Health-related quality of life in paediatric patients with Type 1 diabetes mellitus using insulin infusion systems. A systematic review and meta-analysis.

BACKGROUND: In 2017, more than 1.1 million children were living with type 1 diabetes mellitus (T1DM) globally. The goal in paediatric diabetes therapy is reaching optimal glycaemic control as early as possible in order to avoid complications and early mortality without compromising the quality of life (QoL) of children. Several different insulin regimens are available for T1DM patients to reach this goal. AIMS: This review set out to analyse whether continuous subcutaneous insulin infusion (CSII) regimens are superior to multiple daily injection (MDI) therapy in T1DM youth regarding QoL. Additionally, it assessed glycaemic control and adverse events as secondary outcomes and discussed potential future public health implications and justifications for using CSII as a first-line therapy in diabetic youth. METHODS: A systematic review and random effects meta-analysis was performed on studies investigating the association between QoL and diabetes treatment regimen. Differences in adverse event rates between groups were analysed using a Mann-Whitney U test. Lastly, differences in glycaemic control were assessed using a random effects meta-analysis. RESULTS: QoL and glycaemic control was significantly better in CSII subjects at baseline and follow-up. No significant differences in adverse events were found between study groups. No significant changes over time could be shown for either QoL or glycaemic control. CONCLUSION: CSII proved to provide similar or slightly better outcomes in all analysed fields. This is consistent with previous research. However, to make credible recommendations, better-designed studies are needed to investigate the impact of CSII in children

Latin America and the Caribbean is ageing rapidly, however the projections may be better than expected

The region is projected to experience a rapid change in its population’s age structure. The proportion of citizens older than 65 will more than double in the next three decades. However, rethinking ageing in terms of health is crucial to inform public policy, argue Diego Wachs (LSE) and Andres Roman Urrestarazu (Stanford University)

The impact of community health workers on antenatal and infant health in India: A cross-sectional study.

BACKGROUND: Community health workers (CHWs) are central to India's strategy for reaching the Sustainable Development Goals around maternal and child health. Despite India's significant investment in these programs, few studies have analyzed the effect of CHWs across India. OBJECTIVE: This study aims to analyze multiple types of CHWs and their impact on a broad range of antenatal and infant health outcomes across India. METHODS: In this population-based cross-sectional study, we analyzed data of women interviewed by the most recent 2015-2016 National Family Health Survey-4 (NFHS-4) in India. This study performed multiple variable regressions to examine the effect of receiving ANC during pregnancy from 1) any CHW and 2) by specific type of CHW - Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW), and Community/Village Health Worker (defined in Table 1) on antenatal and infant health outcomes. RESULTS: Of 166,498 women, 14.2% received ANC from any CHW with specifically 5.9% receiving from ASHAs, 10.2% receiving from AWWs, and 0.5% receiving from Community/Village Health Workers. Women who received ANC from an ASHA had increased ANC utilization (OR 1.77; 95% CI 1.65, 1.91) as well as quality (IRR 1.06; 95% CI 1.05, 1.08), increased early initiation of breast feeding (OR 1.20; 95% CI 1.12, 1.29), and decreased one-year mortality (OR 0.75; 95% CI 0.63, 0.88). Women who received ANC from an AWW had increased ANC utilization (OR 2.24; 95% CI 2.12, 2.37) as well as quality (IRR 1.07, 95% CI 1.06, 1.08) and increased early initiation of breast feeding (OR 1.30; 95% CI 1.26, 1.40). CONCLUSION: Receiving ANC from ASHAs and AWWs is associated with improved ANC utilization, ANC quality, early initiation of breastfeeding and the key outcome of reduced infant mortality

Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17.

BACKGROUND: Access to adequate treatment for opioid use disorder (OUD) has been a high priority among American policymakers. Elucidation of the sociodemographic and institutional differences associated with the use, or lack thereof, of opioid agonist therapy (OAT) provides greater clarity on who receives OAT. Timely access to care is a further consideration and bears scrutiny as well. METHODS: We draw upon data from the Treatment Episode Data Set-Admissions (TEDS-A) to analyse the relationship between sociodemographic and institutional characteristics and the receipt of opioid agonist treatments and time waiting to enter treatment. RESULTS: Estimates from logistic regression models highlight certain groups which show lower odds of receipt of OAT, including those in precarious housing arrangements, those unemployed or not otherwise in the labor force, and those referred by drug abuse care providers, educational institutions, employers, and the criminal justice system. Groups which showed higher odds of waiting over a week to enter treatment included those who were separated, divorced, or widowed, those working part-time, and those referred by drug abuse care providers, employers, and the criminal justice system. CONCLUSION: Given the efficacy of OAT and the adverse outcomes associated with long waiting times, coordinated effort is needed to understand why these differences persist and how they may be addressed through appropriate policy responses

Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16.

