TNF)-inhibitor, improves the clinical signs and symptoms of rheumatoid arthritis (RA) when used in combination with methotrexate or as monotherapy. This study evaluatedthe cost-utility of certolizumab pegol versusTNF-inhibitors plus methotrexate in the treatment of moderate-to-severe RA in Spain. Methods: A Markov cohort health state transition model was developed to evaluate the cost-utility (costs and quality-adjusted life years [QALYs]) of certolizumab pegol versus other TNF-inhibitors licensed in Spain in 2009. Efficacy was measured using the American College of Rheumatology (ACR) responses at 6 months, based on adjusted indirect comparisons from published clinical trials. Utilities were derived from EQ-5D data from certolizumab pegol RA clinical trials. Clinical history and resource use data came from published literature. Unit costs were taken from Spanish databases or published data (cost year 2009). Base case analyses were conducted from the payer perspective, with a ifetime horizon, 3.5 % annual discounting rates for costs and outcomes, and 3 % inflation rate for 2009 onwards. One-way sensitivity analyses were conducted. Results: The average lifetime costs for certolizumab pegol, etanercept, adalimumab (every 2 weeks and weekly) and infliximab (3 mg/kg and 5 mg/kg) in combination with methotrexate were €140,971, €141,197, €139,148, €164,741, €136,961 and €152,561, respectively. The QALYs gained were 6.578, 6.462, 6.430 (for both adalimumab doses), 6.430, and 6.318 (for both infliximab doses), respectively. At a €30,000/QALY willingness-to-pay threshold, certolizumab pegol plus methotrexate dominated adalimumab weekly, etanercept, and infliximab 5 mg/kg, and was cost-effective versus adalimumab every 2 weeks and infliximab 3 mg/kg (all with methotrexate), with estimated ICERs of €12,346/QALY and €15,414/QALY, respectively. Certolizumab pegol monotherapy was more cost-effective versus adalimumab, and less expensive with similar health gains versus etanercept (6.416 QALYs vs 6.492). Univariate analysis showed ICERs to be sensitive to changes in time horizon, ACR response time point, baseline Heath Assessment Questionnaire (HAQ) score, and rate of HAQ-disability index deterioration after discontinuing treatment. Conclusions: This analysis shows that certolizumab pegol is cost-effective compared with other TNF-inhibitors recommended in Spain for the treatment of RA. [ABSTRACT FROM AUTHOR]

Little research has examined associations of social support with diabetes (or other physical health outcomes) in Hispanics, who are at elevated risk. We examined associations between social support and diabetes prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Participants were 5,181 adults, 18-74 years old, representing diverse Hispanic backgrounds, who underwent baseline exam with fasting blood draw, oral glucose tolerance test, medication review, sociodemographic assessment, and sociocultural exam with functional and structural social support measures. In adjusted analyses, one standard deviation higher structural and functional social support related to 16 and 15 % lower odds, respectively, of having diabetes. Structural and functional support were related to both previously diagnosed diabetes (OR = .84 and .88, respectively) and newly recognized diabetes prevalence (OR = .84 and .83, respectively). Higher functional and structural social support are associated with lower diabetes prevalence in Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

BACKGROUND The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women. METHODS To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer. RESULTS Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants. CONCLUSIONS Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork. Cancer 2014;120:752-760. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Despite established links between reduced nocturnal blood pressure (BP) dipping and cardiovascular disease, BP dipping research in Hispanics is limited. Purpose: This study investigated socioeconomic status (SES) as a predictor of BP dipping and the contributions of psychosocial factors to this relationship. Analyses were conducted for the overall sample and separately for higher and lower acculturated women. Methods: Mexican-American women ( N = 291; 40-65 years) reported demographics and completed psychosocial assessments and 36-h ambulatory BP monitoring. Results: Lower SES related to reduced BP dipping in the overall sample and in more US-acculturated women ( r's = .17-.30, p's < .05), but not in less-acculturated women ( r's = .07, p's > .10). An indirect effect model from SES to BP dipping via psychosocial resources/risk fits well across samples. Conclusions: In Mexican-American women, the nature of SES gradients in BP dipping and the roles of psychosocial resources/risk differ by acculturation level. [ABSTRACT FROM AUTHOR]

