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People living with Type 1 and Type 2 diabetes (T1DM &T2DM) report that media – including journalism, health promotion, and popular culture – are a primary source of stigmatic representations of diabetes, and that this compromises their physical and mental health. This view of diabetes as stigmatised is not shared by many health professionals and nor the wider public. We used an existing representation of diabetes on Instagram, #DiabetesOnAPlate, to examine how stigmatic representations of diabetes are (re)produced, discussed, and contested. Our analysis found that, consistent with the notion of diabetes as stigmatised, use of the hashtag #DiabetesOnAPlate on Instagram is associated with public health discourses of indulgent eating and with posts that signal recognition of this as a moral transgression. A subsequent on-line survey found that participants who did not have diabetes did not recognise a prototypical #DiabetesOnAPlate post as stigmatic. Whilst some with T1DM and T2DM did perceive and contest the stigma, T1DM participants did so for their group (but not for T2DM); and there was evidence that some T2DM participants internalised the stigma. These findings support concerns about the everyday, divisive nature of stigmatic representations of diabetes on social network sites, which on the one hand reflect public health discourse and on the other may compromise health policy objectives and exacerbate health inequalities. [ABSTRACT FROM AUTHOR]

Context: In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies and expert opinion from across the UK and form other long term conditions. The case for integration: There is good the evidence around the high prevalence of co‐morbidity between diabetes and mental illness of all severities and, the poorer diabetes and mental health outcomes for patients when this co‐morbidity exists. Detecting and managing the mental health co‐morbidity improves these outcomes, but the evidence suggests that detection of mental illness is poor in the context of diabetes care in community and acute care settings and that when it is detected, the access to appropriate mental health resource is variable and generally inadequate. The Model of integrated care for diabetes: The EWG developed a one‐page Model with five core principles and five operational work‐streams to support the delivery of integration, with examples of local case studies for local implementation. The five core principals are: Care for all—describing how care for all PWD needs to explore what matters to them and that emotional wellbeing is supported at diagnosis and beyond; Support and information—describing how HCPs should appropriately signpost to mental health support and the need for structured education programmes to include mental healthcare information; Needs identified–describing how PWD should have their mental health needs identified and acted on; Integrated care—describing how people with mental illness and diabetes should have their diabetes considered within their mental health care; Specialist care—describing how PWD should be able to access specialist diabetes mental health professionals. The five cross cutting work‐streams for operationalising the principles are: Implementing training and upskilling of HCPs; Embedding mental health screening and assessment into diabetes pathways; Ensuring access to clear, integrated local pathways; Ensuring addressing health inequalities is incorporated at every stage of service development; Improving access to specialist mental health services through commissioning. Discussion and conclusions: The Model can be implemented in part or completely, at an individual level, all the way up to system level. It can be adapted across the life span and the UK, and having learnt from other long term conditions, there is a lot of transferability across all long term conditions There is an opportunity for ICBs to consider economies of scale across multiple long term conditions for which there will be a significant overlap of patients within the local population. Any local implementation should be in co‐production with experts by experience and third sector providers. [ABSTRACT FROM AUTHOR]

Community Health Advanced by Medical Practice Superstars is a 1-year, Health Resources and Services Administration (HRSA)-funded fellowship for early career physicians and physician assistants/associates to become primary care transformational leaders. Fellows implement practice-based health care transformation projects in one of the three HRSA priority areas: childhood obesity, mental health, and opioid use disorder. The purpose of these projects is to expand on integrated health in primary care settings where there is a shortage of mental health professionals. The fellows identified areas in which they were able to incorporate mental health care provision to improve diagnostic capacity and whole health delivery, facilitate appropriate behavioral health outcomes, and improve patient physical health outcomes. Project modalities included initiating or increasing behavioral health screenings, aligning screenings with patient outcomes, and coordinating behavioral health care with physical health care. This article describes six mental health-related health care practice transformation projects implemented across rural health care settings, including Federally Qualified Health Centers and academic medical centers. The topics included (a) depression in pregnant and postpartum mothers; (b) adverse childhood experiences screening; (c) depression and chronic disease outcomes, especially diabetes; (d) the use of automated enhancements in patients’ electronic medical records for management of clinical depression; (e) improving health outcomes and medication adherence of patients with opioid use disorder; and (f) the (in)adequacy of the Patient Health Questionairre-2 (PHQ-2) for the assessment of depression among patients with diabetes. Clinical specialties included family medicine, pediatrics, and women’s health. [ABSTRACT FROM AUTHOR]

Editor's note: This article was adapted from the address Dr. Delamater delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2022. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Delamater delivered the address in June 2022 at the Association's virtual 82nd Scientific Sessions. A webcast of this speech is available for viewing on the DiabetesPro website (https://professional.diabetes.org/webcast/stigma-diabetes-care%E2%80%94evidence-and-solutions-richard-r-rubin-award-lecture). [ABSTRACT FROM AUTHOR]

The article presents the discussion on optimizing glycemia before fasting being an essential measure to ensure safe fasting. Topics include transplantation of isolated islet cells allowing the achievement of a more physiological release of endocrine hormones; and DiViD providing evidence about an enterovirus vaccine being effective for the primary and secondary prevention of T1D.

