Sociodemographic Risk Factors of Diabetes and Hypertension Prevalence in Republic of Korea

This study examined the relationships between SES and diabetes and hypertension for Korean adults using the Korean National Health and Nutritional Examination Survey. To handle the four dummy dependent variables: Diabetes and Hypertension, Diabetes alone, Hypertension alone, and Diabetes or Hypertension, four different logistic models were conducted. The descriptive statistics showed a considerable amount of comorbidity between the combined dependent variable of diabetes and hypertension. To gauge more realistic measures of SES, education and income were combined together as four dummy categories. The SES factor indeed had significant impacts on diabetes and hypertension. Socioeconomically disadvantaged groups demonstrated to have increased likelihood of having these diseases. However, we could not find the strong compensating effect between education and income; the higher level of education but lower income variable was only significant in having both diseases, and the higher income but lower level of education variable was only significant in having hypertension alone and either one of the diseases. Only the highest SES one, the one with a higher level of education and a higher income, was significantly lowering the likelihood of having these diseases in all models. Therefore, public policy and intervention programs should focus on individuals matching these socioeconomic characteristics

Self-reported predictors of depressive symptomatology in an elderly population with type 2 diabetes mellitus: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The prevalence of depression increases among the elderly with chronic medical conditions like diabetes. Hence, the purpose of this study was to determine predictors of depressive symptomatology in Medicare enrolled elderly population with type 2 diabetes mellitus.</p> <p>Methods</p> <p>A prospective cohort study was conducted by administrating health risk assessment questionnaire to elderly (≥65 years) with type 2 diabetes. Responses were linked with administrative claim's data. Data were obtained from elderly with type 2 diabetes who were enrolled in Medicare Health Maintenance Organization (HMO) in southeastern United States. The instrument collected information related to demographics, health status, medication use, and healthcare service utilization prior to enrollment. Responses were combined with the administrative claims data of HMO to obtain information on actual utilization of healthcare resources. The Short Form Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. Multivariable logistic regression analyses were conducted to determine predictor variables.</p> <p>Results</p> <p>Of 792 respondents, about 17% had depressive symptoms. Almost 96% of patients were using 1 or more antidiabetic medications. Overall, increased risk of depression was associated with lower health related quality of life (HRQoL) (OR: 0.97; 95% CI: 0.96–0.98) and higher impairments in instrumental activities of daily living (IADLs) (OR: 1.31; 95% CI: 1.14–0.52) in elderly patients. Poor health related quality of life (OR: 0.97, 95%CI: 0.95–0.99) was associated with higher risk of depression in patients on insulin therapy.</p> <p>Conclusion</p> <p>Impairments in daily activities and lower HRQoL were predictors of depressive symptomatology in elderly with diabetes. Determinants of depression varied according to pharmacotherapeutic class of antidiabetic medications.</p

Quality of life in patients with psoriasis

Psoriasis is one of the prevalent skin conditions in the United States. This chronic condition has a significant negative impact on patients' quality of life. Psoriasis has been linked to the depression and suicidal tendencies in the patients. The costs associated with decrements in quality of life, lost productivity, and work absenteeism may be enormous, increasing overall costs associated with the disease management. This review attempts to outline different quality of life measures available for psoriasis and describes their use in studies examining patient reported outcomes associated with pharmacological interventions for psoriasis. Factors associated with quality of life in psoriasis patients are described. It further describes physician's role in the psoriasis management to improve patients' overall well-being

Knowledge of the Human Papillomavirus Vaccine: An Analysis using Together for Health Virginia Population Health Survey

Purpose: The purpose of this analysis was to identify key predictors which impact knowledge of the Human Papillomavirus vaccine in adults aged 21 to 45 in Virginia. Methods: Data was collected from the Together for Health Virginia Population Surveys administered by Virginia Commonwealth University and the University of Virginia. Logistic regression was performed on data using the variables sex, age, rurality, race, education, income, occupation, and type of health insurance coverage. Results: There was a statistically significant positive relationship between knowledge of the HPV vaccine and part-time occupation (OR: 4.288, CI: 1.492-13.325), younger age (OR: 2.31, CI: 1.088-4.905), and higher education (OR: 2.683, CI: 1.227-5.870). There was a statistically significant negative relationship between knowledge of the vaccine and being male (OR: 0.437, CI: 0.248-0.771), living in an urban area (OR: 0.511, CI: 0.267-0.977), and identifying in the lower income category (OR: 0.246, CI: 0.093-0.651). Conclusion: This study identified 6 key predictors in knowledge of the HPV vaccine among adults in Virginia. Future studies should explore, in particular, the category of students and residents of urban areas. Despite these results, knowledge of the HPV vaccine does not translate to intention to receive the vaccine. Therefore, future studies should additionally study attitudes, behaviors, and potential barriers

HPV Vaccination in the Virginia Context: Demographic Disparities, Patient-Provider Gender Concordance and the Impact of Changing Recommendations

