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ABSTRACT BACKGROUND There are few current population-based estimates of the patterns of diabetes screening in the United States. The American Diabetes Association (ADA) recommends universal screening of adults ≥ 45 years, and high-risk adults < 45 years, but there is no current assessment of ADA guideline performance in detecting diabetes and prediabetes. Furthermore, data on racial/ethnic patterns of screening are limited. OBJECTIVE Our aim was to estimate diabetes screening prevalence for the US adult population and specifically for those who meet ADA criteria; to report the prevalence of prediabetes and diabetes among these groups; and to determine if high-risk race/ethnicity was associated with reported screening. DESIGN This was a Cross-sectional survey. PARTICIPANTS Non-pregnant adults (≥ 21 years) without diabetes or prediabetes who participated in the National Health and Nutrition Examination Survey (NHANES) in 2005–2012 ( n  = 17,572) were included in the study. “Screening-recommended” participants, classified by ADA criteria, included (1) adults ≥ 45 years and (2) “high-risk” adults < 45 years. “Screening-not-recommended” participants were adults < 45 years who did not meet criteria. MAIN MEASURES Diabetes screening status was obtained by self-report. We used calibrated HbA 1c and/or fasting glucose levels to define undiagnosed diabetes and prediabetes. KEY RESULTS Seventy-six percent of the study population (approximately 136 million US adults) met ADA criteria. Among them, less than half (46.2 %) reported screening; undiagnosed diabetes affected 3.7 % (5 million individuals), and undiagnosed prediabetes affected 36.3 % (49 million people.) African Americans were more likely to report screening, both among adults ≥ 45 years and among “high risk” younger adults (OR 1.27 and 1.36, respectively.) Hispanic participants were also more likely to report screening (OR 1.31 for older adults, 1.42 for younger adults.) The screening rate among “screening-not-recommended” adults was 29.6 %; the prevalence of diabetes and prediabetes were 0.4 and 10.2 %, respectively. CONCLUSIONS In a nationally representative sample, 76 % of adults met ADA screening criteria, of whom fewer than half reported screening. Limitations include cross-sectional design and screening self-report.

ABSTRACT BACKGROUND Food insecurity— lack of dependable access to adequate food—may play a role in poor diabetes control. OBJECTIVE We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control. DESIGN Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. PARTICIPANTS Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income < 250 % of the federal poverty level, were 30–70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington. MAIN MEASURES We measured food insecurity determined by the Department of Agriculture’s 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample. KEY RESULTS The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p < 0.001), report diabetes distress (55.2 % vs. 33.8 %, p < 0.001) and have low medication adherence (52.9 % vs. 37.2 %, p = 0.02). Based on linear regression modeling, those with food insecurity had significantly higher mean A1c levels (β = 0.51; p = 0.02) after adjusting for sex, age, race/ethnicity, language, education, marital status, BMI, insulin use, depression, diabetes distress and low medication adherence. CONCLUSIONS Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.

To describe community health workers (CHWs) roles in a diabetes self-management intervention. Retrospective qualitative inductive analysis of open text home visit encounter form from Peer Support for Achieving Independence in Diabetes (Peer AID), a randomized controlled trial in which low-income individuals with poorly controlled diabetes received either CHW home visits or usual care. Following visits, CHWs completed encounter forms documenting the health goal of the visit, the self-management strategies discussed and participant concerns. 634 encounter reports were completed for the 145 intervention participants. CHW notes revealed three main obstacles to optimal disease control: gaps in diabetes knowledge and self-management skills; socioeconomic conditions; and the complexity of the healthcare system. CHWs helped participants overcome these obstacles through extensive, hands-on education, connecting participants to community resources, and assistance navigating the medical system. In addition, the CHWs offered uncomplicated accessibility and availability to their clients. CHWs can be a valuable asset for low-income patients with chronic health conditions who may require more support than what can provided in a typical primary care visit.

