Effect of Nutrition Intervention on the Outcomes of Pregnancy: A Rural Urban Comparison

The present study examines the effect of nutritional intervention on two outcomes of pregnancy: birth weight of the baby and gestational age. The study further examines the difference in nutritional intervention in rural and urban areas. The research method used is ex-post facto design. Data for the study is extracted from the health records and tracking sheets of women participating in the Nutrition Intervention Project in Virginia Department of Health. Path analysis and effects analysis are used to analyze the causal and direct effect of the independent variables and each of the outcome variables. A model has been developed grounded on previous studies in order to test the path and effect of nutritional intervention on the two pregnancy outcomes. The results indicate that nutritional intervention has a positive influence on both birth weight and gestational age. However, the Intervention had a greater impact on birth weight than on gestational age. Effects analysis of birth weight and gestational age indicate that the causal effect operates both via intervening variables as well as directly between the nutritional intervention and the outcome variables. This increases our confidence in the present model. Path analysis indicate that the path from nutritional intervention to the pregnancy outcomes via health risk behaviors was strong; path from nutritional intervention to the pregnancy outcomes via nutrient intake and weight gain was weak; path from nutritional intervention to the pregnancy outcomes via health risk behaviors and weight gain was strong; path from nutritional intervention to the pregnancy outcomes via health risk behaviors, nutrient intake, and weight gain was nonexistent; path from nutritional intervention to the pregnancy outcomes via weight gain was the strongest

Community-based participatory research in diabetes prevention programs

Background: The purpose of this study was to determine how community-based diabetes prevention programs utilized the concept and contents of the Community Based Participatory Research approach.   Methods: Keyword search in PubMed and Scopus electronic databases from January 1, 2000, to December 31, 2019, was conducted to search and extract peer-reviewed articles that included words “Community-Based Participatory Research (CBPR)” and “diabetes mellitus” in the title, abstract or in the main article. The initial search yielded 1122 articles. After the final screening, a total of 67 articles were extracted for review.   Results: Findings suggested that an advisory board was used by most diabetes studies, especially for planning and reviewing the study protocol. However, they were not included in the data analysis and study result dissemination process. Furthermore, the majority of the studies that used CBPR were conducted in North America.   Conclusion: Partnership approach to research on community-based diabetes programs that equitably involves community members and researchers can benefit communities. This approach should also be widely adopted globally

Sociodemographic Correlates of Tobacco Consumption in Rural Gujarat, India

Background. The purpose of this study was to examine occupation-, education-, and gender-specific patterns of tobacco use and knowledge of its health effects among 23,953 rural Asian Indians ≥18 years in Gujarat. Methodology. A statewide, community-based, cross-sectional survey was conducted in 26 districts of Gujarat (December 2010–May 2015), using face-to-face interviews by trained community health workers called SEVAKS. Results. Mean age was 39.8 ± 15.2 years. Eighteen percent of respondents used tobacco in various forms. Tobacco consumption was significantly higher among males (32%), 18–34 years’ age group (35%), those who were self-employed (72%), and those with elementary education (40%). The prevalence was 11 times higher among males than females (95% CI = 9.78, 13.13). Adjusted ORs for tobacco use showed strong gradient by age and educational level; consumption was lower among the illiterates and higher for older participants (≥55 years). Tobacco consumption also varied by occupation; that is, those who were self-employed and employed for wages were more likely to use tobacco than those who were unemployed. Knowledge of health effects of tobacco lowered the odds of consumption by 30–40%. Conclusions. Effective educational programs should be tailored by gender, to improve knowledge of health risks and dispel myths on perceived benefits of tobacco

Perceptions of Diabetes Distress and Counseling During the Pandemic - Rural Provider Perspectives

Introduction West Virginia is an Appalachian rural state that ranks highest in the nation in the prevalence of diabetes (16.2%). The COVID-19 pandemic impacted routine diabetes care. As a result, individuals experienced diabetes distress over the physical and psychological burdens of diabetes management. In rural and medically underserved counties (71%), diabetes care is often provided by primary care physicians. However, healthcare providers’ perspectives on diabetes distress and related counseling to address them are unclear. This cross-sectional study’s objective was to explore healthcare providers’ (HCP) perspectives regarding their patient’s diabetes distress and how it guided their counseling for diabetes self-care during clinic visits. Methods Participants included 72 West Virginia Practice-Based Research Network members who completed an online survey in June 2021. However, only HCPs (physicians and advanced practice professionals, N=59) were included in the analysis. Data was collected using validated measures of diabetes distress, health literacy, and counseling for diabetes self-care. Results HCPs frequently evaluated their patients’ diabetes distress and health literacy levels to guide their conversations. Furthermore, HCPs perceived high diabetes distress (58.5%) in their patients during the pandemic and provided optimal counseling, especially for healthier diets and improved physical activity (98%). Multivariable logistic regression showed a significant reduction in diabetes distress with diabetes counseling. Results also showed HCPs were less likely (65%) to counsel for diet and 4.2 times more likely to counsel for exercise for patients with high diabetes distress. Conclusion Formal training of providers on the importance of assessing diabetes distress and tailoring their counseling can further improve diabetes management

The Humanistic and Economic Burden Associated with Anxiety and Depression among Adults with Comorbid Diabetes and Hypertension