We aimed to survey the findings of phenomenological studies built up in the field of diabetes care in Sweden. This is a meta-synthesis of phenomenological studies on experiences related to diabetes in Sweden focusing on learning to live with diabetes. We proceeded by reference to the seven phases of Noblit & Hare. We examined papers from seven phenomenological studies on learning to live with diabetes in Sweden. From the papers, which describe the experience of living with diabetes, three overarching themes were selected—perception and awareness of the body; integration and responsibility; and presence of others who provide support. From those describing the expert's experience, an overarching theme emerged—encouraging reflection in persons with diabetes. We interpreted each of these themes in phenomenological terms and compared them with theories in Japan. Persons with diabetes take responsibility for coping with a range of things brought on by the illness and learn to live with diabetes. Experts support these persons so they can see their world objectively and critically scrutinize it. By building a model of diabetes care in Japan that references Scandinavian human science, it will be possible to find new approaches that support learning at the existential level. [ABSTRACT FROM AUTHOR]

Aim: Diabetes‐related distress is common in diabetes and has implications for well‐being. Cognitive behavioural therapy (CBT) and third‐wave CBT hold promise as treatments for diabetes‐related distress, although previous findings are inconclusive. We aimed to conduct a systematic review with meta‐analysis to understand the efficacy of these interventions in treating diabetes‐related distress, while also assessing the associative benefits of these interventions on depression, anxiety and glycaemic control. We also aimed to conduct a narrative synthesis, and subgroup analyses to identify intervention components most useful in treating diabetes‐related distress. Method: We searched seven electronic databases from inception to April 2021. Data extraction was independently performed by two reviewers. Methodological quality was assessed. The protocol was registered with the Prospective Register Of Systematic Reviews (PROSPERO): CRD42021240628. Results: We included 22 randomised controlled trials investigating the efficacy of CBT and third‐wave CBT interventions on diabetes‐related distress. CBT for diabetes‐related distress significantly reduced distress (SMD = −0.278, p = 0.010) and depression (SMD = −0.604, p = 0.016). Third‐wave CBT for diabetes‐related distress significantly reduced anxiety (SMD = −0.451, p = 0.034). No significant effect of either intervention on glycated haemoglobin was observed. CBT interventions that included a digital component, were delivered by a psychological practitioner, and included behavioural activation bolstered the effects on diabetes‐related distress. Conclusions: CBT aiming to target diabetes‐related distress is beneficial for distress and depression. Third‐wave CBT for diabetes‐related distress is beneficial for anxiety. More work is needed to optimise interventions to improve both mental and physical health outcomes in people with diabetes. [ABSTRACT FROM AUTHOR]

Objective: Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self‐efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self‐efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self‐efficacy at 12‐ and 18‐months post‐diagnosis. Research design and methods: One hundred fifty‐seven primary caregivers (91.7% female, 62.2% White, Non‐Hispanic) of young children (Mage = 4.47 ± 1.65 years, 54.8% female, 60% White, Non‐Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self‐reported on their diabetes self‐efficacy, depressive symptoms, and stress and at baseline (Mdays since diagnosis = 29) and on parent diabetes self‐efficacy again 12‐ and 18‐months post‐diagnosis. Results: Parent diabetes self‐efficacy significantly improved from baseline to 12‐months and 18‐months post‐diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self‐efficacy 12‐ and 18‐months post‐diagnosis compared to parents with normal levels of depressive symptoms and stress. Conclusions: Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self‐efficacy and ultimately support the management of their child's diabetes. [ABSTRACT FROM AUTHOR]

Background: Diabetes has been recognized as a major comorbidity for COVID‐19 severity in adults. This study aimed to characterize the clinical outcomes and risk factors for COVID‐19‐related death in a large cohort of hospitalized pediatric patients with diabetes. Methods: We performed an analysis of all pediatric patients with diabetes and COVID‐19 registered in SIVEP‐Gripe, a Brazilian nationwide surveillance database, between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function. Results: Among 21,591 hospitalized pediatric patients with COVID‐19, 379 (1.8%) had diabetes. Overall, children and adolescents with diabetes had a higher prevalence of ICU admission (46.6% vs. 26%), invasive ventilation (16.9% vs. 10.3%), and death (15% vs. 7.6%) (all P < 0.0001). Children with diabetes had twice the hazard of death compared with pediatric patients without diabetes (Hazard ratio [HR] = 2.0, 95% CI, 1.58–2.66). Among children with diabetes, four covariates were independently associated with the primary outcome, living in the poorest regions of the country (Northeast, HR, 2.17, 95% CI 1.18–4.01, and North, (HR 4.0, 95% CI 1.79–8.94), oxygen saturation < 95% at admission (HR 2.97, 95% CI 1.64–5.36), presence of kidney disorders (HR 3.39, 95% CI 1.42–8.09), and presence of obesity (HR 3.77, 95% CI 1.83–7.76). Conclusion: Children and adolescents with diabetes had a higher risk of death compared with patients without diabetes. The higher risk of death was associated with clinical and socioeconomic factors. [ABSTRACT FROM AUTHOR]