Background: Food insecurity – lack of dependable access to adequate foods – may play a role in poor diabetes control and be associated with poor health outcomes. Objective: To determine the relationship between food security status and multiple health outcomes – including glycemic control, depression, diabetes distress and medication adherence – among low-income individuals with diabetes. Design: Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. Participants: Participants had poorly controlled type 2 diabetes (A1c ≤8.0%), household income <250% of the federal poverty level and were 30-70 years old, recruited from a large public hospital, VA medical center and community-health center in King County, Washington. Intervention: Home-based diabetes self-management intervention delivered by community health workers. Main Measures: Food security status determined by Department of Agriculture's 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Hypoglycemic episodes per patient report. Glycosylated hemoglobin (A1c) values obtained through fingerstick blood sample. Key Results: The prevalence of food insecurity was 47.4%. Food-insecure participants more likely to be depressed (74.1% vs. 35.6%, p<0.001), report diabetes distress (55.1% vs. 33.7%, p<0.001), have low medication adherence (52.9% vs. 37.2%, p=0.02) and higher incidence of hypoglycemia (57.7% vs. 45.2%, p=0.04). Those with food insecurity had significantly higher A1c levels (9.4% vs. 8.7%, p=0.001) after adjusting for socio-demographic characteristics, depression, diabetes distress and medication adherence. Conclusions: The prevalence of food insecurity among low-income individuals with diabetes was high. Food insecurity was associated with multiple adverse health outcomes, including poor glycemic control. Without dependable access to safe and nutritious foods, optimal health and glycemic control likely remain out of reach for those with food insecurity.

Bacteria mediate interactions with their surroundings by exporting a variety of proteins into the extracellular environment. Gram-negative bacteria have evolved at least six dedicated secretory pathways to accomplish this task, each exporting a discrete set of proteins through complex and genetically divergent systems. One such system is the type VI secretion system (T6SS), which is a contact-dependent protein export pathway that delivers toxic effectors into target bacterial and eukaryotic cells. The export of effectors is controlled by sophisticated regulatory networks that can be triggered by specific environmental cues. The characterization of these regulatory pathways has yielded new insight into the physiologically relevant conditions in which these systems are active. In this thesis work, the Hcp secretion island I (HSI-I)-encoded T6SS (H1-T6SS) of the opportunistic pathogen, Pseudomonas aeruginosa, was used as a model system to investigate the factors that govern T6S activity. Specifically, this work describes two distinct posttranslational regulatory pathways — mediated by H1-T6SS associated proteins — that coordinate T6S apparatus assembly and effector export. One of these regulatory pathways, the threonine phosphorylation pathway (TPP), is stimulated when P. aeruginosa is subjected to surface-associated growth conditions. In contrast, the second pathway, which is mediated by a negative regulator, TagF, does not respond to surface or planktonic growth conditions and, instead, is likely stimulated by an unknown cue. As productive H1-T6S-dependent toxin delivery requires close cell contact, the presence of these regulatory pathways may provide a means to efficiently initiate H1-T6S activity under appropriate environmental conditions. Another important aspect of the T6SS and secretion systems in general, is the mechanisms used to specifically select substrates for export. This thesis work has uncovered a mechanism for substrate recognition by the T6SS. I found that specific interactions between T6S-effectors and a secreted T6S component, Hcp (haemolysin co-regulated protein), are essential for effector export. Thus, Hcp plays a central role in T6S substrate discrimination. Together, these findings have advanced our understanding of the T6SS and have shed light on the diverse mechanisms by which proteins can be exported by bacteria.

The latest exercise in mental gymnastics was the board's comments on stem cell research (\"Lift lock on stem cells,\" Editorial, July 17). Aside from the backhanded slap at Catholics by using the term \"anti-abortion zealots,\" the editorial continues to mislead the public by creating the impression that only embryonic stem cells have potential for medical cures. In fact, the National Institutes of Health states that both the degree of plasticity of somatic stem cells as well as their sources in adult tissue are greater than first realized. The U.S. Senate voted to expand federally funded stem cell research (\"Stem cell bill OK sets up Bush veto,\" Page One, July 19). All Georgians should take note that Sens. Johnny Isakson (R-Ga.) and Saxby Chambliss (R-Ga.) voted against this bill, presumably because they are anti-abortion and need to pander to their conservative base. President Bush vetoed the bill, presumably for the same reasons Isakson and Chambliss voted against it. If the emotional issues of morality and cures for specific diseases were left out of this debate, what could we say about stem cell research? Theologians and philosophers can grapple with morality, and scientists should determine the most beneficial results of any research. What's left is whether the government should fund such research, whether the source be embryonic, umbilical cord or adult stem cells. I submit that there is no authorization given in the Constitution, after reading and rereading, for government to raid the public treasury to fund any scientific research.