Understanding the complexities of equity within the emergence and utilization of AI in academic medical centers.

This editorial discusses positions for academic medical centers to consider when designing and implementing artificial intelligence (AI) tools.

Individual- and Community-Level Socioeconomic Status and Deceased Donor Renal Transplant Outcomes.

BACKGROUND: This study examined the relationship between socioeconomic status (SES), race, and ethnicity and clinical outcomes following deceased donor kidney transplant (DDKT) at a high-volume transplant center. METHODS: This retrospective cohort study used regression models and survival analyses to examine the relationship between individual- and community-level SES, race, and ethnicity and DDKT outcomes (i.e., delayed graft function, graft failure, mortality) adjusting for potential confounders. RESULTS: The analytic sample included 3366 patients; 40.7% (n = 1370) were female, the mean age was 54.7 (SD = 13.3) years, 49.3% were non-Hispanic White, and the median follow-up time was 39.5 months (IQR = 24.2-68.1). Patients living in the most disadvantaged communities (using the US Census data) had a higher likelihood of delayed graft function (adjusted relative risk [RR] = 1.12, p = 0.042) and a higher hazard of mortality (adjusted hazard ratio [HR] = 1.32, p = 0.025) compared to patients living in the least disadvantaged communities. Patients without a high school diploma had a higher risk of delayed graft function compared to patients with an associate degree or more (RR = 1.37, p < 0.001). Patients with public insurance coverage had a higher risk of delayed graft function (RR = 1.24, p < 0.001) and a higher hazard of mortality (HR = 1.37, p < 0.001) and graft failure (HR = 1.71, p < 0.001) compared to patients without public insurance. There were no differences in graft failure or mortality by race and ethnicity. CONCLUSIONS: SES was not consistently associated with outcomes following DDKT; however, many of the predictors were associated with delayed graft function. With a large and diverse sample size, these findings further the heterogeneity of the present renal transplant research suggesting the need for further investigation to guide implementation of innovative strategies and interventions.

Association between Foot Care Knowledge and Practices among African Americans with Type 2 Diabetes: An Exploratory Pilot Study.

OBJECTIVES: African Americans bear a disproportionate burden of lower extremity complications associated with a type 2 diabetes diagnosis. We examined the relationship that self-reported foot care knowledge, foot self-care behaviors, and foot self-care management barriers had on a participants' intention to maintain long term foot self-care. METHODS: African Americans were recruited using a convenience and snowball sampling plan, as well as telephone, email and flyers detailing the study. The data from the previously modified foot care knowledge questionnaire was analyzed using SPSS. Descriptive analysis and ANOVAs analyzed basic foot care knowledge, specialized foot care knowledge, and foot self-care. RESULTS: The analysis indicated that a main effect of insurance status, F(2,87) = 4.082, p = .020, was detected, and was the only significant interaction found. CONCLUSION: When comparing the basic and extended foot care education means scores, participants had less extended foot care knowledge than basic foot care knowledge. This study also showed that insurance status had considerable influence on extended foot care knowledge. In an African American population with T2DM, regardless of education and gender, there are considerable differences between how foot care knowledge is translated into actual foot self-care behaviors.

Diabetes Prevention for African-Americans: a Scoping Review.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is preventable in many instances. African-Americans are disproportionately represented in T2DM statistics. The strategies in place to prevent disease development in this population warrant critical examination. METHODS: A scoping review of literature was conducted to provide an overview of the largely inconsistent approach to African-American T2DM prevention research. Specific research questions included: (1) How are African-Americans treated in the existing T2DM literature? (1a) Are African-Americans primarily treated as a homogenous group in the literature? (1b) Has the literature addressed middle-class African-Americans? (2) Is the T2DM prevention literature focused on primary or secondary prevention? The review included articles published from 1985 to 2016, examining the methodology and approach toward African-Americans in each article. RESULTS: The review yielded 653 unduplicated articles. Through title, abstract, and full-text screenings, 381 articles were excluded. Of the remaining articles only 37% were focused on the prevention of T2DM development, and only 22.7% described a participant education component. The majority of the studies were observational (n = 19). Only 53.5% included majority African-American participants. Samples ranged from 2 to 27,899 individuals, which were often treated as homogeneous groups in terms of income and/or education (62.3%). CONCLUSION: The approach to T2DM prevention in African-Americans is largely inconsistent, which may be contributing to stagnation in this area of research.

Early Results of States' Efforts to Support, Scale, and Sustain the National Diabetes Prevention Program.

The Centers for Disease Control and Prevention (CDC) developed a cooperative agreement with health departments in all 50 states and the District of Columbia to strengthen chronic disease prevention and management efforts through the implementation of evidence-based strategies, such as CDC's National Diabetes Prevention Program. The National Diabetes Prevention Program supports organizations to deliver the year-long lifestyle change program that has been proven to prevent or delay the onset of type 2 diabetes among those at high risk. This article describes activities, barriers, and facilitators reported by funded states during the first 3 years (2013-2015) of a 5-year funding cycle.

A Qualitative Inquiry of Lower Extremity Disease Knowledge Among African Americans Living With Type 2 Diabetes.