This study used mixed methods to investigate the experiences of 33 participants who are blind (PWB) and have diabetes in managing their diabetes, support (or lack thereof) from their health care providers, and diabetes distress as PWB. Participants most frequently reported barriers to check blood glucose (55%), maintaining a healthy diet (45%), and distress due to their intersectional status of having blindness and diabetes. Those who mentioned intersectional distress of managing diabetes as a PWB tended to be Braille illiterate and less likely to use mobility tools that are symbolic of blindness (e.g., white cane, guide dog). These results illuminate heterogenous characteristics of PWB with diabetes, an understudied population of public health significance, to be considered when setting priorities for diabetes self-management support and health care coverage policy. [ABSTRACT FROM AUTHOR]

Objectives: Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care. Methods: Cross-sectional data from 157 people with diabetes aged between 12 and 68 years were collected. Of the 157, 59% were people with type 1 diabetes and 37% with type 2 diabetes. About 4% had missing information in their record but had either type 1 or type 2 diabetes. Coping styles were measured using the Brief Version of the Coping Orientation to Problems Experienced (Brief COPE), diabetes specific-distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale. Results: Data showed that adaptive coping strategies such as religious coping, acceptance among others, were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies e.g., self-blame and self-distraction were related to increased diabetes specific-distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care. Conclusion: There is need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life. [ABSTRACT FROM AUTHOR]

Objectives This study examines total life expectancies (TLEs) for both healthy and diabetic U.S.-born populations and 2 measures capturing quality of life: (a) the proportion of remaining life to be spent without either other chronic conditions or activities of daily living disabilities (ADLs) and (b) the proportion of remaining life to be spent with ADLs for U.S.-born diabetic populations by race/ethnicity and educational attainment. Methods Using the 1998–2014 waves of the Health and Retirement Study (n = 16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables. Results TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex–race combinations and from 5.6 to 9.2 years across sex–education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower. Discussion The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals. [ABSTRACT FROM AUTHOR]

Diabetes-related distress differs from depression as it develops from the mental and emotional burden that comes from the constant management of diabetes. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. In order to potentially encourage providers to implement the 17-item Diabetes Distress Scale (DDS-17) into practice and clinic appointments with patients, the authors researched and analysed results from voluntary and anonymous participants with diabetes, aged 18 years and older, who completed demographic survey questions and the DDS-17. The results revealed that areas of statistically significant distress can be found in people recently diagnosed with diabetes and occurs more often in those with type 1 diabetes compared with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes mellitus is a chronic systemic disease with a high morbidity and mortality rate. As it can affect several organs and systems, diabetes mellitus has a negative impact on the quality of life of its patients. The aim of the study was to demonstrate which domains of quality of life are impacted by diabetes mellitus. A cross-sectional study was carried out with 111 people with diabetes mellitus. The Brazilian version of the Medical Outcome Survey Short-Form 36 (SF-36) questionnaire was used to assess quality of life. The data were submitted to descriptive statistical analysis. Most of the sample was female (61.3%) and the mean age was 53.2±16.8 years. The greatest impairment was observed in the pain domain, with a score of 35.8±22.8. The functional capacity domain presented the least impairment, with a mean score of 60.8±31.5. Thus, pain was the domain with the most impact on the lives of individuals with diabetes mellitus, while functional capacity showed the least impairment. Scores in all domains were below the normative values for the Brazilian population. [ABSTRACT FROM AUTHOR]

Aim: Group-based programs have the potential to help patients manage their diabetes and prevent complications. However, participant retention has been identified as one of the major issues hampering these programs. Previous empirical studies have identified factors related to retention, such as age and body mass index. However, there has been little investigation on the factors that contribute to retention in group-based diabetes programs. This study explored the perspectives of diabetes program educators on the factors that lead to participant retention in group-based diabetes programs. Methods: A qualitative multiple case study design was employed to understand retention factors across six purposefully selected group-based diabetes programs. Diabetes educators participated in a one-time, in-depth, semi-structured phone interview. Data was analyzed inductively using within and cross-case thematic analysis. Results: Four major themes were identified that impact retention in these programs, including individual factors, logistical factors, social factors, and program factors. Conclusion: The findings of this study shed insight on the factors impacting participant retention across group-based diabetes programs. These findings have the potential to inform diabetes educators on how to improve retention in ongoing or future diabetes programs. [ABSTRACT FROM AUTHOR]

