Relationships Between Antihypertensive, Glucose‐ and Lipid‐Lowering Medication Adherence, and Demographic and Clinical Characteristics in American Indian Adults With Type 2 Diabetes

Journal of Diabetes Research · 2026-01-01

OBJECTIVE: This study examined the relationships between medication adherence and demographic and clinical characteristics in American Indian adults with Type 2 diabetes who live on tribal lands and receive medication at no cost to them. RESEARCH DESIGN AND METHODS: From tribal electronic health record data, we constructed a cross-sectional cohort of 3042 adults with Type 2 diabetes. Tribal citizens of a federally recognized tribe were included if aged ≥ 18 years, had Type 2 diabetes, had ≥ 1 Choctaw Nation of Oklahoma healthcare encounter in 2018, and were on antihypertensive, glucose- and lipid-lowering medications in 2018. Proportion of days covered (PDC) was used to assess medication adherence with a threshold of ≥ 80%. RESULTS: The cohort mean age was 59.3 ± 11.6 years; the majority were male (52%), married (52%), BMI ≥ 30 (74%), and lived in a rural setting (87%). Overall, 63% of patients were adherent to their medications with a mean PDC across all medication classes of 0.81 ± 0.18. Patients aged > 55 years had a significantly higher PDC across all three medication classes compared with those aged ≤ 55 years (84% vs. 77%, p < 0.001). Also, BMI ≥ 30 (β = 0.033, p < 0.001) or having a comorbid condition (β = 0.040, p < 0.001) were each associated with higher overall PDC. Whereas insulin use (β = -0.023, p = 0.001) and rural residence (β = -0.020, p = 0.03) were associated with lower overall PDC. Additionally, patients with comorbid kidney or heart disease had a higher overall PDC compared with those without these conditions (p < 0.001). CONCLUSION: In a setting with access to no-cost medication, nearly two-thirds of our sample were considered adherent to their medications. Older adults and those with comorbid conditions or BMI ≥ 30 had higher overall adherence to medications, whereas those residing in rural areas or using insulin had lower overall medication adherence.

The Influence of Supervisory Justice and Perceived Career Development Support on Employees' Knowledge Sharing and Knowledge Hiding

The Korean Data Analysis Society · 2025-02-28

This study empirically investigates the effects of supervisory justice on employees' knowledge-sharing and knowledge-hiding behaviors, while exploring organizational strategies to enhance these outcomes. Specifically, the research hypothesizes that supervisory justice positively influences knowledge-sharing and reduces knowledge-hiding behaviors through the mediating role of team commitment. Furthermore, it posits that employees' perceptions of career development support moderate the relationship between supervisory justice and knowledge-related behaviors. The findings demonstrate a significant direct effect of supervisory justice on promoting knowledge-sharing behaviors, whereas no direct relationship was found with knowledge-hiding behaviors. Supervisory justice also exerts an indirect positive effect on knowledge-sharing via team commitment, although its indirect effect on mitigating knowledge-hiding behaviors was not statistically significant. Additionally, higher perceptions of career development support were found to strengthen the positive impact of supervisory justice on knowledge-sharing and its inhibitory effect on knowledge-hiding behaviors. This study underscores the pivotal role of supervisory justice as a key antecedent of knowledge-sharing in organizations and highlights the amplifying effect of organizational career development support. These findings provide practical implications, suggesting that fostering supervisory justice and offering career development opportunities can enhance organizational knowledge-sharing, ultimately contributing to improved organizational performance and sustainability.

Correction to: Association of food insecurity with overall and disease‑specific mortality among cancer survivors in the US

Supportive Care in Cancer · 2025-09-01

Perceived Discrimination Is a Mediator of Rural Identity and Cardiometabolic Multimorbidity Among U.S. Adults

International Journal of Environmental Research and Public Health · 2025-03-14

The rise in prevalence of cardiometabolic multimorbidity indicates the need for more research examining associated risk factors. Identifying multilevel risk factors is especially critical for U.S. health disparity populations who have been shown to experience a disproportionate burden of chronic disease-related morbidity and mortality. This study examines differences in the prevalence of and risk factors associated with cardiometabolic multimorbidity status among health disparity populations in a representative sample of U.S. adults. Additionally, we investigate the role of perceived discrimination as a mediator of the relationship between rural identity and cardiometabolic multimorbidity status. We report the overall and stratified prevalence of cardiometabolic multimorbidity. Findings from multivariate logistic regression indicated that age, rural identity, healthcare access, and perceived discrimination were associated with higher odds of cardiometabolic multimorbidity. Perceived discrimination was found to be a significant mediator for the relationship between rural identity and cardiometabolic multimorbidity status. These findings have implications for the design and implementation of effective multilevel interventions to reduce the impact of perceived discrimination on cardiometabolic multimorbidity among rural adults.