The article focuses on a research in which researchers analyses the prevalence of major cardiovascular diseases (CVD) risk factors and CVD (coronary heart disease [CHD] and stroke) among U.S. Hispanic or Latino individuals of different backgrounds. The researchers analyzed the adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. They found that age-standardized prevalence of CVD risk factors varied by Hispanic or Latino background. The study showed that obesity and current smoking rates were the highest among Puerto Rican participants and hypercholesterolemia prevalence was highest among Central American men and Puerto Rican women.

Despite the effectiveness of cancer screening procedures, its utilization among Latinas remains low. Guided, in part, by the Behavioral Model for Vulnerable Populations, this study examined the associations between predisposing, enabling, and need factors with self-reported breast, cervical, and colorectal cancer screening adherence. Participants were 319 Mexican-American women, from a range of socioeconomic backgrounds, living near the United States-Mexico border. Women were adherent with breast cancer (BC) screening (≥42 years) if they had received at least one mammogram within the last 2 years, with cervical cancer (CC) screening (≥40 years) if they had received at least one Pap exam in the last 3 years, and with colorectal cancer (CRC) screening (≥52 years) if they had undergone one or more of the following: Fecal Occult Blood Test within the last year, or sigmoidoscopy in the last 5 years, or colonoscopy within the last 10 years. BC and CC screenings were higher in the current sample compared to national and state figures: 82% with mammography and 86% adherent with Pap exam screening. However, only 43% were adherent with CRC screening recommendations. Characteristics associated with mammography adherence included CC adherence and usual source of care. BC adherence was associated to CC adherence. Characteristics associated with CRC adherence included BC adherence, being premenopausal, and insurance coverage. A key correlate of cancer screening adherence was adherence to other preventive services. Results underscore the need for continued efforts to ensure that Latinas of all SES levels obtain regular and timely cancer screenings. [ABSTRACT FROM AUTHOR]

Abstract: At present, photovoltaic grid-connected systems (PVGCS) are experiencing a formidable market growth. This is mainly due to a continuous downward trend in PV cost together with some government support programmes launched by many developed countries. However, government bodies and prospective owners/investors are concerned with how changes in existing economic factors – financial incentives and main economic parameters of the PVGCS – that configure a given scenario may affect the profitability of the investment in these systems. Consequently, not only is a mere estimate of the economic profitability in a specific moment required, but also how this profitability may vary according to changes in the existing scenario. In order to enlighten decision-makers and prospective owners/investors of PVGCS, a sensitivity analysis of the internal rate of return (IRR) to some economic factors has been carried out. Three different scenarios have been assumed to represent the three top geographical markets for PV: the Euro area, the USA and Japan. The results obtained in this analysis provide clear evidence that annual loan interest, normalised initial investment subsidy, normalised annual PV electricity yield, PV electricity unitary price and normalised initial investment are ordered from the lowest to the highest impact on the IRR. A short and broad analysis concerning the taxation impact is also provided. [Copyright &y& Elsevier]

With reference to the Communication-Persuasion model, we describe various research issues and challenges when considering the health of Latinos, and implications for designing and evaluating health communication and behavior change efforts in this population. Latinos, collectively the nation's largest minority group, vary substantially in terms of socioeconomic and legal status, their country of origin and the extent of ongoing contact with that country, their region of residence within the United States, their generation status and levels of acculturation, and psychosocial factors. Health communication efforts with Latinos need to focus on family, cultural traditions, and collectivism while attending to acculturation, language, generation and national origin. The most extensive intervention topic in Latino health promotion has been the application of the lay health advisor model. This and other fundamental communication approaches, as well as audience and population characteristics, need to be considered within the context of dynamic and complex societal changes. [ABSTRACT FROM AUTHOR]

