Vida Sana y Completa: A randomized controlled trial to examine the effectiveness of diabetes prevention with and without medically supportive groceries among Latina women.

Latina women have a high prevalence of obesity and obesity-related chronic diseases, such as diabetes. Approximately half of Latinas with obesity will also experience food insecurity, or a lack of access to enough food for an active and healthy life. Food insecurity is a barrier for effective prevention and management of obesity-related chronic diseases. The goal of this type 1 hybrid comparative effectiveness trial is to compare a culturally-tailored diabetes prevention intervention with and without medically supportive groceries. Adult Latina women (n = 412) with obesity (Body Mass Index (BMI) of >30 kg/m2) and food insecurity will be 1:1 randomized to the Vida Sana intervention (control), or to Vida Sana y Completa (intervention plus integrated treatment for food insecurity). Vida Sana is an evidence-based culturally tailored, 12-month diabetes prevention intervention that targets at least 5% weight loss and at least 150 min/week of moderate-to-vigorous physical activity. Participants enrolled in Vida Sana y Completa will also receive 12 weekly deliveries of medically supportive groceries. Those in Vida Sana alone will receive information on local food resources. Participants will be assessed at baseline and every 6 months for 24 months. The primary outcome is weight loss at 12 months. Secondary outcomes include weight loss maintenance, diet quality, and quality of life. Barriers and facilitators of implementation will be assessed using mixed methods according to the Consolidated Framework for Implementation Research. This study will provide critical evidence for addressing the combination of obesity and food insecurity in primary care for diabetes prevention. Trial Registration: NCT052111.

Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19.

With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).

What matters for weight loss in behavioral trials in the Latinx community: Learnings from three randomized controlled trials.

BACKGROUND: Nearly half of Latinx adults in the US are obese, making effective weight loss interventions crucial to prevent associated chronic conditions. OBJECTIVE: To identify factors associated with increased session attendance and clinically significant weight loss among Latinx adults. PARTICIPANTS: Latinx participants from the Vivamos Activos (n = 207), Vida Sana (n = 191), and HOMBRE (n = 424 Latinx men) randomized clinical trials. DESIGN: Post-hoc analysis of randomized controlled trial data. INTERVENTION: Culturally-adapted behavioral weight loss interventions based on the Diabetes Prevention Program among Latinx adults over 12 months. MAIN OUTCOME MEASURE: Demographic, clinical, and psychosocial predictors of session attendance and 5% weight loss at 12-months. STATISTICAL ANALYSIS PERFORMED: Bi-variable associations between baseline characteristics and outcomes were tested with chi-square and t-tests. Those with p-value< 0.15 were then included in stepwise logistic regressions. RESULTS: Participants (N = 822) were middle age with diverse socioeconomic backgrounds. Older age in the Vivamos Activos and Vida Sana trials, and lower acculturation in the HOMBRE trial were significant predictors of increased session attendance. Factors associated with 5% weight loss varied by trials. These included younger age (OR 0.96 95% CI 0.92, 0.99) in Vivamos Activos, higher acculturation (OR 1.88 95% CI 1.05, 3.37) in Vida Sana, and higher education (OR 3.20 95% CI 1.3, 7.03) and greater body image dissatisfaction (OR 1.29, 95% CI 1.04, 1.6), and lower acculturation (0.69 95% CI 0.5, 0.96) in HOMBRE. CONCLUSIONS: Few and conflicting baseline characteristics were associated with session attendance and clinically significant weight loss, suggesting that alternative approaches to optimizing interventions are needed.

Influence of Diabetes Mellitus and Nutritional Parameters on Clinical and Functional Aspects and Quality of Life in Patients Hospitalized Due to Exacerbation of Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations. During severe exacerbations, nutritional and endocrinological comorbidities can play an important role in the clinical and functional aspects of these patients. The aim of this study was to analyse the influence of the presence of diabetes mellitus (DM) and nutritional parameters on the deterioration of symptoms and quality of life during a severe exacerbation in patients with COPD. An observational study was conducted on COPD patients admitted due to an exacerbation. The COPD Assessment Test (CAT) questionnaire was administered, and clinical and functional parameters were compared based on the presence of nutritional and endocrinological alterations. A total of 50 patients were included, of whom 30 (60%) were male. The mean age was 70.5 years (standard deviation (SD) 9.6). The median CAT score during exacerbation was 25 (interquartile range (IQR) 17.5-30), and the baseline score was 13.5 (IQR 7-19), which represented a statistically significant difference (p < 0.001). Patients with iron deficiencies had a lower total CAT score (p = 0.041), specifically for items related to daily activity (p = 0.009) and energy (p = 0.007). Diabetic patients exhibited a greater decline in pulmonary function during exacerbation (p = 0.016), while patients with high thyroid-stimulating hormone (TSH) levels had a shorter hospital stay (p = 0.016). For COPD patients admitted due to an exacerbation, the metabolic assessment is useful and relevant in the clinical set-up, as endocrinological comorbidities negatively affect clinical and functional aspects of these patients.