OBJECTIVE: To identify the geographic, organisational, and payment correlates of buprenorphine and methadone treatment among substance abuse treatment (SAT) providers. METHODS: Secondary analyses of the National Survey of Substance Abuse Treatment Services (NSSATS) from 2007-16 were conducted. We provide bivariate descriptive statistics regarding substance abuse treatment services which offered buprenorphine and methadone treatment from 2007-16. Using multiple logistic regression, we regressed geographic, organisational, and payment correlates on buprenorphine and methadone treatment. RESULTS: Buprenorphine is increasingly offered at SAT facilities though uptake remains comparatively low outside of the northeast. SAT facilities run by tribal governments or Indian Health Service which offer buprenorphine remain low compared to privately operated SAT facilities (AOR = 0.528). The odds of offering buprenorphine among facilities offering free or no charge treatment (AOR = 0.838) or a sliding fee scale (AOR = 0.464) was lower. SAT facilities accepting Medicaid payments showed higher odds of offering methadone treatment (AOR = 2.035). CONCLUSIONS: Greater attention towards the disparities in provision of opioid agonist therapies is warranted, especially towards the reasons why uptake has been moderate among civilian providers. Additionally, the care needs of Native Americans facing opioid-related use disorders bears further scrutiny

Systematic review of hepatitis C virus prevalence and incidence among HIV-positive men who have sex with men (MSM) in England

Background: Hepatitis C virus (HCV) infection is a leading cause of hepatitis C, liver cancer, and cirrhosis. It is treatable with directing acting antivrials (DAAs), yet still accounts for over 580,000 global deaths annually. Due to the nature of transmission and particular risk factors, men living with HIV who have sex with other men (HIV+ MSM) are disportionately burdened. Whilst HCV is a statutorily notifiable disaease in England and a virtually complete registry exists, data specific to MSM are not captured, leaving gaps in our knowledge of HCV trends among HIV+ MSM. Methods: This paper aims to investigate the HCV prevalence and incidence among HIV+ MSM in England through a systematic review of academic literature. Results: The systematic review resulted in six articles. Evidence suggests that incidence has generally risen between 2002-2015 and declined between 2015-2018, which may be attributed to the introduction of DAAs. The range of reported prevalences varied from 2.2%-9.9% , the most recent estimate being 4.24% in 2018. Conclusions: This review's deficiency is the non-existent record of behavioural risk factors across the studies. Most studies recruited HIV+ MSM from HIV clinics, an arguably robust sampling method considering that 90% of those living with HIV in England are engaged in care at an HIV clinic. The gaps in the academic literature and national surveillance for HCV among HIV+ MSM demonstrate this group to be disproportionately under-studied. National surveillance ought to record HCV cases and risk factors specific to HIV+ MSM to better inform interventions

Dependency ratios in healthy ageing.

Although people are living longer, there is no discernible pattern about the quality of life in an increasing lifespan. This restricts our capacity to predict and prepare for the consequences of population ageing. Accordingly, we propose a population ageing indicator that combines demographic and disability prevalence data through a characteristics approach and explore different scenarios to account for uncertainty in life quality projections. Our results, available for 186 countries, show that countries that rank older under conventional chronological ageing measures may rank younger under our qualitative measure. Additionally, we find substantial differences in our projections depending on different health assumptions, demonstrating the risk of using ageing indicators that make implicit assumptions about health characteristics.This work is the result of a 2018 Ignacio H. Larramendi Research Grant of Fundación MAPFRE. AR-U' work received funding from the Gillings Fellowship in Global Public Health and Autism Research, Grant Award YOG054. JO acknowledges the financial support of Spanish Ministry of Science, Innovation and Universities (formerly, Ministry of Economy and Competitiveness), Project ECO2016-76506-C4-3-R

