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      Evaluation of a digital diabetes prevention program adapted for the Medicaid population: Study design and methods for a non-randomized, controlled trial

      Contemporary Clinical Trials Communications
      Elsevier BV

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          Design and implementation of the Hispanic Community Health Study/Study of Latinos.

          The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive multicenter community based cohort study of Hispanics/Latinos in the United States. The Study rationale, objectives, design, and implementation are described in this report. The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino, 18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago, Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000 persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban, and Central and South American. The study includes research in the prevalence of and risk factors for heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders. The HCHS/SOL will (1) characterize the health status and disease burden in the largest minority population in the United States; (2) describe the positive and negative consequences of immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population with diverse environmental exposures, genetic backgrounds, and early life experiences. Published by Elsevier Inc.
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            Long-term Effects of Lifestyle Intervention or Metformin on Diabetes Development and Microvascular Complications: the DPP Outcomes Study

            Background The worldwide epidemic of type 2 diabetes requires effective prevention. We determined the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally demonstrated during the 3-year Diabetes Prevention Program (DPP), and whether diabetes-associated microvascular complications are reduced. Methods The DPP (1996–2001) was a randomized trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk to develop diabetes. All participants were offered lifestyle training at DPP-end. 2776 (88%) of the surviving DPP cohort were followed in the DPP Outcome Study (DPPOS 2002–2013) and analyzed by intention-to-treat based on original DPP assignment. During DPPOS, the lifestyle group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. Findings During 15 years of average follow-up, lifestyle intervention and metformin reduced diabetes incidence rates by 27% (p<0.0001) and 18% (p=0.001), respectively, compared with the placebo group, with declining between group differences over time. At year 15, the cumulative incidences of diabetes were 55, 56 and 62%, respectively. The prevalences at study-end of the aggregate microvascular outcome, composed of nephropathy, neuropathy, and retinopathy, were not significantly different among the treatment groups (11–13%) in the total cohort. However, in women (n=1887) lifestyle intervention was associated with a lower prevalence (8.7%) than in the placebo (11%) and metformin (11.2%) groups, with 21% (p=0.03) and 22% (p=0.02) reductions with lifestyle compared with placebo and metformin, respectively. Compared with participants who progressed to diabetes, those who didn’t progress had a 28% lower prevalence of microvascular complications (p<0.0001). Interpretation Lifestyle intervention or metformin significantly reduce diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome among treatment groups; however, those who did not progress to diabetes had a lower prevalence of microvascular complications than those who progressed. Funding National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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              Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net.

              Electronic and internet-based tools for patient-provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations. To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network. Observational, cross-sectional study Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH) MAIN MEASURES: Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data-all self-reported via survey. Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians. A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients' language, literacy level, and experience with communication technology.
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                Author and article information

                Journal
                10.1016/j.conctc.2018.05.007
                http://creativecommons.org/licenses/by-nc-nd/4.0/

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