We conducted a retrospective cross-sectional study to estimate the humanistic and economic burden associated with depression and anxiety among adults with comorbid diabetes and hypertension. Pooled data from the 2013 and 2015 Medical Expenditure Panel Survey were used to include adults (≥18 years old) who were alive and diagnosed with both diabetes and hypertension during the observation period. We assessed the humanistic burden with health-related quality of life (HRQoL) and economic burden with the total annual healthcare expenditures. Depending on the presence/absence of depression and anxiety, the study sample was divided into four groups (i.e., no depression/anxiety, depression only, anxiety only, and depression and anxiety). Multivariable regression analyses were used to evaluate the associations between the depression/anxiety categories and disease burden measures. The incremental burden associated with depression and/or anxiety was estimated with the counterfactual recycled prediction. Of the 4560 adults with comorbid diabetes and hypertension, 13.2% reported depression only, 8.7% reported anxiety only, and 7.7% reported both. Results from adjusted analyses indicated that the presence/absence of depression and anxiety was associated with significantly poorer HRQoL, especially on the mental component. Having either depression or anxiety corresponded to reduced mental component summary scores by more than four points. The reduction was as high as 10.35 points when both conditions occurred. Comparing to adults without depression or anxiety, the per-capital incremental annual healthcare expenditures were $4607 for the depression group,$2481 for the anxiety group, and $8709 for adults with both conditions. Furthermore, adults with depression and anxiety were 58% more likely to spend at least 10% of annual household income on healthcare as compared to those with neither the conditions. Our results highlight the needs for integrating cost-effective mental health services into diabetes management to improve the HRQoL and reduce healthcare costs for adults with comorbid diabetes and hypertension

Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States

Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs

Género y autocuidado de la diabetes mellitus tipo 2 en el Estado de México

La diabetes mellitus es un problema epidemiológico nacional poco tratado en los estudios de género. La obesidad, la inadecuada alimentación y el sedentarismo son factores de riesgo de esta patología que se diagnostica con mayor frecuencia a edades más tempranas, impactando en el equilibrio de las familias. Aunque esta enfermedad se presenta en ambos géneros, la prevalencia es más elevada en mujeres. Se realizó un estudio de diseño transversal con una muestra no probabilística de 239 personas de dos comunidades del Estado de México, a quienes previo consentimiento informado se aplicó un cuestionario para analizar el género como factor de riesgo para el autocuidado en diabetes mellitus tipo 2. El estudio da a conocer los factores no clínicos que pueden considerarse como diferenciales de género. La prevención considera aspectos educativos de autocuidado con un abordaje transdisciplinario e incorporando a la familia para el cuidado de la salud, por sus creencias, saberes y prácticas

Impact of rural versus urban geographic location on length of stay after carotid endarterectomy

Abstract Background: Reducing the incidence of extended length of stay (ELOS) after carotid endarterectomy (CEA), defined as LOS \u3e I day, is an important quality improvement focus of the Vascular Quality Initiative (VQI). Rural patients with geographic barriers pose a particular challenge for discharge and may have higher incidences of ELOS as a result. The purpose of this study was to examine the impact of patients’ home geographic location on ELOS after CEA. Methods: The VQI national database for CEA comprised the sample for analyses (N = 66,900). Rural-Urban Commuting Area (RUCA) codes, a validated system used to classify the nation’s census tracts according to rural and urban status, was applied to the VQI database and used to indicate patients’ home geographic location. LOS was categorized into two groups: LOS ≤ 1 day (66%) and LOS \u3e 1 day (ELOS) (34%). Multivariable logistic regression was conducted to examine the effect of geographic location on ELOS after adjustment for age, gender, race, and comorbid conditions. Results: A total of 66,900 patients were analyzed and the mean age of the sample was 70.5 ± 9.3 years (40% female). After adjustment for covariates, the urban group had increased risk for ELOS (OR = 1.20, p \u3c 0.001). Other factors that significantly increased risk for ELOS were non-White race/Latinx/Hispanic ethnicity (OR = 1.44, p \u3c 0.001) and nonelective status (OR =3.31, p \u3c 0.001). In addition, patients treated at centers with a greater percentage of urban patients had greater risk for ELOS (OR = 1.008, p \u3c 0.001). Conclusions: These analyses found that geographic location did impact LOS, but not in the hypothesized direction. Even with adjustment for comorbidities and other factors, patients from urban areas and centers with more urban patients were more likely to have ELOS after CEA. These findings suggest that other mechanisms, such as racial disparities, barriers in access to care, and disparities in support after discharge for urban patients may have a significant impact on LOS

The Effect of Adherence to Dietary Tracking on Weight Loss: Using HLM to Model Weight Loss over Time

The role of dietary tracking on weight loss remains unexplored despite being part of multiple diabetes and weight management programs. Hence, participants of the Diabetes Prevention and Management (DPM) program (12 months, 22 sessions) tracked their food intake for the duration of the study. A scatterplot of days tracked versus total weight loss revealed a nonlinear relationship. Hence, the number of possible tracking days was divided to create the 3 groups of participants: rare trackers (\u3c33% total days tracked), inconsistent trackers (33–66% total days tracked), and consistent trackers (\u3e66% total days tracked). After controlling for initial body mass index, hemoglobin A1c, and gender, only consistent trackers had significant weight loss (−9.99 pounds), following a linear relationship with consistent loss throughout the year. In addition, the weight loss trend for the rare and inconsistent trackers followed a nonlinear path, with the holidays slowing weight loss and the onset of summer increasing weight loss. These results show the importance of frequent dietary tracking for consistent long-term weight loss success