The Mediating Effect of Self-Efficacy in the Relationship Between Goal Orientation and Career Management Behavior

Journal of Social Sciences · 2025-02-28

본 연구의 목적은 성취목표지향성과 학습목표지향성이 경력관리행동에 미치는 영향에서 자기효능감의 매개효과를 확인하는 데 있다. 국내 다양한 기업에 근무하는 500명의 직장인을 대상으로 온라인 설문조사를 실시하였다. 분석 결과, 성취목표지향성과 학습목표지향성 모두 경력관리행동에 유의미한 정적인 영향을 미쳤으며, 성취목표지향성과 학습목표지향성이 경력관리행동에 영향을 미치는 과정에서 자기효능감의 매개효과가 유의한 것으로 확인되었다. 성취목표지향성과 학습목표지향성의 매개효과를 통합분석 한 결과, 학습목표지향성과 경력관리행동의 관계에서만 자기효능감의 매개효과가 유의한 것으로 나타났다. 연구 결과를 통해 조직구성원의 성취목표지향성과 학습목표지향성이 자기효능감을 높여 경력관리행동을 촉진하는 데 중요한 역할을 할 수 있음을 알 수 있다. 특히, 학습목표지향성이 새로운 지식과 기술 습득을 통해 자기효능감을 강화하고 경력관리행동을 촉진한다는 것을 확인하였다. 본 연구는 성취목표지향성과 학습목표지향성의 동기적 성향이 자기효능감을 매개로 경력관리행동에 미치는 영향을 실증적으로 확인함으로써 경력개발 연구의 이론적 기반을 확장하였다. 또한, 조직구성원의 학습목표지향성을 강화하기 위한 개인의 목표 수립의 중요성을 확인하고 체계적인 교육과 지원 프로그램의 설계, 자기효능감 증진을 통한 경력관리행동 촉진 방안을 실무적 함의로 제시하였다는 점에 의의가 있다.

More Evidence of the Health Risks from Being Skinny Fat: The Association with Systemic Inflammation

2025-09-01

<h3>Context</h3> Recent data shows many people with a healthy body mass index (BMI) but high body fat percentage (BF%) have prediabetes, undiagnosed diabetes, hypertension &amp; nonalcoholic fatty liver disease. These individuals may be at increased risk for cardiometabolic dysregulation. This study examined whether high BF% at a healthy BMI is associated with elevated inflammation, a marker of cardiovascular risk. <h3>Population, Design and Outcome Measures</h3> Using 2017–2018 National Health and Nutrition Examination Survey (NHANES) data, we categorized adults aged &gt;18 years with BMI &gt;18.5 kg/m2 into body composition (BC) groups based on BMI and BF%: 1)Normal BMI (18.5-24.9 kg/m2) &amp; normal BF% (&lt;25% in men/&lt;35% in women) 2)Normal BMI &amp; high BF% (≥25% in men/≥35% in women) 3)Overweight/Obese BMI (≥25 kg/m2) &amp; normal BF% 4)Overweight/Obese BMI &amp; high BF% Logistic regression assessed associations between BC group and elevated hs-CRP (&gt;3 mg/L), adjusting for age and race/ethnicity. Sex-stratified models were also conducted. All analyses were survey-weighted for nationally representative estimates. <h3>Results</h3> Overall, 32.7% had elevated hs-CRP, with the highest prevalence (43.6%) in those with overweight/obese BMI &amp; high BF%. Compared to the reference group (normal BMI &amp; normal BF%), adults with normal BMI &amp; high BF% had over threefold increased odds of elevated hs-CRP (AOR 3.34 [95% CI: 1.83, 6.08]), while those with overweight/obese BMI &amp; high BF% had over sixfold increased odds (AOR 6.19 [95% CI: 3.66, 10.50]). Overweight/obese BMI &amp; normal BF% was not significantly associated with inflammation in the overall population. In sex-stratified analyses, compared to the reference group, normal BMI &amp; high BF% was associated with elevated hs-CRP in both sexes, with a stronger association in males (AOR 4.44 [95% CI: 1.62, 12.10]) than females (AOR 2.78 [95% CI: 1.40, 5.52]). Overweight/obese BMI &amp; high BF% showed a stronger association with inflammation in females (AOR 8.51 [95% CI: 4.70, 15.40]) than males (AOR 4.39 [95% CI: 2.28, 8.43]). Overweight/obese BMI &amp; normal BF% was significant only in females (AOR 2.05 [95% CI: 1.09, 3.86]). <h3>Conclusions</h3> Adults with normal BMI &amp; high BF% (a “skinny-fat” phenotype) had significantly higher odds of inflammation than both those with normal BMI &amp; normal BF% and those with overweight/obese BMI &amp; normal BF%, with the strongest association seen in males. These findings suggest BF% provides vital insight into inflammation risk beyond BMI alone.