This paper investigates the link between the optimal level of nonfinancial firms’ short-term leverage and macroeconomic and idiosyncratic sources of uncertainty. We develop a structural model of a firm’s value maximization problem that predicts a negative relationship between uncertainty and optimal levels of borrowing. This proposition is tested using a panel of nonfinancial U.S. firms drawn from the COMPUSTAT quarterly database covering the period 1993–2003. The estimates confirm that as either form of uncertainty increases, firms decrease their levels of short-term leverage. This effect is stronger for macroeconomic uncertainty than for idiosyncratic uncertainty. ( JEL C23, D8, D92, G32) [ABSTRACT FROM AUTHOR]

The article focuses on health-seeking behavior and barriers encountered in unauthorized immigrants living in the U.S.-Mexico borderlands. Among the barriers include fear of obstacles, direct legal mandates, and interaction of unauthorized legal status with workplace and household relations, which are found to occur as webs that are more difficult challenges than individual barriers alone. Other significant resilience factors include community-oriented healthcare services and the learning/confidence-building process.

Objectives. We sought to examine the relationships between individual and area-based indicators of acculturation and metabolic syndrome (MetS) risk among a sample of Mexican American women living in the Califomia-Baja California border region. Methods. We examined data collected between October 2003 and December 2004 from 141 women (mean age=47.07 years) who completed physical and psychosocial assessments. We reviewed medical records for laboratory values. Results. Individual-level US acculturation was associated with a greater consumption of fruits, vegetables, and fiber; increased odds of engaging in health-enhancing levels of physical activity; and decreased odds of meeting the clinical criteria for MetS. Moreover, beyond the influence of individual-level factors, US neighborhood acculturation was associated with less fat intake. Conclusions. These findings provide preliminary evidence for a relationship between acculturation and the development of MetS in this population. Such information may assist efforts aimed at understanding and eliminating ethnic disparities in MetS risk and related health conditions. (Am J Public Health. 2008; 98:1979-1986. doi:10.2105/AJPH.2008.141903) [ABSTRACT FROM AUTHOR]

The Massachusetts Institute of Technology's iLab project has developed a distributed software toolkit and middleware service infrastructure to support Internetaccessible laboratories and promote their sharing among schools and universities on a worldwide scale. The project starts with the assumption that the faculty teaching with online labs and the faculty or academic departments that provide those labs are acting in two roles with different goals and concerns. The iLab architecture focuses on fast platform-independent lab development, scalable access for students, and efficient management for lab providers while preserving the autonomy of the faculty actually teaching the students. Over the past two years, the iLab architecture has been adopted by an increasing number of partner universities in Europe, Australia, Africa, Asia, and the United States. The iLab project has demonstrated that online laboratory use can scale to thousands of students dispersed on several continents. [ABSTRACT FROM AUTHOR]

Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians’ need to consider culture in the delivery of effective services. To address these issues we investigated predictors of culturally competent actions among a sample of 134 practicing San Diego County physicians. They provided demographic information and completed questions assessing their cultural knowledge, cultural awareness, and culturally competent actions specific to Mexican Americans with diabetes. We then developed a structural cultural competence model. Results indicated that participation in diverse medical education settings and experience in community clinics predicted cultural knowledge. Participation in diverse educational settings, Latino ethnicity, bilingual skills, and cultural knowledge predicted cultural awareness. An internal medicine specialty predicted less cultural awareness. Culturally competent actions were only predicted by cultural awareness. Goodness-of-fit statistics supported the overall model''s acceptability. The number of Mexican Americans physicians see in practice did not predict any tested cultural competence dimension. Our model supports a number of conclusions. First, knowledge of cultural factors per se and simple exposure to Mexican Americans in practice do not directly facilitate culturally competent care. Rather, such care is most strongly predicted by recognition that cultural factors and awareness of personal biases are important. Results further support medical education that does not solely focus on basic information about Mexican Americans but also explores provider biases and preconceptions. Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence. [Copyright &y& Elsevier]