Objective: Despite its effectiveness in preventing several cancers, there are marked disparities in HPV vaccination initiation and series completion. The present study sought to understand disparities in HPV vaccinations among patients in northern Virginia (ages 9-26) and the impact of patient and provider gender concordance, in lieu of CDC’s vaccine recommendation changes in 2016, which reduced the recommended doses from three to two, in this population. Design: Analyses of electronic medical records collected from 2012 to 2017. Setting: A large health care system in Northern Virginia. Participants: A total of 37,427 patients, ages 9 to 26, were included in analyses. Main outcome measures: We examined odds of initiating vaccination, completing vaccination at 6 months, completing vaccination at 12 months and clinical completion. We examined if patient and provider characteristics were associated with initiating vaccination and vaccination completion at different durations. Results: Racial minorities had higher odds of getting vaccinated, relative to non-Latino whites. Each additional year between the patient’s first and last visit was associated with higher odds of initiating vaccination, completing vaccination at both 6 and 12 months, and clinical completion. Compared to female patients who were 19 years and older, female patients aged 9-18 years had higher odds of initiating vaccination and clinical completion. Compared to male patients who were 19 years and older, female patients aged 9-18 years had higher odds of clinical completion Female and male patients had better outcomes when seen by female primary care providers than male primary care providers. Conclusions and Relevance: Further research should investigate the observed benefit of female providers and to understand the long-term impact of changes in CDC recommendations

Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91348/1/hpm2106.pd

Adjuvant therapy use among Appalachian breast cancer survivors

There is a paucity of literature systemically examining the effects of access to cancer care resources on adjuvant endocrine therapy (AET) use behaviors, especially in underserved regions such as the Appalachian region in the United States, where gaps in healthcare access are well documented. The objectives of this study were to explore AET adherence and persistence in Appalachia, delineate the effects of access to care cancer on adherence/persistence, and evaluate the influences of adherence and persistence on overall survival. A retrospective cohort study from 2006 to 2008 was conducted among female breast cancer survivors living in the Appalachian counties of 4 states (PA, OH, KY, and NC). We linked cancer registries to Medicare claims data and included patients with invasive, nonmetastatic, hormone-receptor-positive breast cancer who received guideline-recommended AET. Medication adherence was defined as corresponding to a Medication Possession Ratio (MPR) ≥0.8 and logistic regression was utilized to assess predictors of adherence. Medication nonpersistence was defined as the discontinuation of drugs after exceeding a 60-day medication gap, and multivariate adjusted estimates of nonpersistence were obtained using the Cox proportional hazards (PH) model. About 31% of the total 428 patients were not adherent to AET, and 30% were not persistent over an average follow-up period of 421 days. Tamoxifen, relative to aromatase inhibitors, was associated with higher odds of adherence (odds ratio = 2.82, P \u3c 0.001) and a lower risk of nonpersistence (hazard ratio = 0.40, P \u3c 0.001). Drug-related side effects like pain may be an important factor leading to nonadherence and early discontinuation. In addition, aromatase inhibitor (AI) adherence and persistence were significantly influenced by out-of-pocket drug costs, dual eligibility status, and coverage gaps. Nonadherence to and nonpersistence with AET were associated with higher risks of all-cause mortality. Our findings of suboptimal AET adherence/persistence in Appalachia as well as positive associations between AET adherence/persistence and overall survival outcomes further underscore the importance of ensuring appropriate AET use in this population to reduce breast cancer mortality disparities. Our findings also suggest that intervention strategies focusing on individualized treatment and medication-related factors may improve adjuvant treatment use

Assessing adherence to dermatology treatments: a review of self-report and electronic measures

Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self-report measures may be less reliable.To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease.A PubMed literature search was conducted using the terms ‘scale,’‘measure,’‘self-report,’‘electronic,’ and ‘medication adherence.’ Relevant articles were reviewed and selected if they addressed self-report or electronic measures of adherence in chronic disease.Eleven self-report instruments for the measurement of adherence were identified. Four were validated using electronic monitors. All produced an estimate of adherence that correlated with actual behavior, although this correlation was not strong for any of the measures. None of the scales was tested in patients who had dermatologic disease and/or used topical medications. Several electronic monitoring systems were identified, including pill counts, pharmacy refill logs, and the Medication Event Monitoring System (MEMS ® ). Validity was higher among electronic monitoring systems compared with self-report measures.While several self-report measures of adherence have been validated in chronic disease populations, their relevance in dermatology patients has not been studied. A dermatology-specific instrument for the measurement of adherence would contribute to improved outcomes; until such a tool exists, researchers and clinicians should consider nonadherence as a possible factor in skin disease that is not responsive to treatment. Electronic monitoring provides the most reliable means of measuring adherence, and may provide additional clues to identify barriers to adherence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79087/1/j.1600-0846.2010.00431.x.pd