Objective: This study compared the recall and precision of MeSH-term versus text-word searching to better understand psychosocial MeSH terms and to provide guidance on whether to include both strategies in an information literacy session or how much time should be spent on teaching each search strategy. Methods: Using the relevant recall method, a total of 3,162 resources were considered and evaluated to form a gold standard set of 1,521 relevant resources. We compared resources discussing psychosocial aspects of children and adolescents living with type 1 diabetes using two search strategies: text-word strategy versus MeSH-term strategy. The frequency of MeSH terms, the MeSH hierarchy, and elements of each search strategy were also examined. Results: Using the 1,521 relevant articles, we found that the text-word search strategy had 54% recall, while the MeSHterm strategy had 75% recall. Also, the precision of the text-word strategy was 34.4%, while the precision of the MeSHterm strategy was 47.7%. Therefore, the MeSH-term search strategy yielded both greater recall and greater precision. The MeSH strategy was also more complicated in design and usage than the text-word strategy. Conclusions: This study demonstrates the effectiveness of text-word and MeSH search strategies on precision and recall. The combination of text-word and MeSH strategies is recommended to achieve the most comprehensive results. These results support the idea that MeSH or a similar controlled vocabulary should be taught to experienced and knowledgeable students and practitioners who require a myriad of resources for their literature searches. [ABSTRACT FROM AUTHOR]

Background: Global COVID-19 outbreak has been such a stressful experience for most of the people. Using a web-based cross-sectional study, we aimed to evaluate the acute stress response, depression, and anxiety in patients with diabetes mellitus (DM) during the COVID-19 pandemic, and to examine the effect of these psychiatric problems on diet habits and glycemic controls of patients. Methods: This web-based survey of COVID-19 was sent to the patients through the Whatsapp platform. All participants reported their demographic data, diabetes-related information, changes in self-monitoring blood glucose measurements, physical parameters, and eating habits after COVID-19, then completed Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale, Revised (IES-R) questionnaires which assessed acute stress sypmtoms, anxiety, and depression. Results: Three hundred and four patients with DM [(141 type 1 DM (T1D) and 163 type 2 (T2D)] were included in the study. In our study, female gender, higher BMI and weight, decreased in financial income after outbreak, presence of diabetic complications and comorbid diseases (i.e., retinopathy, neuropathy, diabetic foot, hypertension, dyslipidemia), worsened glycemic levels, increased carbohydrate consumption, and snacking were associated with higher anxiety and depression scores. Depression was higher in patients with T2D and duration of illness was correlated with acute stress level. Conclusions: It is important to be aware of the possibility of acute stress, depression, and anxiety after pandemic in patients with DM whose glycemic control is impaired. Psychological problems should not be ignored beyond physical inactivity and worsening eating habits. [ABSTRACT FROM AUTHOR]

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes. Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses. Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants. Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is one of the most common and expensive endocrine diseases in the world. The age of onset in Iran is 10-15 years younger than the average age of onset in developed countries. Some measures have been adopted to identify the main risk factors and the national response to diabetes in numerous countries to prevent and control this disease. This study aimed to compare the main risk factors and national response to diabetes in selected countries. Materials and Methods: This comparative review study evaluated six countries, including Iran, India, China, Germany, Canada, and Somalia. Required information (i.e., demographic information, statistical information, main risk factors, and dimensions of the national response to diabetes) was obtained from official and credible databases and sites. Results: Based on the find, three factors, including obesity, overweight, and physical inactivity were identified as the main risk factors for diabetes in the selected countries. It was revealed that these countries have partially or fully implemented the national response to diabetes. Conclusion: The multifaceted nature of diabetes requires the provision of multi-dimensional solutions to reduce the burden of the disease via controlling the main risk factors. Lifestyle modification should not only be limited to education and promotion of nutrition and physical activity but also include modifications in methods, attitudes, and cultural, social, and economic values. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study explored the possibility of a common health-related stigma reduction intervention among people living with HIV, leprosy, schizophrenia and diabetes in Indonesia by assessing their perspectives towards others with the same (within group) and different health conditions (across groups), and willingness to participate in such a program. This mixed-methods study was conducted in West Java, Indonesia between March and June 2018. Eighty participants completed a survey with social distance scale (SDS), while 12 focus group discussion were conducted. Participants with HIV, leprosy and diabetes reported lower within-group SDS scores (4.14 ± 3.65; 4.25 ± 3.95; 7.23 ± 5.31, respectively) while those with schizophrenia reported the highest within-group SDS score (7.76 ± 4.63). Participants with diabetes reported a twofold higher across-group SDS score towards people with the other three health conditions (p < 0.05). The qualitative findings showed that the perception of participants towards one another was shaped by knowledge, understanding and relatedness to the experience of living with health-related stigma. Overall, participants supported the idea of a common stigma reduction intervention for different health conditions, but recommended step-wise implementation of such interventions. Accordingly, this study recommends piloting a common stigma reduction intervention with special focus on fostering understanding, awareness and empathy between people living with different health conditions. [ABSTRACT FROM AUTHOR]

Objective: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person's motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior. Materials and Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed. Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons. Conclusion: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM. [ABSTRACT FROM AUTHOR]

The article proposes the need to eliminate discrimination against people with chronic diseases and disabilities. Topics mentioned include a description of examples of ignorance on the health of people with diabetes, some techniques to address people with disabilities in the workplace, and the need to apprehend offenders of discrimination and accept the differences in all kinds of people.

Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress. [ABSTRACT FROM AUTHOR]

The article presents Proceedings of 20th ISPAD science school for physicians 2021. Topics discussed include Qualitative research is divided into three subtypes: ethnographic, phenomenological, and grounded theory. Though qualitative research is less commonly used in medicine; and the prevalence of childhood obesity is rising around the world. Although this has mainly been attributed to higher caloric intake and lifestyle changes during previous decades.

Depression is common among individuals with diabetes and contributes to poorer prognoses. Optimism is associated with enhanced mental health. Therefore, this study tested whether optimism buffered against increases in depressive symptoms following a diabetes diagnosis. Participants were drawn from the Health and Retirement Study (n = 328, Mage = 65.8). Optimism, assessed before diagnosis, was inversely associated with depressive symptoms within 2 (B = −.30, p =.004, Δ R 2 =.02) and 6 (B = −.29, p =.008, Δ R 2 =.02) years of a diabetes diagnosis. Results suggest that optimism is a protective factor for comorbid depressive symptoms. [ABSTRACT FROM AUTHOR]

The article presents the highlights of the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2020 conference. Topics include the progression of type 1 diabetes (T1D) through stages, the prevention strategies for diabetes, and the advances in diabetes technology like continuous glucose monitors (CGM), insulin pumps, and smart pens.

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a prevalent chronic worldwide disease, and sexual dysfunction is a common complication of this disease. Diabetes and its disabling complications often threaten sexual life. Despite the critical role of the psychosocial and cultural issues in the quality of sexual life in women with diabetes, these aspects have not yet been adequately addressed. This study aimed to explore the psychosocial and cultural aspects of the sexual life quality of women with diabetes in reproductive ages. Purposeful sampling was performed in two diabetes clinics and three physicians' offices in Tehran. After 29 In-depth interviews (25 women with diabetes and four key informants), data saturation was achieved. The qualitative content analysis method by Granheim and Lundman was used for data analysis, and consequently, two themes emerged. The first theme, "The dominant role of sociocultural context," consisted of two categories: "The influence of diabetes stigma on sexual identity" and "preferred silence." The second theme was "The burden of psychological distress on sexual life," which included three categories: "diabetes distress," "distress regarding social and health services unmet needs," and "stress management ability." Preferred silence to sexual problems was identified as the dominant sexual coping strategy of Iranian women with diabetes. This identification is an achievement of this study regarding the first theme. Thus, screening the quality of sexual life in women with diabetes is suggested. According to the second theme, psychological, sexual, and family planning health care integrated with medical diabetes care in diabetes clinics is recommended. [ABSTRACT FROM AUTHOR]

Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions. [ABSTRACT FROM AUTHOR]

Importance: Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown.Objective: To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension.Design, Setting, and Participants: Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018).Interventions: An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima).Main Outcomes and Measures: The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months.Results: Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant.Conclusions and Relevance: In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months.Trial Registration: ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima). [ABSTRACT FROM AUTHOR]

Aims: To evaluate the relationship between newly diagnosed diabetes or prediabetes and depressive symptoms among individuals with risk factors for diabetes in China. We also investigated the associations of depressive symptoms with pancreatic β‐cell function and insulin resistance. Methods: We used cross‐sectional data from the Shanghai High‐Risk Diabetic Screen (SHiDS) project. Between 2014 and 2017, a total of 1728 participants were enrolled in this study and underwent an oral glucose tolerance test to screen for diabetes and prediabetes. Insulin resistance was evaluated using the homeostatic model assessment of insulin resistance and the modified Matsuda index. Pancreatic β‐cell function was calculated using the homeostatic model assessment of β‐cell function, Stumvoll first‐ and second‐phase indexes. Elevated depressive symptoms were determined using the Patient Health Questionnaire‐9 (PHQ‐9 score ≥ 10). Results: The prevalence of elevated depressive symptoms in the total study population was 4.8% (83 of 1728). Compared with the normal glucose tolerance group, individuals with newly diagnosed diabetes were less likely to have elevated depressive symptoms even after controlling for potential confounders [adjusted odds ratio (OR) 0.35, 95% confidence interval (CI) 0.18–0.68; P = 0.002]. However, prediabetes was not associated with depressive symptoms. The odds for elevated depressive symptoms were increased in individuals with higher levels of the Stumvoll first‐phase index. No association was observed between depressive symptoms and insulin resistance. Conclusion: Elevated depressive symptoms were less prevalent in Chinese individuals with newly diagnosed diabetes among a high‐risk population for diabetes. [ABSTRACT FROM AUTHOR]