OBJECTIVE — To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes. RESEARCH DESIGN AND METHODS — A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels o[ HbA[sub 1c], lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. RESULTS — After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA[sub 1c] (12.0-8.3%, P < 0.0001), total cholesterol (5.82-4.86 mmol/l, P < 0.0001), LDL cholesterol (.3.39-2.79 mmol/l, P < 0.0001), and diastolic blood pressure (80-76 mmHg, P < 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture based beliefs (P = 0.001) were also improved. CONCLUSIONS — A novel, culturally appropriate, community-based, nurse case manage merit/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations. [ABSTRACT FROM AUTHOR]

An abstract of the study "Measuring Botanical Supplement Use among Hispanics/Latinos in the United States: A Comparison of Methods in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)" by Keturah Faurot and colleagues is presented.

The landmark, multicenter HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is the largest, most comprehensive, longitudinal community-based cohort study to date of diverse Hispanic/Latino persons in the United States. The HCHS/SOL aimed to address the dearth of comprehensive data on risk factors for cardiovascular disease (CVD) and other chronic diseases in this population and has expanded considerably in scope since its inception. This paper describes the aims/objectives and data collection of the HCHS/SOL and its ancillary studies to date and highlights the critical and sizable contributions made by the study to understanding the prevalence of and changes in CVD risk/protective factors and the burden of CVD and related chronic conditions among adults of diverse Hispanic/Latino backgrounds. The continued follow-up of this cohort will allow in-depth investigations on cardiovascular and pulmonary outcomes in this population, and data from the ongoing ancillary studies will facilitate generation of new hypotheses and study questions. [Display omitted] • The HCHS/SOL is the largest longitudinal, community-based cohort study of diverse Hispanic/Latino persons in the United States. • This review highlights the objectives and methodology of the HCHS/SOL and its contributions to understanding the prevalence of cardiovascular risk factors and the burden of CVD among diverse Hispanic/Latino adults. • Continued follow-up of this cohort and data from ancillary studies will generate new hypotheses and research questions. [ABSTRACT FROM AUTHOR]

Background Incidence rates for breast cancer are higher among Mexican-American (MA) women in the United States than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in more acculturated than less acculturated Hispanic/Latinas in the United States. We compared the prevalence of behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent. Methods Data were collected from 1,201 newly diagnosed breast cancer patients living in Mexico ( n = 581) and MAs in the United States ( n = 620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual, and English dominant); women living in Mexico were used as the referent group. The prevalence of behavioral risk factors and family history of breast cancer were assessed according to acculturation level, adjusting for age at diagnosis and education. Results In the adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index of 30 kg/m 2 or greater, consume more than one alcoholic beverage a week, and report having a family history of breast cancer than women living in Mexico. All three U.S. acculturation groups were significantly more likely to have lower total energy expenditure (≤533 kcal/d) than women in Mexico. English-dominant women were significantly less likely to ever smoke cigarettes than the Mexican group. Conclusions Our findings add to the limited scientific literature on the relationships among acculturation, health behavior, and family history of breast cancer in Mexican and MA women. [ABSTRACT FROM AUTHOR]

