Quality Of Breast Cancer Care In The US Territories: Insights From Medicare.

The quality of breast cancer care among Medicare beneficiaries in the US territories-where federal spending for health care is lower than in the continental US-is unknown. We compared female Medicare beneficiaries who were residents of the US territories and had surgical treatment for breast cancer in 2008-14 to those in the continental US in terms of receipt of recommended breast cancer care (diagnostic needle biopsy and adjuvant radiation therapy [RT] following breast-conserving surgery) and the timeliness (time from needle biopsy to surgery and from surgery to adjuvant RT) of that care. Residents of the US territories were less likely to receive recommended care (24 percent lower odds of receiving diagnostic needle biopsy and 34 percent lower odds of receiving adjuvant RT) and to receive timely care (45 percent lower odds of receiving surgery and 82 percent lower odds of receiving adjuvant RT, both within three months). Further research is needed to identify barriers to the provision of adequate and timely breast cancer care in this unique population.

A Church-Based Diabetes Care Survey in St. Thomas, U.S. Virgin Islands.

Forty-eight (N = 48) African-Caribbeans participated in a church-based diabetes care survey in St. Thomas, U.S. Virgin Islands. The purpose of this pilot study was to determine whether integration was a significant predictor of depressive symptoms and glycemic control in persons with type 2 diabetes among African-Caribbeans in faith-based organizations (FBO), controlling for demographic variables. Data were collected on measures of integration of diabetes, acceptance, depressive symptoms, number of hypoglycemic episodes, hemoglobin Alc, and demographic characteristics. The majority of subjects were female. Acceptance and depression were negatively correlated, and acceptance and integration were positively correlated. Depression and number of mild hypoglycemic episodes were also positively correlated. Surprisingly, integration was not significantly related to hemoglobin Alc, number of hypoglycemic episodes, and depressive symptoms. Implications of these findings are presented.

Self-management among patients living with diabetes in the United States Virgin Islands.

The United States Virgin Islands (USVI) is facing a diabetes epidemic similar to the one on the U.S. mainland, yet little is known regarding the cultural context relevant to self-management in this U.S. territory. We conducted in-home interviews (n=53) supplemented by self-administered questionnaire and A1c testing with U.S. Virgin Islanders to characterize self-management knowledge, attitudes, and behaviors among patients living with diabetes. The mean glycosylated hemoglobin (A1c) was 7.63 (Range=5-13); a composite score of traditional self-management behaviors was not associated with A1c. Several recurrent themes emerged from qualitative analysis including: 1) cultural nuances shaped perspectives on self-management, 2) culturally-specific challenges were barriers to effective self-management, 3) medical homes were rarely viewed as the primary source of education and support, and 4) fear largely motivated or stalled self-management practices. This study highlights the need for culturally-tailored measures and interventions to address the specific needs within this population.