Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study
Clinic-based versus outsourced implementation of a diabetes health literacy intervention.
We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. ⋯ An outsourced diabetes education and counseling approach for community health centers appears more feasible than clinic-based models. Patients receiving the carve-out strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach. Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed.
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Observational Study
The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease.
The prevalence and consequences of financial barriers to health care among patients with multiple chronic diseases are poorly understood. ⋯ In diabetic adults with CHD, financial barriers to health care were associated with impaired access to medical care, inferior quality of care and greater vascular morbidity. Eliminating financial barriers and adherence to guideline-based recommendations may improve the health of individuals with multiple chronic diseases.
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The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel. ⋯ The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.
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Review Meta Analysis
SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials.
Hot flashes are the most commonly reported vasomotor symptom during the peri- and early post-menopausal period. ⋯ SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects.
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Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. ⋯ Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.