• Cultural stressors and family dynamics influence Latino/a health outcomes. • Among Latino/as, Mexican immigrants exhibit distinct patterns of alcohol use. • Recognizing diversity within Latinos/as is crucial for tailored interventions. As the Latino/a population in the United States continues to grow, disparities among subgroups within this population are becoming more evident. Understanding how cultural stressors and family dynamics relate to behavioral and mental health outcomes among Latino/a immigrants offers valuable insights for addressing inequities among specific Latino/a subgroups. As a result, we conducted a moderated-mediation analysis, using a multi-group path analysis approach, to examine the extent to which cultural stressors and family etiologic factors relate to hazardous alcohol use and mental health symptoms among Mexican and other Latino/a immigrant (i.e., Argentina, Chile, Colombia, Peru, Uruguay, Venezuela, Cuba, Dominican Republic, Costa Rica, Guatemala, Honduras, Nicaragua, Panama, and El Salvador) parents in the United States. Additionally, we explored the extent to which cultural stressors would indirectly relate to hazardous alcohol use and mental health symptoms through elevated family risk factors and compromised family functioning among both subgroups. The sample consisted of 827 Latino/a immigrant parents with children aged 8 to 16 years, including 287 (35 %) Mexican (M =38.9 years, 61 % female) and 540 (65 %) other Latino/a (M =40.8 years, 72 % female). Variables assessed in this study, and self-reported by participants, included cultural stress, family conflict, poor family management, positive attitudes toward drug use, family functioning, hazardous alcohol use, and symptoms of anxiety and depression. We conducted a series of multiple linear regressions, as well as a multigroup path analysis adjusting for covariates. Scores on all study variables (except family functioning, which evidenced the opposite pattern) were significantly greater in Mexicans than in other Latino/a individuals. We found that hazardous alcohol use was more closely related to family and cultural level predictors among Mexicans, but that links of family and cultural level predictors with mental health indicators were similar between the two subgroups. Grouping Mexicans into a homogenous ethnic group along with other Latino/a subgroups might undermine our understanding of the associations of cultural stress and family-level etiologic factors vis-à-vis the incidence and prevention of hazardous alcohol use and mental health among different subgroups of Latino/a immigrant families, especially those of Mexican origin. Our findings highlight the critical need for tailored interventions aimed at Latino/a immigrant subgroups to ensure equitable substance use and mental health outcomes in the United States. [ABSTRACT FROM AUTHOR]

Although human mucosal leishmaniasis is much more common in Latin America, a few cases that are the result of local transmission occur in Europe. A suspected case of leishmaniasis is usually confirmed by the demonstration of amastigotes in smears, the culture of promastigotes from blood or tissue samples, or the PCR-based demonstration of leishmanial DNA. Biopsies may contain too few parasites to be found positive by microscopy or culture, however, and then a diagnosis may be difficult, especially in regions where human leishmaniasis in general or particular forms of the disease are rarely seen. The aim of the present study was to investigate the histopathological characteristics of three Spanish cases of non-granulomatous mucosal leishmaniasis caused by Leishmania infantum. The hope was that the information collected will help European clinicians diagnose such cases, even when amastigotes cannot be readily demonstrated. [ABSTRACT FROM AUTHOR]

The nutritional status of women in the preconception period is of paramount importance due to its role in reproduction. Our aim was to assess overall diet quality during the preconception period and its association with infant birth weight adjusted for gestational age (GA). This is an observational longitudinal cohort of Hispanic people living in the United States. Data are from the Hispanic Community Health Study/Study of Latinos baseline (2008-2011) and second clinic examinations (2014-2017). Included are the first 497 singleton live-born infants among the 2,556 women (younger than 45 years) who attended the second visit. Field sites were located in Miami, FL; Bronx, NY; Chicago, IL; and San Diego, CA, and represent individuals with heritage from Cuba, Dominican Republic, Mexico, Puerto Rico, and Central and South America. Diet assessment included two 24-hour recalls from baseline. The 2010 Healthy Eating Index (HEI-2010) was used to measure diet quality, with higher scores indicating better quality. Complex survey linear regression estimated the association between HEI-2010 scores (continuous variable and categorized into tertiles) and birth-weight z score and birth weight for GA percentile. Mean (standard deviation) age of women was 25.8 (5.2) years and 36.4% were classified as underweight or normal weight, 30.0% were overweight, and 33.6% had obesity at baseline. Mean (standard deviation) HEI-2010 score was 56.5 (13.4), and by weight classifications was 54.4 (14.1) for underweight or normal weight and 57.7 (12.8) for overweight or obesity. Median (interquartile range) birth-weight z score was 0.5 (interquartile range [IQR], –0.2 to 1.3) overall and 0.2 (IQR, –0.5 to 1.0), 0.6 (IQR, –0.2 to 1.3), and 0.5 (IQR, –0.2 to 1.4) for the first, second, and third HEI-2010 tertile, respectively. Median birth weight for GA percentile was 68.2 (IQR, 40.2 to 89.7) overall, and 56.8 (IQR, 29.6 to 85.0), 71.5 (IQR, 42.8 to 90.0), and 70.1 (IQR, 42.9 to 91.2) by HEI-2010 tertile. In adjusted models, the highest tertile of the HEI-2010 score was associated with a higher birth-weight z score and birth weight for GA percentile, and the continuous HEI-2010 score was only associated with birth weight for GA percentile. Preconception body mass index (calculated as kg/m2) did not modify these associations. Overall diet quality, as measured by the HEI-2010, in the preconception period is associated with infant birth weight adjusted for GA among US Hispanic and Latina women. [ABSTRACT FROM AUTHOR]