Community of Practice of Promotoras de Salud to address health inequities during and beyond the COVID-19 pandemic.

Using principles of Community-Based Participatory Research, we describe a community of practice for community health workers and promotoras (CHW/Ps) to address COVID-19 inequities in the Latinx community. We offer a concrete example of how programs can engage CHW/Ps as full partners in the research process, and how programs can support CHW/Ps' capacity and workforce development during implementation. We conducted four focus groups with CHW/Ps (n = 31) to understand needs and invited 15 participants to the community of practice to work on issues identified by the group. We examined impact according to number of community members reached, types of outreach activities, surveys, and online views of educational materials. Process evaluation involved two focus groups with seven organizations and a Ripple Effects Mapping session with the CHW/Ps. Our community of practice has built CHW/Ps' capacity via 31 workshop and co-created culturally and linguistically relevant COVID-19 materials that have reached over 40,000 community members and over 3 million people online. The community of practice proved effective in supporting CHW/Ps to address COVID-19 inequities in the Latinx community. Our evaluations demonstrated benefits for community-academic partnerships, for CHW/Ps, and for the community. This model represents an innovative workforce training model to address health inequities and can be applied to other health topics.

Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches.

BACKGROUND: Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions. METHOD: The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3 years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm. RESULTS: Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married. CONCLUSION: Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions. TRIAL REGISTRATION: NCT00131105.

Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping.

Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

Improving lifestyle behaviors is a complex task. Interventions to support such change often have multiple components, making their evaluation difficult. Within the context of an intervention trial delivered at senior public housing sites and designed to increase physical activity among ethno-racially diverse aging adults, we assessed the utility of a novel method, called Ripple Effects Mapping (REM), in identifying useful information for additional refinement of the interventions being studied. We facilitated REM sessions across 6 study sites. Using this method, we were able to uncover useful information, including expected and unexpected outcomes of the interventions from the perspective of the participants themselves. We also learned about participants' own challenges and solutions to problems they encountered during the intervention period, and how these kinds of interventions can be further revised to be most helpful in other settings and with similar populations. Thus, these types of participant-centered methods are feasible and can complement more traditional, investigator-driven evaluation efforts, particularly for complex interventions or those with multiple components. They can also inform scientists about the outcomes most valued by participants, how those outcomes came about, and how future interventions can enhance and sustain healthy behavior change over time.

Addressing racial/ethnic inequities in vaccine hesitancy and uptake: lessons learned from the California alliance against COVID-19.

Lack of trust in biomedical research, government, and health care systems, especially among racial/ethnic minorities and under-resourced communities, is a longstanding issue rooted in social injustice. The COVID-19 pandemic has further highlighted existing health and socioeconomic inequities and increased the urgency for solutions to provide access to timely, culturally, and linguistically appropriate evidence-based information about COVID-19; and ultimately to promote vaccine uptake. California's statewide alliance STOP COVID-19 CA (comprising eleven sites), leverages long standing community partnerships to better understand concerns, misinformation, and address racial/ethnic inequities in vaccine hesitancy and uptake. Using data from the California CEAL Communication Working Group, we demonstrate the wide range of strategies, communication methods, languages, and trusted messengers that have been effective in reaching diverse communities across the state. We also showcase challenges and lessons learned, such as the importance of including trusted community partners to share information or provide vaccines. These approaches, rooted in community engagement, are crucial for addressing inequities and responding to future public health emergencies.

Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration.

BACKGROUND: Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS: Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS: Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS: Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

Understanding Historical Trauma Among Urban Indigenous Adults at Risk for Diabetes.