Understanding predictors of mental health and substance use treatment utilization among US adults: a repeated cross-sectional study

Background: Understanding discrepancies in mental health and substance use treatment utilization can help identify inequities in access to health services. We investigate mental health and substance use treatment utilization as function of demographic and social determinants, as well as pre-existing mental health and substance use disorders. Methods: In this repeated cross-sectional study, we used the 2017–2019 National Survey on Drug Use and Health data on US adults above age 18. Two logistic regression models were conducted, using predictors of age, gender, race/Hispanicity, sexual identity, education, insurance, family income, and past year mental health and substance use disorders, with outcomes of mental health or substance use treatment utilization. Weighted estimates of substance use disorders and insurance types and Pearson's correlation tests of vulnerability among age, gender, and treatment type were reported. Findings: Racial minorities, uninsured populations, sexual minorities, and females had lower odds of receiving mental health treatment, while older populations, lower income groups, and dual eligible enrollees had higher odds. Individuals with substance use disorders but no mental illness had higher odds of receiving mental health treatment. Those utilizing mental health treatment were mostly of high income, privately insured, and using cannabis, cocaine, and opioids. Older populations, men, and Medicaid only enrollees had higher odds of receiving substance use disorder treatment, whereas racial minorities had lower odds. Distribution of income, insurance type, and substance use were more widespread than mental health treatment. Interpretation: Mental health treatment can be used as an avenue for substance use treatment, particularly opioid use disorders. It is important to target vulnerable populations, like racial minorities and uninsured populations to improve access to mental health and substance use treatment

Binge alcohol and substance use across birth cohorts and the global financial crisis in the United States

The social and economic consequences of the global financial crisis (GFC) of 2007–9 has had serious impacts on population health, economic prospects, and overall wellbeing in all generations, particularly Millennials, Generation X, and Baby Boomers. The ways in which intergenerational inequality and global economic crises have affected population health, particularly with respect to excessive drinking and substance use in disadvantaged population groups has been understudied. Consequently, in this article, we seek to characterise the effects of the GFC on national trends in binge alcohol and substance use among Millennials, Generation X, and Baby Boomers. By doing so, we aim to contribute to a fuller understanding of the ways in which socioeconomic disadvantage engendered by the GFC has disparately affected the wellbeing of these generational cohorts.Dr. Andres Roman-Urrestarazu was funded through the Gillings Fellowship in Global Public Healt

Changing Trends in the Use of Kratom (Mitragyna speciosa) in Southeast Asia

This is the pre-peer reviewed version of the following article: Darshan Singh, Suresh Narayanan, Balasingam Vicknasingam, Ornella Corazza, Rita Santacroce, and Andres Roman-Urrestarazu, ‘Changing trends in the use of kratom (Mitragyna speciosa) in Southeast Asia, Human Psychopharmacology: Clinical & Experimental, Vol. 32 (3), e2582, May 2017, which has been published in final form at https://doi.org/10.1002/hup.2582. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Under embargo. Embargo end date: 24 May 2018. Copyright © 2017 John Wiley & Sons, Ltd.Objective: Kratom (Mitragyna speciosa. Korth) is an indigenous medicinal plant of Southeast Asia. This review paper aims to describe the trends of kratom use in Southeast Asia, particularly, in Malaysia and Thailand, where its use has been extensively studied by social scientists. Design: A literature review search was conducted through the internet. Nineteen articles illustrating kratom use in humans in Southeast Asia were reviewed. Results: The kratom has long been used by rural folk in Southeast Asia as a remedy for common ailments, to fight fatigue from hard manual work, as a drink during social interaction among men and in village religious functions. Studies based on self-reports suggest that prolonged kratom use does not result in serious health risks or impair socialfunctioning. Two recent trends have emerged: kratom is reportedly being used to ease withdrawal from opioid dependence in rural settings, while in urban areas, adulterated kratom cocktails are being consumed by younger people to induce euphoria. Meanwhile, kratom use is no longer classified under the Dangerous Drug Act in Thailand and attempts to classify it under the Dangerous Drug Act in Malaysia have not been successful. Conclusions: Legal sanctions appear to have preceded serious scientific investigations into the claimed benefits of ketum. More objective controlled trials and experiments on humans need to be conducted to validate self-report claims by kratom users in the community.Peer reviewe