Background National guidelines disagree on who should be screened for undiagnosed diabetes. No existing diabetes risk score is highly generalizable or widely followed. Objectives To develop a new diabetes screening score and compare it to other available screening instruments (Centers for Disease Control and Prevention, American Diabetes Association (ADA) and U.S. Preventive Services Task Force guidelines; two ADA risk questionnaires; and Rotterdam model) Design Cross-sectional data. Setting National Health and Nutrition Examination Survey (NHANES) 1999–2004 for model development, and NHANES 2005–2006 plus a combined cohort of two community studies, Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS), for validation. Participants U.S. adults ≥20 years old. Measurements A risk scoring algorithm for undiagnosed diabetes, defined as fasting plasma glucose ≥7.0 mmol/L(126 mg/dL) without known diabetes, was developed in the development dataset. Logistic regression was used to determine participant characteristics that were independently associated with undiagnosed diabetes. The new algorithm and other methods were evaluated by standard diagnostic and feasibility measures. Results Age, sex, family history of diabetes, history of hypertension, obesity, and physical activity were associated with undiagnosed diabetes. In NHANES (in ARIC/CHS), the cutpoint of ≥5 selected 30(40)% of persons for diabetes screening and yielded sensitivity of 79(72)%, specificity of 67(62)%, positive predictive value of 10(10)% and likelihood ratio-positive of 2.39(1.89). In contrast, the comparison scores yielded sensitivity of 44–100%, specificity of 10–73%, positive predictive value of 5–8%, and likelihood ratio-positive of 1.11–1.98. Limitations Data during pregnancy were not available. Conclusions This new diabetes screening score, simple and easily implemented, seems to demonstrate improvements upon the existing methods. Future studies are needed to evaluate it in diverse populations in real world settings. Primary Funding Source Clinical and Translational Science Center at Cornell Medical College.
IMPORTANCE Home health care workers care for community-dwelling adults and play an important role in supporting patients with confirmed and suspected coronavirus disease 2019 ) who remain at home. These workers are mostly middle-aged women and racial/ethnic minorities who typically earn low wages. Despite being integral to patient care, these workers are often neglected by the medical community and society at large; thus, developing a health care system capable of addressing the COVID-19 crisis and future pandemics requires a better understanding of the experiences of home health care workers.OBJECTIVE To understand the experiences of home health care workers caring for patients in New York City during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTSFrom March to April 2020, a qualitative study with 1-to-1 semistructured interviews of 33 home health care workers in New York City was conducted in partnership with the 1199SEIU Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest health care union in the US. Purposeful sampling was used to identify and recruit home health care workers.MAIN OUTCOMES AND MEASURES Audio-recorded interviews were professionally transcribed and analyzed using grounded theory. Major themes and subthemes were identified. RESULTSIn total, 33 home health care workers employed by 24 unique home care agencies across the 5 boroughs of New York City participated. Participants had a mean (SD) age of 47.6 (14.0) years, 32 (97%) were women, 21 (64%) were Black participants, and 6 (18%) were Hispanic participants. Five major themes emerged: home health care workers (1) were on the front lines of the COVID-19 pandemic but felt invisible; (2) reported a heightened risk for virus transmission; (3) received varying amounts of information, supplies, and training from their home care agencies; (4) relied on nonagency alternatives for support, including information and supplies; and (5) were forced to make difficult trade-offs in their work and personal lives. CONCLUSIONS AND RELEVANCEIn this qualitative analysis, home health care workers reported providing frontline essential care, often at personal risk, during the COVID-19 pandemic. They experienced challenges that exacerbated the inequities they face as a marginalized workforce. Interventions and policies to better support these frontline health care professionals are urgently needed.
ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6 .
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