Training Community-Based Professionals to Implement an Empirically Supported Parenting Program

Professionals representing 14 community-based organizations were trained at three different sites serving urban and rural families to implement an empirically supported parenting program for families of young children with challenging behaviors. Of the 44 practitioners trained, 23 successfully completed the program, which involved passing a knowledge test and facilitating the entire 10session program with a family. A total of 28, primarily low-income families completed the program. The family outcomes obtained by the facilitators, based on multiple pre-program and post-program measures, were comparable with those reported previously in the literature for facilitators trained in university settings. The challenges inherent in efforts to increase the community’s capacity to implement empirically supported programs are addressed

Association of Self-Reported Weight Change and Quality of Life, and Exercise and Weight Management Behaviors Among Adults with Type 2 Diabetes Mellitus: The SHIELD Study

Purpose. This study examined the association between self-reported weight change and quality of life, and exercise and weight management behaviors among individuals with type 2 diabetes mellitus (T2DM). Methods. In the US SHIELD study, respondents reported whether they had lost or gained weight compared with 1 year earlier and completed the SHIELD-WQ-9 quality of life questionnaire as well as provided information on their exercise and weight management behaviors in the past 12 months. Results. Sixteen percent of the respondents reported gaining weight (n = 460), and 30% reported losing weight (n = 895). More respondents who reported losing weight exercised regularly, limited calorie and fat intake, and increased fiber, fruit, and vegetable intake compared with respondents who reported gaining weight (P < 0.01). For all nine aspects of daily life, a significantly greater proportion of respondents who reported losing weight reported improved well-being (12%–44%) compared with respondents who reported gaining weight (P < 0.0001). Conclusions. Self-reported weight loss was associated with improved well-being, better exercise, and weight management behaviors among individuals with T2DM

Quality of Life, Depression, and Healthcare Resource Utilization among Adults with Type 2 Diabetes Mellitus and Concomitant Hypertension and Obesity: A Prospective Survey

Background. This study compared quality of life, depression, and healthcare resource utilization among adults with type 2 diabetes mellitus (T2DM) and comorbid hypertension (HTN) and obesity with those of adults reporting T2DM alone. Methods. Respondents to the US SHIELD survey self-reported their height, weight, comorbid conditions, hospitalizations, and outpatient visits and completed the Short Form-12 (SF-12) and Patient Health Questionnaire (PHQ-9). Respondents reporting T2DM and HTN and obesity (body mass index, BMI, ≥30 kg/m2) were compared with a T2DM-alone group. Results. Respondents with T2DM, HTN, and obesity (n = 1292) had significantly lower SF-12 Physical and Mental Component Summary scores (37.3 and 50.9, resp.) than T2DM-alone respondents (n = 349) (45.8 and 53.5, resp., P < 0.0001). Mean PHQ-9 scores were significantly higher among T2DM respondents with comorbid HTN and obesity (5.0 versus 2.5, P < 0.0001), indicating greater depression burden. Respondents with T2DM, HTN, and obesity had significantly more resource utilization with respect to physician visits and emergency room visits but not hospitalizations than respondents with T2DM alone (P = 0.03). Conclusions. SHIELD respondents with comorbid conditions of T2DM, HTN, and obesity reported greater healthcare resource utilization, more depression symptoms, and lower quality of life than the T2DM-alone group

Trends in Method of Diagnosis of Type 2 Diabetes Mellitus: Results from SHIELD

Aims. This study assessed whether recent screening recommendations have led to increased diagnosis of type 2 diabetes mellitus (T2DM) through routine screening. Methods. Respondents to the 2006 US SHIELD survey reported whether a physician told them they had T2DM, age at diagnosis, specialty of the physician who made the diagnosis, and whether the diagnosis was made after having symptoms, during routine screening, or when being treated for another health problem. Results. Of 3 022 T2DM respondents, 36% of respondents reported that T2DM diagnosis was made during routine screening alone, 20% after having symptoms alone, and 6% when being treated for another health problem alone. The proportion of T2DM respondents reporting a diagnosis based only on screening increased approximately 42% over a 15+-year time span (absolute increase from 31% to 44%) (P < .001), whereas symptom-based diagnosis did not change significantly (P = .10). T2DM was diagnosed primarily by family physicians (88.3%). Conclusion. These findings highlight the importance of regular screening for diabetes and the vital role of primary care physicians in recognizing individuals with T2DM

Changing the Latitudes and Attitudes about Content Analysis Research

The current research employs the use of content analysis to teach research methods concepts among students enrolled in an upper-division research methods course. Students coded and analyzed Jimmy Buffett song lyrics rather than using a downloadable database or collecting survey data. Students’ knowledge of content analysis concepts increased after a lecture on the topic of content analysis, but it further improved after participating in the song coding, data cleaning, and writing of results. Additionally, students reported high satisfaction with the project and believed it was an interesting and enjoyable technique for learning about research methods. We provide suggestions for incorporating similar data collection activities in undergraduate research methods courses

Estimation of Cachexia among Cancer Patients Based on Four Definitions

Objectives. Estimate and compare the proportion of cancer patients with cachexia using different definitions from available clinical data. Methods. Electronic medical records were examined to estimate the proportion of cancer patients with cachexia using 4 definitions: (1) ICD-9 diagnostic code of 799.4 (cachexia), (2) ICD-9 diagnosis of cachexia, anorexia, abnormal weight loss, or feeding difficulties, (3) prescription for megestrol acetate, oxandrolone, somatropin, or dronabinol, and (4) ≥5% weight loss. Patients with cancer of the stomach, pancreas, lung, colon/rectum, head/neck, esophagus, prostate, breast, or liver diagnosed between 1999 and 2004 were followed for cachexia. Results. Of 8541 cancer patients (60% men and 55% Caucasian), cachexia was observed in 2.4% of patients using the cachexia diagnostic code, 5.5% expanded diagnoses, 6.4% prescription medication definition, and 14.7% with ≥5% weight loss. Conclusions. The proportion of patients with cachexia varied considerably depending upon the definition employed, indicating that a standard operational definition is needed

Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events

Background: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%. Methods: A probabilistic Monte Carlo simulation model based on data from JUPITER (the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) was used to estimate the long-term cost-effectiveness of rosuvastatin 20 mg daily versus simvastatin or atorvastatin 40 mg for the prevention of cardiovascular death and morbidity. The three-stage model included cardiovascular event prevention simulating the 4 years of JUPITER, initial prevention beyond the trial, and subsequent cardiovascular event prevention. A Swedish health care payer perspective (direct costs only) was modeled for a lifetime horizon, with 2008/2009 as the costing period. Univariate and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life-year (QALY) gained with rosuvastatin 20 mg over simvastatin or atorvastatin 40 mg ranged from SEK88,113 (rosuvastatin 20 mg versus simvastatin 40 mg; Framingham risk ≥30%; net avoidance of 34 events/1000 patients) to SEK497,542 (versus atorvastatin 40 mg: Framingham risk ≥20%; net avoidance of 11 events/1000 patients) over a lifetime horizon. Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%–85% of simulations relative to atorvastatin or simvastatin 40 mg. Sensitivity analyses indicated the findings to be robust. Conclusion: Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden

Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study

Background: Transfusion patterns are not well characterized in non-dialysis (ND) chronic kidney disease (CKD) patients. This study describes the proportion of patients transfused, units of blood transfused and trigger-hemoglobin (Hb) levels for transfusions in severe anemic, ND-CKD patients in routine practice. Methods. A retrospective cohort study of electronic medical record data from the Henry Ford Health identified 374 adult, ND-CKD patients with severe anemia (Hb \u3c 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb \u3c 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥1 days between units of blood transfused was counted as a separate transfusion. Results: At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (±SD) follow-up of 459 (±427) days. The mean (±SD) Hb level closest and prior to a transfusion was 8.8 (±1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p \u3c 0.0001). Patients with peripheral vascular disease (PVD) were twice as likely to have a transfusion as patients without PVD (p = 0.04). Conclusions: Transfusions were prevalent and the trigger hemoglobin concentration was approximately 9 g/dL among ND-CKD patients with anemia. To reduce the transfusion burden, clinicians should consider other anemia treatments including ESA therapy. © 2012 Fox et al; licensee BioMed Central Ltd

Clinical and economic burden associated with cardiovascular events among patients with hyperlipidemia: a retrospective cohort study

Onur Başer (MEF Author)Background: Annual direct costs for cardiovascular (CV) diseases in the United States are approximately $195.6 billion, with many high-risk patients remaining at risk for major cardiovascular events (CVE). This study evaluated the direct clinical and economic burden associated with new CVE up to 3 years post-event among patients with hyperlipidemia. Methods: Hyperlipidemic patients with a primary inpatient claim for new CVE (myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, coronary artery bypass graft, percutaneous coronary intervention and heart failure) were identified using IMS LifeLink PharMetrics Plus data from January 1, 2006 through June 30, 2012. Patients were stratified by CV risk into history of CVE, modified coronary heart disease risk equivalent, moderate-and low-risk cohorts. Of the eligible patients, propensity score matched 243,640 patients with or without new CVE were included to compare healthcare resource utilization and direct costs ranging from the acute (1-month) phase through 3 years post-CVE date (follow-up period). Results: Myocardial infarction was the most common CVE in all the risk cohorts. During the acute phase, among patients with new CVE, the average incremental inpatient length of stay and incremental costs ranged from 4.4-6.2 days and$25,666-$30,321, respectively. Acute-phase incremental costs accounted for 61-75 % of first-year costs, but incremental costs also remained high during years 2 and 3 post-CVE. Conclusions: Among hyperlipidemic patients with new CVE, healthcare utilization and costs incurred were significantly higher than for those without CVE during the acute phase, and remained higher up to 3 years post-event, across all risk cohorts.WOS:000368239100003Scopus - Affiliation ID: 60105072PMID: 26769473Science Citation Index ExpandedQ3ArticleUluslararası işbirliği ile yapılan - EVETOcak2016YÖK - 2015-1