Historical trauma has been posited as a key framework for conceptualizing and addressing health equity in Indigenous populations. Using a community-based participatory approach, this study aimed to examine historical trauma and key psycho-social correlates among urban Indigenous adults at risk for diabetes to inform diabetes and other chronic disease prevention strategies. Indigenous adult participants (n=207) were recruited from an urban area in California and were asked to identify whether their Indigenous heritage was from a group in the United States, Canada, or Latin America. Historical trauma was assessed using the Historical Loss (HLS) and Historical Loss Associated Symptoms (HLAS) scales. Nearly half (49%) of Indigenous participants from the United States or Canada endorsed thinking about one or more historical losses weekly, daily, or several times a day, compared to 32% for Indigenous participants from Mexico, Central America, and South America. Most participants (62%) reported experiencing one or more historical loss-associated symptoms, such as depression and anger, sometimes, often, or always. Ancestry from the United States or Canada, depression, and participation in cultural activities were associated with greater HLS and HLAS scores, indicating a greater number of losses and associated symptoms. Results suggest a need to consider historical trauma when designing diabetes prevention interventions and the need to further consider ancestry differences. As preventive efforts for Indigenous adults expand in urban environments, behavioral interventions must incorporate strategies that address community-identified barriers in order to succeed.

Inclusionary Trials: A Review of Lessons Not Learned.

The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless, epidemiologic and clinical research do not yet have a strong culture of community partnership in the scientific process, which takes time to build and therefore may be difficult to develop and rapidly scale to respond to the pandemic. We outline practices that contribute to a lack of inclusive participation and suggest steps that trialists and other researchers can take to increase marginalized communities' participation in research. Practices include planning for community engagement during the planning and recruitment phases, having regular dialogues with communities about their priorities, supporting them throughout a study, and navigating complex structural determinants of health. Additionally, we discuss how research institutions can support inclusive practices by reexamining their policies to increase participation in clinical trials and instilling institutional trustworthiness.

Metformina en el tratamiento de enfermedades dermatológicas: una revisión narrativa / The role of metformin in the treatment of dermatological diseases: A narrative review

Objetivo: Revisar y discutir la evidencia actual del uso de la metformina como herramienta terapéutica en enfermedades cutáneas. Diseño. Artículo original. Investigación cualitativa. Revisión narrativa. Emplazamiento: Aragón y Murcia, España. Participantes: Médicos Internos Residentes de Dermatología Médico-Quirúrgica y Venereología y de Atención Primaria y Comunitaria. Métodos: Se ha realizado una revisión narrativa utilizando la base de datos bibliográfica PubMed con fecha de búsqueda el 27 de enero de 2022. Resultados: La metformina ha demostrado ser efectiva en el tratamiento de dermatosis inflamatorias tales como el acné, hidrosadenitis supurativa, psoriasis y dermatitis de contacto alérgica. También ha demostrado propiedades antitumorales frente al carcinoma basocelular, carcinoma espinocelular y melanoma. De forma adicional, se ha descrito efectos beneficiosos del tratamiento adyuvante con metformina en pacientes con carcinoma basocelular que reciben terapia fotodinámica. En pacientes con dermatosis relacionadas con endocrinopatías tales como el hirsutismo, la acantosis nigricans y los xantomas eruptivos, el tratamiento con metformina ha demostrado efectividad terapéutica. El tratamiento tópico con metformina ha demostrado ser eficaz en el tratamiento del melasma. Finalmente se ha propuesto como un fármaco con propiedades antienvejecimiento cutáneo y favorecedoras de la cicatrización. Para ninguna de las indicaciones previamente descritas se han objetivado efectos adversos graves. Conclusiones: La metformina es un tratamiento efectivo y seguro en el esquema terapéutico de dermatosis inflamatorias, neoplasias cutáneas, dermatosis relacionadas con endocrinopatías, melasma, envejecimiento cutáneo y cicatrización.(AU)

Objetive: To review and discuss the current evidence of the use of metformin as a therapeutic tool in frequent skin diseases. Design: Original article. Qualitative research. Narrative review. Location: Aragon and Murcia, Spain. Participants: Resident Physicians. Dermatology and Primary Health Care. Method: A narrative review has been carried out using the PubMed bibliographic database, being the search date the 27th of January of 2022. Results: Metformin has proven to be effective in the treatment of inflammatory skin diseases such as acne, hidradenitis suppurativa, psoriasis and allergic contact dermatitis. It has also shown antitumor properties regarding basal cell carcinoma, squamous cell carcinoma and melanoma. Additionally, beneficial effects of adjuvant treatment with metformin have been described in patients with basal cell carcinoma receiving photodynamic therapy. In patients with endocrinology-related dermatosis such as hirsutism, acanthosis nigricans and eruptive xanthomas, treatment with metformin has demonstrated therapeutic effectiveness. Topical treatment with metformin has also been useful in the treatment of melasma. Finally, it has been proposed as a drug with anti-aging and wound-healing promoting properties. Severe adverse effects have not been observed for any of the previously described indications, being this a well-tolerated treatment. Conclusions: Metformin is an effective and safe adjuvant in the therapeutic scheme of various inflammatory dermatoses, skin neoplasms, endocrinology-related dermatosis, melasma, skin aging and wound healing processes.(AU)

[The role of metformin in the treatment of dermatological diseases: A narrative review]. / Metformina en el tratamiento de enfermedades dermatológicas: una revisión narrativa.

