Body mass index and health care utilization in diabetic and nondiabetic individuals.

BackgroundAlthough controversial, most studies examining the relationship of body mass index (BMI) with mortality in diabetes suggest a paradox: the lowest risk category is above normal weight, versus normal weight in nondiabetic persons. One proposed explanation is greater morbidity of diabetes in normal weight persons. If this were so, it would suggest a health care utilization paradox in diabetes, paralleling the mortality paradox, yet no studies have examined this issue.ObjectiveTo compare the relationship of BMI with health care utilization in diabetic versus nondiabetic persons.DesignPopulation-based cross-sectional study.SubjectsAdults in the 2000-2011 Medical Expenditures Panel Surveys (N=120,389).MeasuresTotal health care expenditures, hospital utilization (≥1 admission), and emergency department utilization (≥1 visit). BMI (kg/m) categories were: <20 (underweight); 20 to <25 (normal); 25 to <30 (overweight); 30 to <35 (obese); and ≥35 (severely obese). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, co-morbidity, urbanicity, region, and year.ResultsAmong diabetic persons, adjusted mean total health care expenditures were significantly lower in obese versus normal weight persons ($1314, 95$513-$2115; P=0.001). By contrast, among nondiabetic persons, total expenditures were nonsignificantly higher in obese versus normal weight persons (-$229, 95% CI, -$460 to$2; P=0.052). Findings for hospital and emergency department utilization exhibited similar patterns.ConclusionsNormal weight diabetic persons used substantially more health care than their overweight and obese counterparts, a difference not observed in nondiabetic persons. These differences support the plausibility of a BMI mortality paradox related to greater morbidity of diabetes in normal weight than in heavier persons

Surveying Persons with Disabilities: A Source Guide (Version 1)

As a collaborator with the Cornell Rehabilitation Research and Training Center on Disability Demographics and Statistics, Mathematica Policy Research, Inc. has been working on a project that identifies the strengths and limitations in existing disability data collection in both content and data collection methodology. The intended outcomes of this project include expanding and synthesizing knowledge of best practices and the extent existing data use those practices, informing the development of data enhancement options, and contributing to a more informed use of existing data. In an effort to provide the public with an up-to-date and easily accessible source of research on the methodological issues associated with surveying persons with disabilities, MPR has prepared a Source Guide of material related to this topic. The Source Guide contains 150 abstracts, summaries, and references, followed by a Subject Index, which cross references the sources from the Reference List under various subjects. The Source Guide is viewed as a “living document,” and will be periodically updated

Changes in BMI and waist circumference in Scottish adults: use of repeated cross-sectional surveys to explore multiple age groups and birth-cohorts

Objective: To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults.<p></p> Subjects: Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. ‘Synthetic birth-cohorts’ were created by dividing participants into thirteen 5-years-of-birth bands (n=20,423). Weight, height and waist circumference were objectively measured by trained observers.<p></p> Results: Subjects with data available on BMI/waist circumference were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and waist circumferences were greater, by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998-2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than BMI (mean 1.8 kg/m2 (6.6%) in men and 1.5 kg/m2 (6.4%) in women) were particularly steep in older women.<p></p> Conclusion: People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than 1998 and 2003. There were proportionally greater increases in waist circumference than BMI, especially in older women. This suggests a disproportionate increase in body fat, compared to muscle, particularly among older women.<p></p&gt

Clinical Pathways to Disability

This paper examines the pathways by which individuals transition from healthy to disabled. Because of the high prevalence and costs associated with disability, understanding these pathways is critical to developing interventions to prevent or minimize disability. We compare two estimates of disabling conditions: those observed in medical claims and conditions indicated by the disabled individual. A small number of conditions explain about half of incident disability: arthritis, infectious disease, dementia, heart failure, diabetes, and stroke. These conditions show up in medical claims and self reports. A large number of elderly also attribute disability to old age and various symptoms. Because so many of the most disabling conditions do not have clear medical treatments, the outlook for major reductions in disability might be limited.

Examining Training Motivations Among Public Health Workers

CONTEXT: As public health needs and priorities evolve, maintaining a trained public health workforce is critical to the success of public health efforts. Researchers have examined training needs in various contexts and subpopulations, but a nationally representative study of what motivates public health workers to seek out training has yet to be conducted. By understanding these motivations, public health agencies and policy makers can appeal to worker motivations in both training programs and organizational incentives. OBJECTIVE: The purpose of this article was to describe overall training motivations and identify patterns of training motivations among public health workers. This study also explored whether or not training needs differ across prevalent motivational patterns. DESIGN AND PARTICIPANTS: Using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), the study used latent class analysis (LCA) to identify motivational patterns and logistic regression to analyze associations with training needs. RESULTS: The most prominent motivation to seek training was personal growth (82.7% of respondents). LCA identified 4 motivational classes of public health workers: those motivated by organizational pressure and requirements (31.8%), those motivated indiscriminately by all factors (28.4%), those motivated primarily by personal growth (21.7%), and those motivated by organizational accommodations and supports (18.2%). Motivational class was not associated with indicating training needs in any of 8 training domains, nor was it associated with indicating any training need in any domain. CONCLUSIONS: Public health agencies should consider the different motivational classes present in the public health workforce. In particular, motivational classes that represent organizational choices suggest that public health agencies should both motivate workers with organizational requirements and pressure from managers and offer institutional support via paid travel and covered time for training

Drawing Lines: Racial Gerrymandering in Bethune-Hill v. Virginia Board of Elections

In Bethune-Hill v. Virginia Board of Elections, the Supreme Court had to decide whether twelve Virginia challenged legislative districts, in which a one-size-fits-all 55% black voting age population floor was imposed, withstood constitutional scrutiny. The Court, though stating that the lower court misapplied precedent, declined to hold that race predominated in the formation of the districts and that strict scrutiny would be triggered, instead remanding to the lower court for reexamination. This commentary argues that the Court missed an opportunity to hold that a 55% BVAP floor prioritized above all else is per se racial predomination, and such a holding would be justified by serious policy goals

Genomics knowledge and attitudes among European public health professionals. Results of a cross-sectional survey

Background The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. Methods EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. Results Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01–2.18). Conclusions Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals