Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study

<p>Abstract</p> <p>Background</p> <p>Our understanding of social disparities in diabetes-related health behaviors is incomplete. The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors.</p> <p>Methods</p> <p>This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States. Self-reported survey data included individual educational attainment ("education") and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated: foot exams (among those with symptoms of peripheral neuropathy or a history of foot ulcers); self-monitoring of blood glucose (SMBG; among insulin users only); smoking; exercise; and certain diabetes-related health seeking behaviors (use of diabetes health education, website, or support group in last 12 months). Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with random effects for clustering within health plans.</p> <p>Results</p> <p>Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors, while SMBG and foot self-examination did not vary by education. Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance, and most education-behavior relationships were similar across sex, race and other patient characteristics. The relationship between education and smoking varied significantly across age, with a strong inverse relationship in those aged 25–44, modest for those ages 45–64, but non-evident for those over 65. Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships. Other measures of socioeconomic position yielded similar findings.</p> <p>Conclusion</p> <p>The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient.</p

Prediksi Kenaikan atau Penurunan Indeks Pasar Keuangan Indonesia dengan Menggunakan Bayesian Network

Investasi saham pada pasar keuangan dilakukan untuk meningkatkan aset pada masa depan. Dalam melakukan investasi harus mempertimbangkan hasil yang akan didapatkan atau biasa disebut return. Setiap investor akan berusaha mendapatkan return semaksimal mungkin dari investasi yang dilakukannya. Oleh karena itu, perlu dilakukan prediksi perubahan kenaikan atau penurunan pada pasar saham. Beberapa metode untuk membuat prediksi adalah Bayesian Network dan Algoritma Naive Bayes. Pada Tugas Akhir ini, dilakukan pemodelan jaringan sektor-sektor pasar keuangan Indonesia dengan menggunakan Bayesian Network, lalu melakukan prediksi berdasarkan kenaikan atau penurunan harga penutupan dari tiap sektor. Metode yang digunakan adalah menggunakan Algoritma Naive Bayes Diskrit dan Kontinu. Setelah itu, menentukan metode yang terbaik untuk perhitungan prediksi dengan melihat tingkat akurasi dari setiap metode dengan confusion matrix. Sektor pasar keuangan yang digunakan yaitu nilai tukar USD/IDR, IHSG, dan Obligasi. Perhitungan dilakukan berdasarkan ketergantungan antara nilai tukar USD/IDR terhadap IHSG, dan nilai tukar USD/IDR terhadap Obligasi. Metode Naive Bayes Diskrit menunjukan hasil yang lebih akurat dengan akurasi sebesar 84% untuk IHSG dan 76% untuk Obligasi. Sedangkan perhitungan dengan metode Naive Bayes Kontinu memiliki akurasi sebesar 52% untuk IHSG dan 48% untuk Obligasi. Sektor nilai tukar USD/IDR lebih mempengaruhi IHSG, karena tingkat akurasi yang diperoleh IHSG lebih tinggi dibandingkan dengan Obligasi

Psychosocial determinants of sustained maternal functional impairment: longitudinal findings from a pregnancy-birth cohort study in rural Pakistan

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed

Age and the balance of emotions

With age, the quality of emotions may shift from negative in tone to positive, but also from active to passive. The shift from negative to positive is consistent with the age as maturity perspective. The shift from active to passive supports the age as decline perspective. If these generalities are correct, then they should apply to positive emotions as well as negative emotions. We should see a shift in positive emotions from active (excitement) to passive (serenity), as well as in the negative emotions (from the agitation of anxiety and anger to the lethargy of depression). In order to accurately portray the shifts in emotional tone, age may best be considered as simultaneously indicating maturity and decline. This paper examines results from the emotions module of the 1996 U.S. General Social Survey and finds support for the idea that age is associated with a shift from negative to positive and from active to passive emotions.Age Depression Anxiety Anger Serenity Emotions Older people Aging USA

The interaction of personal and parental education on health

The association between education and good health is well established, but whether the strength of the association depends on other social statuses is not. We test a theory of resource substitution which predicts a larger correlation between education and health (measured for physical impairment) for people who grew up in families with poorly-educated parents than for those whose parents were well educated. This is supported in the Aging, Status, and Sense of control (ASOC) survey, a representative national U.S. sample with data collected in 1995, 1998, and 2001. The reason that parental education matters more to people who are poorly educated themselves is due to an unhealthy lifestyle, specifically to smoking and being overweight. Finally, as the poorly educated age, the negative health effects of their parents' low educational attainment get worse.Education Parental education Health Physical impairment

Depression, parenthood, and age at first birth

This study tests the hypothesis that the correlation between current depression and parenthood depends on the age at first birth for adults. An early first birth suggests a poor start in life. It may reflect a disordered transition from adolescence into adulthood and may itself disrupt that transition, with life long consequences that influence emotional well-being. To test the hypothesis we analyze data from a 1995 survey of 2592 US 18 through 95. Among the parents we find a generally negative association between age at first birth and recent feelings and signs of depression, adjusting for age, sex, minority status, and education of the respondent's parents. Respondents who had a first birth before age 23 report more feelings and signs of depression than do nonparents; those who had a first birth after age 23 report fewer than do nonparents. The association between depression and age at first birth is monotonic for males but parabolic for females. The age at first birth associated with the lowest predicted depression for females is around 30. Regression analyses indicate that several correlates account for the apparent psychological benefits of delaying first birth: later first marriages, higher educational attainment, lower risk of having had a prolonged period needing a job but not being able to find one, lower risk of having had periods lacking the money for household necessities, and better current physical health. For women, health consequences limit the emotional benefits of prolonged delay of the first birth.Depression Parenthood Age at first birth Family formation United States

Patient satisfaction and visiting the doctor: A self-regulating system

In 1974, Aday and Anderson proposed that client satisfaction may affect utilization of physician services, and that utilization, in turn, may affect satisfaction. Since that time, a number of researchers have investigated the issue, adopting increasingly sophisticated approaches. To date, however, the statistical models used to test the hypothesized feedback have not been completely appropriate. We develop and test alternative hypotheses on the reciprocal effects of satisfaction and utilization. Using methods that allow us to specify models with feedback effects, we examine whether satisfaction with the doctor and visits to the doctor form a self-regulating or a self-amplifying system. In both, satisfaction is expected to result in more visits to the doctor, but in a self-regulating system, visits are hypothesized to lead to lower satisfaction while in the self-amplifying system, visits are hypothesized to produce greater satisfaction. We specify and test the feedback model in two data sets: one based on a cross-sectional survey of pediatric practices in New Haven, Connecticut and the other based on Gray's panel survey of the Federal Employees Health Benefits Program. In both cases the results indicate that satisfaction and visits form a self-regulating system.