Background. Diabetes mellitus (DM) is currently not curable but controllable and must be managed. Family support has been stated as a vital component in successful control of DM and the strongest determinant of adherence to diet therapy in DM patients. Objectives. The study was conducted to examine social support and its relationship with practicing self-care behavior in patients with DM in Mashhad. Material and methods. In this analytical cross-sectional study, 400 patients with DM were selected over two months from DM clinics in Mashhad using the census sampling method. Data was collected using demographic information, social support and self-care questionnaires. Data analysis was done in SPSS 21 using the statistical Spearman’s rank correlation coefficient, t-Test and analysis of variance. Results. The results indicated a significant relationship between the social support and self-care behavior of DM patients (p = 0.031). This means that social support is an effective factor in practicing self-care behaviors. Moreover, the results indicated that most of the samples had moderate social support and self-care behavior. There was a significant relationship between self-care and health literacy in the study (p = 0.026): individuals with higher health literacy had better self-care. There was a significant relationship between education and monthly income with self-care behaviors and support of the individuals (p = 0.001). Conclusions. Individuals with better social support have adhered to DM self-care behaviors, and adhering to self-care behaviors has led to blood sugar control and prevention of adverse effects. Furthermore, patient support and participation in self-care enable them to take the next step for better management of the disease and prevention of future adverse effects. [ABSTRACT FROM AUTHOR]

Historically, diabetes identity has been examined at the individual level as it relates to clinical outcomes and self-management practices. Yet, identity is not experienced as an individually isolated phenomenon. The purpose of this study is twofold: (a) examine the social meaning of diabetes identity and (b) formulate a theoretical model of diabetes identity through a sociopolitical lens. Adults living with diabetes engaged in a diabetes online community (N = 20) participated in a 60-minute semi-structured interview focused on social diabetes experiences and diabetes identity. Seven themes emerged related to illness, individuation, and culture, resulting in a novel theoretical model of diabetes identity: willingness to identify, tales of the un-sick, legends of the responsible, a tradition of change-making, sense of sameness, mystification of difference, and diabetes as a unifying social category. Our study extends previous literature focused on self-management practices and compliance, resulting in a theoretical model of diabetes identity centered around social change. [ABSTRACT FROM AUTHOR]

Context: Lacunar strokes and diabetes are risk factors for cognitive dysfunction. Elucidating modifiable risk factors for cognitive dysfunction has great public health implications. One factor may be glycemic status, as measured by glycated hemoglobin (A1c).Objective: The aim of this study was to assess the relationship between A1c and cognitive function in lacunar stroke patients with diabetes.Methods: The effect of baseline and follow-up A1c on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range, 1-5) was examined in 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov No. NCT00059306).Results: Every 1% higher baseline A1c was associated with a 0.06 lower standardized CASI z score (95% CI, -0.101 to -0.018). Higher baseline A1c values were associated with lower CASI z scores over time (P for interaction = .037). A 1% increase in A1c over time corresponded with a CASI score decrease of 0.021 (95% CI, -0.0043 to -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, body mass index, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy insulin use, and white-matter abnormalities.Conclusion: This analysis of lacunar stroke patients with diabetes demonstrates a relationship between A1c and change in cognitive scores over time. Intervention studies are needed to delineate whether better glucose control could slow the rate of cognitive decline in this high-risk population. [ABSTRACT FROM AUTHOR]

Introduction: Public stigma is one of the important consequences of living with diabetes. The present study aimed to compare and assess diabetes-related public stigma and diabetes knowledge of first and seventh-semester undergraduate students. Materials and Methods: In this cross-sectional descriptive-analytical study, first and seventh- semester undergraduate students of Shahrekord University of Medical Sciences in the first semester of 209 were selected by random sampling. All volunteered students who returned the study consent form completed three questionnaires, including demographic characteristics, diabetes-related public stigma, and diabetes knowledge. A number of 16 experts assessed the face and content validity of questionnaires after translation and back translation. Content validity ratio was estimated at 0.64 for both questionnaires, while content validity indices of 0.87, and 0.88 were calculated for diabetes knowledge and diabetes-related public stigma, respectively. The results were analyzed in SPSS statistical software (version 24). Results: A total of 106 first-semester students participated in the study, the majority of whom (64.2%) were female. Moreover, 106 seventh-semester students participated in the study, the majority of whom (67.9%) were female. The mean scores of knowledge and stigma in first semester students were obtained at 11.23 (0.36) and 8.19 (0.53), respectively, and in seventh-semester students, these scores were reported as 13.97 (0.42) and 8.83 (0.56), respectively. Conclusion: As evidenced by the obtained results, seventh-semester students scored higher in the diabetes knowledge questionnaire, as compared to first-semester students. Nevertheless, the public stigma scores of the two groups were not significantly different. These findings suggested that knowledge improvements alone cannot contribute to stigma changes, and multidimensional interventions may be needed to overcome diabetes-related stigma. [ABSTRACT FROM AUTHOR]