OBJETIVE: To review and discuss the current evidence of the use of metformin as a therapeutic tool in frequent skin diseases. DESIGN: Original article. Qualitative research. Narrative review. LOCATION: Aragon and Murcia, Spain. PARTICIPANTS: Resident Physicians. Dermatology and Primary Health Care. METHOD: A narrative review has been carried out using the PubMed bibliographic database, being the search date the 27th of January of 2022. RESULTS: Metformin has proven to be effective in the treatment of inflammatory skin diseases such as acne, hidradenitis suppurativa, psoriasis and allergic contact dermatitis. It has also shown antitumor properties regarding basal cell carcinoma, squamous cell carcinoma and melanoma. Additionally, beneficial effects of adjuvant treatment with metformin have been described in patients with basal cell carcinoma receiving photodynamic therapy. In patients with endocrinology-related dermatosis such as hirsutism, acanthosis nigricans and eruptive xanthomas, treatment with metformin has demonstrated therapeutic effectiveness. Topical treatment with metformin has also been useful in the treatment of melasma. Finally, it has been proposed as a drug with anti-aging and wound-healing promoting properties. Severe adverse effects have not been observed for any of the previously described indications, being this a well-tolerated treatment. CONCLUSIONS: Metformin is an effective and safe adjuvant in the therapeutic scheme of various inflammatory dermatoses, skin neoplasms, endocrinology-related dermatosis, melasma, skin aging and wound healing processes.

Innovative participatory evaluation methodologies to assess and sustain multilevel impacts of two community-based physical activity programs for women in Colombia.

BACKGROUND: Community-based physical activity (PA) programs are appealing to women in Latin America and show potential for improving women's health. This study aimed to engage healthy middle-aged women, breast cancer survivors and local stakeholders participating in two publicly funded community-based PA programs in Bogotá, Colombia (Recreovía and My Body) to assess and visually map the perceived barriers, facilitators, and outcomes to promote programs' improvement, scaling and sustainability. METHODS: We used two participatory action research methods, the 1) Our Voice citizen science method to capture data and drive local change in built and social environmental facilitators and barriers that influence women's engagement in community-based PA; and 2) Ripple Effects Mapping to visually map the intended and unintended outcomes of PA programs. We used thematic analysis to classify the results at the individual, social, and community levels. RESULTS: The stakeholders engaged in the participatory evaluation included cross-sector actors from the programs (N = 6) and program users (total N = 34) from the two programs (Recreovía N = 16; My Body N = 18). Program users were women with a mean age of 55.7 years (SD = 8.03), 65% lived in low-income neighborhoods. They identified infrastructure as the main feature affecting PA, having both positive (e.g., appropriate facilities) and negative (e.g., poorly built areas for PA) effects. Regarding program improvements, stakeholders advocated for parks' cleaning, safety, and appropriate use. The most highlighted outcomes were the expansion and strengthening of social bonds and the engagement in collective wellbeing, which leveraged some participants' leadership skills for PA promotion strategies in their community. The facilitated dialogue among program users and stakeholders fostered the sustainability and expansion of the community-based PA programs, even during the COVID-19 pandemic. CONCLUSIONS: The implementation of both participatory methodologies provided a multidimensional understanding of the programs' impacts and multisectoral dialogues that fostered efforts to sustain the community-based PA programs.

The Role of Citizen Science in Promoting Health Equity.

While there are many definitions of citizen science, the term usually refers to the participation of the general public in the scientific process in collaboration with professional scientists. Citizen scientists have been engaged to promote health equity, especially in the areas of environmental contaminant exposures, physical activity, and healthy eating. Citizen scientists commonly come from communities experiencing health inequities and have collected data using a range of strategies and technologies, such as air sensors, water quality kits, and mobile applications. On the basis of our review, and to advance the field of citizen science to address health equity, we recommend (a) expanding the focus on topics important for health equity, (b) increasing the diversity of people serving as citizen scientists, (c) increasing the integration of citizen scientists in additional research phases, (d) continuing to leverage emerging technologies that enable citizen scientists to collect data relevant for health equity, and (e) strengthening the rigor of methods to evaluate impacts on health equity.