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Latina Health in the United States: A Public Health Reader
Gloria L.A. Beckles, MD, MSc
Preventing Chronic Disease , 2005,
Abstract: Latina Health in the United States: A Public Health Reader is a collection of articles drawn from journals and books published in the last decade about the health status and health needs of Latin American adolescent and adult females in the United States. In the preface, the editors state that the goals of the anthology are to identify a number of critical issues of importance and relevance to Latina health; to present an overview of the existing literature on Latina health; to highlight the leading indicators of morbidity and mortality affecting various subgroups of Latinas; and to identify gaps in research, policy issues, program planning, and practice. To achieve these goals, the editors organized the book s 29 chapters into nine parts that explore the population s demographics; risk factors, socioeconomic disparities, and race/ethnic disparities among Latinas; sexual and reproductive health issues; chronic conditions such as heart disease, cancer, and diabetes; alcohol, tobacco, other drug use, and mental health; patterns of risk behaviors among Latina adolescents; and the health needs of rural and migrant workers.
Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the Translating Research into Action for Diabetes (TRIAD) study
Shou-En Lu, Gloria L Beckles, Jesse Crosson, Dorian Bilik, Andrew J Karter, Robert B Gerzoff, Yong Lin, Sonja Ross, Laura N McEwen, Beth E Waitzfelder, David Marrero, Norman L Lasser, Arleen F Brown
BMC Endocrine Disorders , 2012, DOI: 10.1186/1472-6823-12-12
Abstract: Prospective cohort of U.S. managed care enrollees aged ≥ 18？years and mean diabetes duration of more than 10？years, participating in the Translating Research into Action for Diabetes (TRIAD) study, was followed for the first occurrence of CHD events from 2000 to 2003. The UKPDS and Framingham risk equations were evaluated for discriminating power and calibration.A total of 8303 TRIAD participants, were identified to evaluate the UKPDS (n？=？5914, 120 events), Framingham-initial (n？=？5914, 218 events) and Framingham-secondary (n？=？2389, 374 events) risk equations, according to their prior CHD history. All of these equations exhibited low discriminating power with Harrell’s c-index <0.65. All except the Framingham-initial equation for women and the Framingham-secondary equation for men had low levels of calibration. After adjsusting for the average values of predictors and event rates in the TRIAD population, the calibration of these equations greatly improved.The UKPDS and Framingham risk equations may be inappropriate for predicting the short-term risk of CHD events in patients with long-standing type 2 diabetes, partly due to changes in medications used by patients with diabetes and other improvements in clinical care since the Frmaingham and UKPDS studies were conducted. Refinement of these equations to reflect contemporary CHD profiles, diagnostics and therapies are needed to provide reliable risk estimates to inform effective treatment.
Access to health care and undiagnosed diabetes along the United States-Mexico border
Zhang,Xuanping; Beckles,Gloria L.; Bullard,Kai McKeever; Gregg,Edward W.; Albright,Ann L.; Barker,Lawrence; Zhang,Xinzhi; Ruiz-Holguín,Rosalba; Cerqueira,Maria Teresa; Frontini,María; Imperatore,Giuseppina;
Revista Panamericana de Salud Pública , 2010, DOI: 10.1590/S1020-49892010000900008
Abstract: objetive: to examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the united states of america and mexico. methods: using survey and fasting plasma glucose data from phase i of the u.s.-mexico border diabetes prevention and control project (february 2001 to october 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. access to health care among that sample (n = 3 470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. results: people with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [or] 2.6, 95% confidence interval [ci] 1.0-6.6, and or 4.5, 95% ci 1.4-14.1, respectively). when stratified by country, the survey data showed that on the u.s. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% ci 11.5%-46.3%, versus 9.1%, 95% ci 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made > 4 visits (40.8%, 95% ci 19.6%-62.0%, and 23.4%, 95% ci 9.9%-36.9%, respectively, versus 2.4%, 95% ci -0.9%-5.7%) (all, p < 0.05). no similar pattern was found in mexico. conclusions: limited access to health care-especially not having health insurance and/or not having a place to receive routine health services-was significantly associated with undiagnosed diabetes in the u.s.-mexico border region.
A historical overview of the United States-Mexico border diabetes prevention and Control Project
Diaz-Kenney,Rita V.; Ruiz-Holguín,Rosalba; de Cosío,Federico G.; Ramos,Rebeca; Rodríguez,Betsy; Beckles,Gloria L.; Valdez,Rodolfo; Thompson-Reid,Patricia E.;
Revista Panamericana de Salud Pública , 2010, DOI: 10.1590/S1020-49892010000900003
Abstract: diabetes is a serious public health problem in the border region between the united states of america and mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. the u.s.-mexico border diabetes prevention and control project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 u.s. and mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. this report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned.
Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study
Andrew J Karter, Mark R Stevens, Arleen F Brown, O Kenrik Duru, Edward W Gregg, Tiffany L Gary, Gloria L Beckles, Chien-Wen Tseng, David G Marrero, Beth Waitzfelder, William H Herman, John D Piette, Monika M Safford, Susan L Ettner
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-308
Abstract: This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States. Self-reported survey data included individual educational attainment ("education") and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated: foot exams (among those with symptoms of peripheral neuropathy or a history of foot ulcers); self-monitoring of blood glucose (SMBG; among insulin users only); smoking; exercise; and certain diabetes-related health seeking behaviors (use of diabetes health education, website, or support group in last 12 months). Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with random effects for clustering within health plans.Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors, while SMBG and foot self-examination did not vary by education. Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance, and most education-behavior relationships were similar across sex, race and other patient characteristics. The relationship between education and smoking varied significantly across age, with a strong inverse relationship in those aged 25–44, modest for those ages 45–64, but non-evident for those over 65. Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships. Other measures of socioeconomic position yielded similar findings.The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated
Nueva clasificación y criterios diagnósticos de la diabetes mellitus
López Stewart,Gloria;
Revista médica de Chile , 1998, DOI: 10.4067/S0034-98871998000700012
Abstract: the new classification and diagnostic criteria for diabetes mellitus (dm), prepared by a group of experts from the american diabetes association is presented and analyzed. on an etiopathogenic basis, it designates insulin dependent and non insulin dependent as type 1 and type 2 respectively. it specifies dm having specific known causes. it maintains gestational diabetes and glucose intolerance and adds the impaired fasting glucose condition. it recommends fasting plasma glucose for search and diagnosis, and lowers the level to 3126 mg/dl instead of 3140 mg/dl, due to its association with chronical complications of dm. it mantains the diagnostic criteria of random and post charge glycemia 3200 mg/dl. it does not alter the glucose intolerance figure (140ó200 mg/dl in ogtt) and introduces fasting abnormality 3110 and <126 mg/dl. it encourages the search with fasting glucose every 3 years in individuals aged over 45, and at more frequent intervals in younger individuals with high risk factors. analysis of the report allows to conclude that, although the classification does not introduce any significant change in daily clinical use, its pathogenic orientation makes future innovations possible. the preferential use of fasting glucose 3126 mg/dl for diagnosis of dm has theoretical basis and practical advantages. identification of individuals with impaired fasting glucose allows to detect, in a simple manner, a high risk group in which to start preventive measures. however, there is a percentage of cases which are not diagnosed by fasting glycemia, but are diagnosed by ogtt, therefore the latter should not be discarded.
Management of diabetes mellitus
Gloria López Stewart
Medwave , 2010,
Abstract:
Nueva clasificación y criterios diagnósticos de la diabetes mellitus New classification and diagnostic criteria for diabetes mellitus
Gloria López Stewart
Revista médica de Chile , 1998,
Abstract: The new Classification and Diagnostic Criteria for Diabetes Mellitus (DM), prepared by a group of experts from the American Diabetes Association is presented and analyzed. On an etiopathogenic basis, it designates Insulin Dependent and Non Insulin Dependent as Type 1 and Type 2 respectively. It specifies DM having specific known causes. It maintains Gestational Diabetes and Glucose Intolerance and adds the Impaired Fasting Glucose Condition. It recommends fasting plasma glucose for search and diagnosis, and lowers the level to 3126 mg/dl instead of 3140 mg/dl, due to its association with chronical complications of DM. It mantains the diagnostic criteria of random and post charge glycemia 3200 mg/dl. It does not alter the glucose intolerance figure (140ó200 mg/dl in OGTT) and introduces fasting abnormality 3110 and <126 mg/dl. It encourages the search with fasting glucose every 3 years in individuals aged over 45, and at more frequent intervals in younger individuals with high risk factors. Analysis of the report allows to conclude that, although the classification does not introduce any significant change in daily clinical use, its pathogenic orientation makes future innovations possible. The preferential use of fasting glucose 3126 mg/dl for diagnosis of DM has theoretical basis and practical advantages. Identification of individuals with impaired fasting glucose allows to detect, in a simple manner, a high risk group in which to start preventive measures. However, there is a percentage of cases which are not diagnosed by fasting glycemia, but are diagnosed by OGTT, therefore the latter should not be discarded.
Maestros de la medicina interna chilena Masters of Internal Medicine, in Chile
Gloria López S
Revista médica de Chile , 2011,
Abstract:
？GENERAN VALOR LAS FUSIONES A LAS EMPRESAS COLOMBIANAS?
MARTíNEZ,GLORIA; LóPEZ,GLORIA;
Estudios Gerenciales , 2003,
Abstract: a study about the value generation of mergers in colombia is conducted over the 1997-1999 period, wich presented the higthest numbers of mergers. in order to aisle several socioeconomic factors the analysis was made over a sample of mergered companies compared with a pair sample of nomergered companies. a colombian database, benchmark, was used mainly, and eva was the variable studied to compare mergered an no-mergered companies using a regression model in excel.
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