Objective: Describe the social representations of Diabetes Mellitus for diabetic individuals and for health professionals who assist these patients. Methods: Descriptive study, exploratory, with qualitative approach, in the light of the Theory of Social Representations by Serge Moscovici. Developed from a semi-structured document divided into demographic profile and issues facing the object of research through evocation of words. The sample was composed by 14 people, among patients and health professionals present in the Lesions Outpatient Clinic from a public hospital, in the city of Recife -- PE. Results: The group of patients related to disease with words of emotional nature as fear/sadness, but the professionals have raised more technical words and aimed at the control and prevention of the disease. Conclusion: The level of knowledge is directly connected to the representativeness of the disease for the individual, interfering in the therapeutic adhesion and hindering the acceptance of the condition, resulting in more grievances physical or psychological. [ABSTRACT FROM AUTHOR]

Communal coping occurs when relationship partners view a stressful health problem as "ours," rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we‐talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we‐ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap‐Up), described here in manual‐like detail. [ABSTRACT FROM AUTHOR]

Childhood diabetes is a rising concern as the overall annual increase in diabetes among children/adolescents is estimated to be around 3% over the past decade. Diabetes management places children/adolescents and their parents at greater risks of psychological distress. This study aims to measure the levels of diabetes-related emotional distress in children/adolescents with diabetes and their caregiving parents and to identify associations between sociodemographic characteristics and clinical variables in Singapore. A cross-sectional study was conducted using validated questionnaires. Ninety-two parent–child/adolescent dyads completed self-reported questionnaires. Elevated levels of diabetes-related distress were found in both children/adolescents with diabetes and their parents. Female children/adolescents with diabetes, low-income households, and less-educated parents of children/adolescents with diabetes were more susceptible to diabetes-related distress. It is important for healthcare professionals to educate less-educated parents in the management of their children's/adolescents' diabetes. Greater financial assistance should be provided to low-income households that may not have access to advanced diabetes treatments. [ABSTRACT FROM AUTHOR]

Diabetes, a serious disease resulting in significant morbidity and early mortality, is currently on the rise globally. A major contributor to this observed increase in low- and middle-income countries, such as South Africa, has been the observed change in diet at the population level—a shift from a traditional diet, to one consisting of more energy-dense, processed foods, with more added sugar, salt and fat. Implicated in this degradation of diet are changing local food environments. Participant-generated digital photographs and facilitated focus group discussion-style workshops were utilized to better understand diabetic community members' perspectives on their food environments in both an urban and rural setting in South Africa, and what (and how) aspects of these physical environments influence their food acquisition behaviours and diet. Qualitative data were analysed using a deductive thematic analysis approach. The resulting predominant themes of accessibility, availability and affordability are outlined and discussed. Findings from this study have implications beyond the self-management of diabetes and extend to the self-management and reduction of all diet-related non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background: There is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes. The study aims are (i) to identify the frequency and valence of thoughts about health in people with diabetes mellitus using questions based on the day reconstruction method (DRM) and (ii) to analyse associations between thoughts about health and health-related quality of life (HRQoL), diabetes-related distress and depressive symptoms.Methods: Cross-sectional study of a random sample of a German statutory health insurance population with diabetes aged between 18 and 80 linking questionnaire and claims data. Associations between frequency and valence of thoughts about health on a previous day and HRQoL assessed by a 12-Item Short-Form Health Survey, diabetes-related distress assessed using the Problem Areas in Diabetes scale and depressive symptoms assessed by Patient Health Questionnaire-9 were analysed using linear and logistic regression analysis, adjusting for sociodemographic and clinical characteristics.Results: Thoughts about health were analysed in 726 participants (86% type 2 diabetes, 62% male, mean age 67.6 ± 9.7 years). A total of 46% had not thought about their health the day before, 17.1% reported low frequency and negative thoughts, 21.4% low frequency and positive thoughts, 12.1% high frequency and negative thoughts and 3.4% high frequency and positive thoughts. The presence of thoughts about health irrespective of their frequency and valence is associated with a lower physical and mental component summary score of the 12-Item Short-Form Health Survey. Negative thoughts are associated with high diabetes-related distress. Frequent or negative thoughts are associated with depressive symptoms.Conclusions: Thoughts about health are a part of everyday life for a substantial number of people with diabetes. Surprisingly, even positive thoughts are associated with poorer HRQoL in our study. Further research within the DRM paradigm is needed to understand how thoughts about health may affect people's (assessment of) state of health. Thoughts about health should be considered in diabetes education and patient counselling with a view to preventing and treating emotional disorders. More attention should be paid to the outcomes of interventions that may themselves lead to an increase in the frequency of thoughts about health. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is a chronic, metabolic, and progressive disease that can lead to physiological and psychological disorders, such as increased blood glucose and emotional behavioral disorders, and results in poor quality of life. Therefore, the present study aimed to determine the effect of self-care education on blood glucose, diabetic quality of life, and emotional/behavioral disorders in adolescents with diabetes. Materials and Methods: This was a semi-experimental study with a pretest, posttest, and follow-up design and experimental and control groups. The study population consisted of an adolescent diabetic member of the Tehran Diabetes Association in 2019. In total, 30 diabetic adolescents were selected using a simple random sampling method from among members of the Tehran Diabetes Association and were randomly divided into experimental (n=15) and control (n=15) groups. The experimental group received self-care education for 10 sessions of 45 minutes (two sessions per week) and the control group did not receive any education. Data were collected through blood glucose test, diabetes quality-of-life questionnaire, and emotional behavioral disorders scale and analyzed using repeated measures and Bonferroni post-hoc test in SPSS software (version 21). Results: Based on the obtained results, a significant difference was observed between the experimental and control groups in terms of blood glucose, diabetic quality of life, and externalizing disorders (P<0.001). However, no significant difference was observed in terms of internalizing disorders (P>0.05). In the other words, self-care education led to a decrease in blood glucose and externalizing disorders and increased quality of diabetic life in adolescents with diabetes. The results remained consistent in the follow-up stage (P<0.001). Conclusion: The results revealed the effect of self-care education on improving blood glucose, diabetic quality of life, and externalizing disorders in adolescents with diabetes. The results remained consistent in the followup phase. Therefore, health professionals can use self-care education to improve health-related problems, especially decreased blood glucose, externalizing disorders, and diabetic quality of life. [ABSTRACT FROM AUTHOR]