The purpose of this study was to investigate how personal illness representations of type 2 diabetes affected the level of foot care knowledge and self-care strategies among African Americans adults. Thirteen African Americans (ages 32-72 years) participated in individual semistructured qualitative interviews regarding self-care practices and lower extremity disease knowledge related to type 2 diabetes. Using phenomenological methodology, all interviews were transcribed and analyzed by the research team for themes. Three major themes emerged from the interviews: basic foot care knowledge, lower extremity disease knowledge, and patient-provider communication. The study yielded that the majority of the participants lacked understanding of basic diabetic foot care as well as how lower extremity complications can evolve from uncontrolled type 2 diabetes. Diabetes self-management education is an essential component that could aid in the improvement of poor health outcomes of African Americans. Diabetes self-management education programs should consider implementing more detailed foot care educational tools, especially those individuals who are affected with complications due to the disease and that can lead to lower extremity amputations. This study provided insight on the importance of this knowledge as it relates to making common sense assumptions about the disease and self-management strategies.

An Analysis of the Recruitment and Participation of African American Men in Type 2 Diabetes Self-Management Research: A Review of the Published Literature.

Research studies have shown that African American men have experienced higher rates of serious complications of type 2 diabetes, due in part to poor disease management. Although type 2 diabetes research among minority populations is consistently advancing, there still remains a scarcity of African American male representation within these studies. It is unclear if this scarcity stems from lack of interest among men, location of recruitment, or ways in which these men are motivated to participate in research studies. As a result, an analysis of recruitment methods and locations of literature that includes African American men with type 2 diabetes is needed. The purpose of this review of the literature is threefold: (a) determine the number of published empirical studies specific to type 2 diabetes self-management that included African Americans in the sample, (b) to evaluate the percentage of men that were represented in the study sample as compared to how many women, and

Pathways between physical activity and quality of life in African-American breast cancer survivors.

INTRODUCTION: Several studies have indicated that the relationship between physical activity and quality of life is not directed but mediated through various pathways. The purpose of this study was to assess the role of cancer-related fatigue, disability, and functional status as potential mediators in African-American breast cancer survivors. METHODS: African-American breast cancer survivors (N = 135, mean age = 63) aged 55 years and older participated in a web-based survey consisting of measures assessing physical activity, functional status, cancer-related fatigue, disability, quality of life, and sociodemographic and medical characteristics. Structural equation modeling was used to assess the structural relationships among the constructs. RESULTS: The initial structural model fit the data and revealed a significant relationship between physical activity and quality of life (ß = 0.34, P < 0.01). Subsequent structural models with proposed complementary and mediating paths of fatigue, function, and disability fit the data. The adjusted model indicated that physical activity was no longer associated with quality of life (ß = 0.11, P > 0.05) and mediated through pathways of functional status and fatigue (total ß = 0.16, P < 0.01). The final adjusted model accounted for 32 % of the variance in quality of life. CONCLUSION: Our data suggest that physical activity may be indirectly related to quality of life through pathways consisting of fatigue and functional status. Further longitudinal studies are needed to test the pathways through which varying levels of physical activity influence cancer-related and quality of life outcomes in minority cancer survivors.

Racial/Ethnic Differences in Predictors of Mental Health Treatment in Persons with Comorbid Diabetes and Depression.

Diabetes and depression are two of the most frequently diagnosed health conditions in the United States and often co-occur. The present study examines racial/ethnic differences in predictors of mental health service use among a national sample of African Americans, Hispanics, and non-Hispanic Whites with a self-reported diabetes and depression diagnosis. Multiple logistic regression was used to analyze a cross-sectional sample (N = 3377) of the 2012 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey. African Americans were less likely to have visited a mental health professional in the last 12 months (odds ratio [OR] = .634, confidence interval [CI] [0.429, 0.911]). Significant odds ratios also uncovered results for the "never married" (OR = 1.737, CI [1.322, 2.281]) category. Also for the entire sample, being 55 years or older (OR = .352, CI [0.234, 0.533]) was found to be strongly associated with mental health service use for individuals with diabetes. Being unemployed or not in the labor force increased the odds of mental health service use in persons with diabetes and depression, whereas having less than a high school diploma or Graduate Equivalency Diploma decreased odds of visits (OR = .611, CI [0.394, 0.945]) as did not having health insurance (OR = .540, CI [0.365, 0.800]). Racial/ethnic variation in mental health service utilization exists among persons with self-reported diabetes and depression. Due to the challenges associated with comorbid depression and diabetes, as well as the impact depression can have on diabetes self-management, it is imperative that more strategies for managing both depression and diabetes be explored.

Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature.

INTRODUCTION: The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. METHODS: Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. RESULTS: Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. CONCLUSION: Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.

Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial.

BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01221090.

Factors affecting acceptability and usability of technological approaches to diabetes self-management: a case study.

PURPOSE: This study explored the impact of personal digital assistant (PDA) features, users' perceptions, and other factors that may have hindered PDA acceptability and usability as technology advances in e-health diabetes self-management. STUDY DESIGN AND RESULTS: An ongoing study on PDA usage is set within the context of the advancements of Web 2.0 for type 2 diabetes mellitus (T2DM) self-management e-interventions. Advancements in technology as it relates to the future of T2DM mobile applications are discussed as possible deterrents of PDA acceptability and usability. CONCLUSIONS: This case study illustrates the importance of addressing factors that may impede the adoption of electronic devices intended for sustained health behavior change. Recognizing the importance of individual perception within the context of rapid technological advancements is imperative for designing future health interventions. Incorporating electronic devices that individuals are more inclined to utilize, such as smartphones, as the platform for health interventions is a promising strategy to improve acceptability and usability, allowing researchers to more accurately assess the health benefits of self-management programs.