The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used self-report measure of depression symptomatology. This study evaluated the reliability, validity, and measurement invariance of the CES-D 10 in a diverse cohort of Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The sample consisted of 16,415 Hispanic/Latino adults recruited from 4 field centers (Miami, FL; San Diego, CA; Bronx, NY; Chicago, IL). Participants completed interview administered measures in English or Spanish. The CES-D 10 was examined for internal consistency, test-retest reliability, convergent validity, and measurement invariance. The total score for the CES-D 10 displayed acceptable internal consistencies (Cronbach's alpha's = .80-.86) and test-retest reliability (r values = .41-.70) across the total sample, language group and ethnic background group. The total CES-D 10 scores correlated in a theoretically consistent manner with the Spielberger State-Trait Anxiety Inventory, r = .72, p < .001, the Patient Health Questionnaire-9 depression measure, r = .80, p < .001, the Short Form-12's Mental Component Summary, r = -.65, p < .001, and Physical Component Summary score, r = -.25, p < .001. A confirmatory factor analysis showed that a 1-factor model fit the CES-D 10 data well (CFI = .986, RMSEA = .047) after correlating 1 pair of item residual variances. Multiple group analyses showed the 1-factor structure to be invariant across English and Spanish speaking responders and partially invariant across Hispanic/Latino background groups. The total score of the CES-D 10 can be recommended for use with Hispanics/Latinos in English and Spanish. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Individuals with favorable levels of all readily measured major CVD risk factors (low CV risk) during middle age incur lower cardiovascular morbidity and mortality, lower all-cause mortality, and lower Medicare costs at older ages compared to adults with one or more unfavorable CVD risk factors. Studies on predictors of low CV risk in Hispanics/Latinos have focused solely on Mexican-Americans. The objective of this study was to use data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; enrolled 2008 to 2011) to assess relationships of nativity and length of residence in the US, a commonly used proxy for acculturation, with low CV risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure<120/<80; body mass index <25kg/m(2); and no major ECG abnormalities) in 15,047 Central American, South American, Cuban, Dominican, Mexican, Puerto Rican men and women, and Hispanic/Latino men and women identifying as other or >1 heritage. We also tested whether associations varied by Hispanic/Latino background. Women living in the US<10years were 1.96 (95% confidence interval: 1.37, 2.80) times more likely to be low CV risk than US-born women after adjusting for sociodemographic characteristics, diet, physical activity, and self-reported experiences of ethnic discrimination. Findings varied in men by Hispanic/Latino background, but length of residence was largely unrelated to low CV risk. These findings highlight the role acculturative processes play in shaping cardiovascular health in Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Purpose: Metabolic syndrome (MetS), the clustering of several risk factors for cardiovascular disease, is highly prevalent in Hispanics/Latinos. We tested whether all components significantly loaded on the syndrome in Hispanics/Latinos and whether their contribution differed by sex and Hispanic ancestry. We also examjned associations of MetS with prevalent diabetes and coronary heart disease in Hispanics/ Latinos. Methods: Data were obtained from a population-based cohort of n = 15,823 participants in the HCHS/SOL study who self-identfiied as being of Central American, Cuban, Dominican, Mexican American, Puerto Rican, or South American ancestry and were aged 18 to 74 years at screening. Results: A latent variable model of waist circumference, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting glucose fit the data in men and women, but the contribution of HDL-C was weak. No difference in the latent model of MetS was detected across Hispanic/Latino ancestry groups. MetS was significantly associated with diabetes and coronary heart disease. Conclusions: Our results indicate that similar criteria for MetS may be applied across Hispanic/Latino ancestry groups but call into question the role of HDL-C in classifying the MetS in Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Aims: To determine whether loss of muscle mass (approximated using fat free mass [FFM]) is associated with risk for type 2 diabetes mellitus (T2DM) in Hispanic/Latino adults in the United States.Methods: Participants were Hispanic/Latino adults (18-74-year-olds) who completed Visit 2 of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; multi-site, prospective cohort study; 6.1-year follow-up) and did not have T2DM at baseline (n = 6264). At baseline and Visit 2, FFM was measured using bioelectrical impedance analysis and fasting glucose, HbA1c, and fasting insulin were measured by examiners. Diabetes was defined according to American Diabetes Association criteria. Survey-weighted Poisson regression models examined the association of percent change in relative FFM (%ΔFFM) with incident prediabetes and T2DM. Survey-weighted multivariable regression models examined associations of %ΔFFM with changes in glucose and insulin measures.Results: Relative FFM declined by 2.1% between visits. %ΔFFM was inversely associated with incident prediabetes (p-for-trend = 0.001) and with changes in glucose and insulin measures (p-for-trend <0.0001). Findings were null, except for HOMA-IR, after adjustment for changes in adiposity measures. Associations were generally stronger for individuals with baseline overweight/obesity.Conclusions: Reducing loss of FFM during adulthood may reduce prediabetes risk (primarily insulin resistance), particularly among individuals with overweight/obesity. [ABSTRACT FROM AUTHOR]

