Sexual Dysfunction among Latino men and women with poorly controlled diabetes

Latinos are the largest minority population in the United States and are diagnosed with diabetes at nearly twice the rate of non-Hispanic whites. Latinos not only suffer disproportionately from diabetes but also from diabetes related complications, including sexual dysfunction. Much of the existing literature on sexual dysfunction among Latinos with diabetes has focused on erectile dysfunction (ED). There is a dearth of information on sexual functioning among Latina women with diabetes or information on both genders in other sexual domains. Our study examined the prevalence of sexual dysfunction among a cohort of 106 poorly controlled Latino diabetics in South Florida who participated in the Miami Healthy Heart Initiative, an NIH/NLBI sponsored clinical trial addressing diabetes management among Latinos. We explored gender differences in various domains of sexual health and examined the role of poor glycemic control and depression on sexual dysfunction. A large proportion of both genders in our sample met the criteria for sexual dysfunction though females exhibited a greater prevalence than males. Depression affected more than one third of our sample, but we did not find any significant associations between sexual dysfunction and depression. We also did not find a linear correlation between glycemic control and sexual dysfunction. We concluded that interventions are needed to address high rates of sexual dysfunction among Latinos with diabetes with particular emphasis on Latina women, who were much more likely than men to report problems with desire and other areas of sexual functioning. Until effective pharmacologic agents to improve desire among women with diabetes become available, clinicians caring for this population should consider behavioral approaches that may limit the impact of sexual dysfunction

Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes

BACKGROUND: Type 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited. METHODS: The Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A(1c) (HbA(1c)) ≥8.0% were recruited from Miami-Dade’s public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA(1c). Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake. DISCUSSION: The Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities

Acceptability and Feasibility of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening

Objectives: Women in safety-net institutions are less likely to receive cervical cancer screening. Human papilloma virus (HPV) self-sampling is an alternative method of cervical cancer screening. We examine the acceptability and feasibility of HPV self-sampling among patients and clinic staff in two safety-net clinics in Miami. Materials and Methods: Haitian and Latina women aged 30–65 years with no Pap smear in the past 3 years were recruited. Women were offered HPV self-sampling or traditional Pap smear screening. The acceptability of HPV self-sampling among patients and clinic staff was assessed. If traditional screening was preferred the medical record was reviewed. Results: A total of 180 women were recruited (134 Latinas and 46 Haitian). HPV self-sampling was selected by 67% women. Among those selecting traditional screening, 22% were not screened 5 months postrecruitment. Over 80% of women agreed HPV self-sampling was faster, more private, easy to use, and would prefer to use again. Among clinic staff, 80% agreed they would be willing to incorporate HPV self-sampling into practice. Conclusions: HPV self-sampling was both acceptable and feasible to participants and clinic staff and may help overcome barriers to screening

Community Health Workers, Access to Care, and Service Utilization Among Florida Latinos: A Randomized Controlled Trial

To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes. We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records. Participants randomized to the community health worker intervention self-reported fewer problems accessing needed care and prescriptions than did those in the usual care group (30% vs 43% and 28% vs 41%, respectively; P < .05 for both). Adjusting for age, gender, education, depression, and comorbidities showed similar results (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.93 and OR = 0.45; CI = 0.24, 0.82, respectively). We found no significant utilization differences in primary care visits, emergency department utilization, or hospitalization between the 2 groups. Among Latinos with poorly controlled diabetes, a 1-year community health worker intervention was associated with improvements in self-reported access to care but not service utilization

A profile of Latinos with poorly controlled diabetes in South Florida

Introduction: Latinos are the largest minority group in the United States and diabetes or pre-diabetes affects more than 70% of Latinos aged 45 years and older. Miami-Dade County is home to one of the highest populations of diverse Latinos. In this descriptive manuscript, we present baseline characteristics of participants enrolled in the Miami Healthy Heart Initiative (MHHI). This was a study conducted to determine the effects of a community health worker (CHW) intervention among Latinos with poorly controlled diabetes in South Florida. Methods: We recruited 300 diverse Latino adults with suboptimal diabetes outcomes (HbA1c≥8) into MHHI. This randomized control trial examined the impact of a 1-year CHW-led intervention on glycemic control, blood pressure, and cholesterol levels. At baseline, physiologic measures, including HbA1c, LDL, blood pressure, and BMI, were assessed. Data on socio-demographic characteristics and additional determinants of health such as depression status, provider communication, diet, exercise, cigarette smoking, readiness to change diabetes management behaviors (stages of change), and confidence in ability to improve diabetes self-care (self-efficacy) were collected. Results: Participants came from 20 different countries, with Cuban Americans representing 38% of the sample. Most had lived in the US for more than 10 years, had completed at least 12 years of school, and had high levels of health literacy, yet 48% had very low acculturation. Nearly 80% had poor self-efficacy, 80% met the criteria for depression, and 83% were not adherent to their medications. More than half the population was not at their target for blood pressure, 50% were above the recommended LDL goal, and most were obese. Conclusion: In a diverse population of Latinos with poorly controlled diabetes in Miami, we found high rates of depression, obesity, medication non-adherence, poor self-efficacy, and provider communication. These may contribute to poor diabetes control, high blood pressure, and elevated cholesterol

Community Health Workers, Access to Care, and Service Utilization Among Florida Latinos: A Randomized Controlled Trial.

OBJECTIVES: To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes. METHODS: We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records. RESULTS: Participants randomized to the community health worker intervention self-reported fewer problems accessing needed care and prescriptions than did those in the usual care group (30% vs 43% and 28% vs 41%, respectively; P \u3c .05 for both). Adjusting for age, gender, education, depression, and comorbidities showed similar results (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.93 and OR = 0.45; CI = 0.24, 0.82, respectively). We found no significant utilization differences in primary care visits, emergency department utilization, or hospitalization between the 2 groups. CONCLUSIONS: Among Latinos with poorly controlled diabetes, a 1-year community health worker intervention was associated with improvements in self-reported access to care but not service utilization