Perceptions of Nursing Students on Infectious Disease Nursing in the Era of Climate Change: Applying a Content Analysis Method

2025-08-21

Purpose: This study aimed to explore nursing students' perceptions of infectious disease nursing in the context of climate change and to identify resulting implications for nursing education and practice. Methods: This qualitative study employed content analysis of data from 105 third- and fourth-year nursing students at universities in Seoul and Gyeonggi Province. Semi-structured interviews and open-ended survey responses were analyzed thematically to assess awareness, experiences, and educational needs regarding climate-related infectious diseases. Results: Most students acknowledged that climate change significantly contributes to the emergence and spread of infectious diseases and emphasized the need for nurses to assume expanded, specialized roles in response. However, their engagement in self-directed learning and application of scientific evidence was limited. Students expressed a strong preference for digital and immersive educational strategies, such as simulation, community-based practice, and interdisciplinary curricula. They also recognized the importance of nursing leadership in public health and active involvement in health policy. Conclusion: To respond effectively to health threats from climate-related infectious diseases, nursing education must integrate climate-health content and adopt practical, technology-enhanced teaching methods. Furthermore, strengthening nurses' roles in community intervention and health policy advocacy requires robust institutional support.

Evaluating the Economic Impact of Project ECHO Diabetes: Cost Savings From HbA1c Reduction in Type 1 and Type 2 Diabetes

Endocrine Practice · 2025-07-03

More evidence of the health risks of normal weight obesity: the association with systemic inflammation

Frontiers in Medicine · 2025-11-18 · 3 citations

Background: Normal weight obesity (NWO) - a normal body mass index (BMI) with high body fat percentage (BF%) - has been linked to increased cardiometabolic risk. This study examined whether NWO is associated with systemic inflammation. Methods: Using 2017-2018 NHANES data, we categorized adult respondents aged 18-59 with BMI ≥ 18.5 into four groups:Reference: Normal BMI (18.5-24.9) with normal BF% (< 25% males/ < 35% females)NWO: Normal BMI with high BF% (≥ 25% males/ ≥ 35% females)Elevated BMI (≥ 25) with normal BF%Elevated BMI with high BF%Survey-weighted logistic regression examined associations with elevated hs-CRP (> 3.0 mg/L), adjusting for age and race/ethnicity. Sex-stratified analyses were also conducted. Results: Inflammation prevalence was 32.7% overall, highest among individuals with elevated BMI and high BF% (43.6%). Compared to the reference group, individuals with NWO had over 3-fold increased odds of inflammation [AOR 3.34 (95% CI: 1.83, 6.08)]; individuals with elevated BMI and high BF% had over 6-fold increased odds [AOR 6.19 (95% CI: 3.66, 10.50)]. Elevated BMI with normal BF% was not significantly associated with inflammation.In sex-stratified analyses, NWO was associated with inflammation in both males [AOR 4.44 (95% CI: 1.62, 12.10)] and females [AOR 2.78 (95% CI: 1.40, 5.52)]. Elevated BMI and high BF% was also associated with inflammation in both sexes. Conclusion: In this cross-sectional study, NWO was associated with inflammation, although causality cannot be inferred. Reliance on BMI alone may misclassify cardiometabolic risk therefore BF% should be considered in clinical assessments.

The Effects of Teachers' Age, Class-Age, Empathy, and Social Support on Early Childhood Teachers' Practice for the Rights of Young Children by Applying the Hierarchical Regression Analysis

Korea Journal of Child Care and Education · 2025-08-31

본 연구는 영유아 교사의 연령, 담당학급연령, 공감능력과 사회적지지가 영유아 권리존중 실행에 미치는 영향력을 위계적으로 분석하는 것을 목적으로 한다. 연구대상자는 비확률추출법에 의한 편의표집을 이용하여 영유아 교육기관에 근무 중인 영유아 교사 295명을 대상으로 2024년 9월 16일부터 10월 4일까지 온라인 설문조사를 진행하였다. 수집된 자료는 SPSS 31.0 프로그램을 사용하여 빈도분석, 기술통계, 신뢰도 분석, 상관관계 분석, 위계적 회귀분석을 실시하였다. 본 연구의 주요 분석 결과는 다음과 같다. 첫째, 영유아 교사의 공감능력 및 사회적지지, 영유아 권리존중 실행의 수준은 평균 이상으로 높은 수준임이 확인되었다. 둘째, 영유아 교사의 영유아 권리존중 실행과 교사의 연령, 담당학급연령, 공감능력, 사회적지지 간에는 유의한 상관관계가 있는 것으로 나타났다. 셋째, 영유아 교사의 영유아 권리존중 실행에 미치는 영향에 대한 위계적 회귀분석 결과, 사회적지지의 하위요인인 평가적지지와 정보적지지, 교사의 연령, 인지적 공감순으로 영향력이 나타났다. 또한 영유아 권리존중 실행의 하위요인인 하루일과 존중에는 정보적지지, 교사의 연령, 인지적 공감과 정서적 공감이, 그리고 또 다른 하위요인인 아동 최선의 이익에는 평가적지지, 정보적지지 그리고 인지적 공감순으로 유의한 영향을 미치는 것으로 확인되었다. 이로써 영유아 교육기관에서 양질의 돌봄과 교육이 이루어지기 위해 영유아 교사의 공감능력과 사회적지지를 강화하기 위한 지원 방향을 재고하며 영유아 권리존중 실행의 기초를 확립하는 데 연구의 의의를 둔다.