Aims: We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes.Methods: Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/economic- related factors and low medication adherence stratified by sex.Results: More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p < 0.05). We found significant differences between levels social support and medication adherence (p < 0.05). In hierarchical models, being US born and higher levels of social support were associated with low adherence among males (p < 0.05, and p < 0.001).Conclusions: Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the association between undocumented immigration status and anxiety, depression, and use of anxiolytic or antidepressant medications in the Hispanic Community Health Study/Study of Latinos.Methods: Cross-sectional analysis of data collected between 2014 and 2017. Participants were categorized as U.S.-born citizens, naturalized citizens, documented noncitizens, or undocumented noncitizens. We calculated prevalence and prevalence ratios for anxiety, depression, and use of anxiolytic or antidepressant medication, by immigration status.Results: Of 9257 participants, 1403 (15%) were undocumented noncitizens, 2872 (31%) were documented noncitizens, 3766 (41%) were naturalized citizens, and 1216 (13%) were U.S.-born citizens. Prevalence of anxiety was lower among undocumented than documented noncitizens (9 vs. 15%, P < .0001) but not significantly different in adjusted analyses. Prevalence of depression was similar among undocumented and documented noncitizens (20 vs. 24%, P = .07) and not significantly different in adjusted analyses. Among participants with depression, 7% of undocumented and 27% of documented noncitizens reported use of antidepressants (adjusted prevalence ratio 0.49, 95% CI 0.27-0.87).Conclusions: Undocumented noncitizens had similar likelihood of anxiety and depression, but lower likelihood of antidepressant use, compared with documented noncitizens. These results may reflect the resilience of an undocumented population facing multiple stressors but suggest that this group may be undertreated for depression. [ABSTRACT FROM AUTHOR]

Background The prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known. Methods Lipid and lipoprotein data were used from the Hispanic Community Health Study/Study of Latinos–a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74 years. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, and biological and acculturation characteristics were compared among those with and without dyslipidemia. Results Mean age was 41.1 years, and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated low-density lipoprotein cholesterol was 36.0%, and highest among Cubans (44.5%; P < .001). Low high-density lipoprotein cholesterol (HDL-C) was present in 41.4% and did not significantly differ across Hispanic background groups ( P = .09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; P < .001). Elevated non-HDL-C was seen in 34.7%, with the highest prevalence among Cubans (43.3%; P < .001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index, and low physical activity. Older age, female sex, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence. Conclusion Dyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds, with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population. [ABSTRACT FROM AUTHOR]