National reports of diabetes and mental health for Native Hawaiian and Pacific Islanders (NHPI) are high, yet mental health professional access is low. We used multiple logistic regression to analyze data from the 2014 NHPI National Health Interview Survey. We evaluated the association between diabetes and serious psychological distress, and the interaction effect of mental health professional utilization among 2,587 adults. Self-reported diabetes was positively associated with serious psychological distress, but mental health professional utilization did not affect this association. Stigma and measurement gaps may influence self-report and measurement of mental health symptomatology, suggesting the need for culturally grounded approaches. [ABSTRACT FROM AUTHOR]

Background: Dementia has become a public health priority as the number of cases continues to grow worldwide.Objective: To assess dementia incidence and determinants in the EPIC-Spain Dementia Cohort.Methods: 25,015 participants (57% women) were recruited from three Spanish regions between 1992-1996 and followed-up for over 20 years. Incident cases were ascertained through individual revision of medical records of potential cases. Crude and age-adjusted incidence rates (IR) of dementia and sub-types (Alzheimer's disease (AD), and non-AD) were calculated by sex. Neelson-Aalen cumulative incidence estimates at 10, 15, and 20 years were obtained for each sex and age group. Multivariate Royston-Parmar models were used to assess independent determinants.Results: Global IR were higher in women for dementia and AD, and similar by sex for non-AD. IR ranged from 0.09 cases of dementia (95% confidence interval: 0.06-0.13) and 0.05 (0.03-0.09) of AD per 1000 person-years (py) in participants below 60 years, to 23.2 (15.9-33.8) cases of dementia and 14.6 (9.1-33.5) of AD (per 1000 py) in those ≥85 years. Adjusted IR were consistently higher in women than men for overall dementia and AD. Up to 12.5% of women and 9.1% of men 60-65 years-old developed dementia within 20 years. Low education, diabetes, and hyperlipidemia were the main independent predictors of dementia risk, whereas alcohol showed an inverse association.Conclusion: Dementia incidence increased with age and was higher among women, but showed no geographical pattern. Dementia risk was higher among subjects with lower education, not drinking alcohol, and presenting cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: Dementia has no known cure and age is its strongest predictor. Given that populations in the Caribbean are aging, a focus on policies and programs that reduce the risk of dementia and its risk factors is required.Objective: To estimate the proportion of dementia in the Jamaican setting attributable to key factors.Methods: We analyzed the contribution of five modifiable risk factors to dementia prevalence in Jamaica using a modified Levin's Attributable Risk formula (low educational attainment, diabetes, smoking status, depression, and physical inactivity). Four sources of data were used: risk factor prevalence was obtained from the Jamaica Health and Lifestyle Survey, 2008, relative risk data were sourced from published meta-analyses, shared variance among risk factors was determined using cross-sectional data from the Health and Social Status of Older Persons in Jamaica Study. Estimated future prevalence of dementia in Jamaica was sourced from a published ADI/BUPA report which focused on dementia in the Americas. We computed the number of dementia cases attributable to each risk factor and estimated the effect of a reduction in these risk factors on future dementia prevalence.Results: Accounting for the overlapping of risk factors, 34.46% of dementia cases in Jamaica (6548 cases) were attributable to the five risk factors under study. We determined that if each risk factor were to be reduced by 5% -10% per decade from 2010-2050, dementia prevalence could be reduced by up to 14.0%.Conclusion: As the risk factors for dementia are shared with several of the main causes of death in Jamaica, a reduction in risk factors by even 5% can result in considerable public health benefit. [ABSTRACT FROM AUTHOR]