Comparing the Health Care Resource Utilization and Medication Adherence of People with Epilepsy and People with Diabetes by Insurance Status

Background: Epilepsy is one of the most common neurological diseases worldwide; diabetes is a chronic metabolic disease that affects how the body produces and uses insulin. Prescribed medications are vital for controlling these and other chronic diseases by minimizing severe health issues, which can be affected by insurance type and status. Consequences of non-adherence include uncontrolled blood glucose in people with diabetes and uncontrolled seizures in people with epilepsy. We aimed to compare the healthcare resource utilization and medication adherence of people with epilepsy and people with diabetes by insurance status. Methods: Data was from the 2021 National Health Interview Survey. The sample (n=3,645) focused on adults 18 and older who self-reported having epilepsy (n=511) or diabetes (n=3,134). Covariates included sex, age, education level, and race. Descriptive and logistic regression analyses were weighted to account for the complex survey design. Results: When compared with public insurance and after adjusting for covariates, uninsured people with epilepsy had 5.96 times (95% CI 1.71-20.75) the odds and uninsured people with diabetes had 5.33 times (95% CI 3.11-9.12) the odds of delaying care. The uninsured with epilepsy had 9.63 (95% CI 2.24-41.43) times the odds, and those with diabetes had 3.82 (95% CI 2.16-6.73) times the odds of taking less medication. Conclusions: In line with previous research, being uninsured is a barrier to adherence and to healthcare utilization. Uninsured people with epilepsy and people with diabetes had higher odds of non-adherence with prescriptions; they also had higher odds of inconsistent healthcare resource utilization

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Relative Energy Deficiency in Sport (RED-S)

PURPOSE: Relative Energy Deficiency in Sport (RED-S) awareness is low in the athletics community, resulting in athletes going without treatment and suffering consequences to their health.1 The purpose of this study is to explore the associations between RED-S and key factors that may contribute to nutrition status in the collegiate setting. SUBJECTS: Participants included 175 female varsity student athletes from Grand Valley State University (GVSU). METHODS AND MATERIALS:A Qualtrics survey was used to collect data from GVSU varsity student athletes. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 29. Survey content included menstrual cycle history, bone injuries, and nutritional status. Each athlete was given a RED-S score by assigning numerical points to survey questions and calculating a cumulative number. ANALYSES: Kruskal– Wallis tests were used to determine the research questions\u27 outcomes. RESULTS: The data indicates that the distribution of RED-S scores for collegiate athletes differs between age groups (p = \u3c0.001). Athletes who started their sport at younger ages tended to have lower RED-S scores than athletes who started their sport at an older age. CONCLUSIONS: Further research on this topic will increase understanding of the relationship between the age an athlete began playing their sport and their RED-S status while participating in college athletics. This knowledge will inform stakeholders on the risks of RED-S and benefits of screening and prevention, as well as support the need for Registered Dietitian Nutritionists (RDNs) to be an integral part of the collegiate athletics health care team

Urban Form, Heart Disease, and Geography: A Case Study in Composite Index Formation and Bayesian Spatial Modeling

Recent studies indicate a relationship between measures of urban form as applied to urban and suburban areas, and obesity, a risk factor for heart disease. Measures of urban form for exurban and rural areas are considerably scarce; such measures could prove useful in measuring relationships between urban form and both mortality and morbidity in such areas. In modeling area-level mortality, geographic relationships between counties warrant consideration because geographically adjacent areas tend to have more in common than areas farther from each other. We modify county-level indices of urban form found in the literature so that they can be applied to exurban and rural counties. We then use these indices in a Bayesian spatial model that accounts for spatial autocorrelation to determine if there is a relationship between such measures and cardiovascular disease mortality for white males age 35 and older for the time period 1999-2001. Issues related to the formation and usefulness of the indices, and issues related to the spatial model, are discussed. Maps of observed and expected relative risk of mortality are presented

Urban Form, Heart Disease, and Geography: A Case Study in Composite Index Formation and Bayesian Spatial Modeling

Bayesian modeling, Mortality, Spatial modeling, Sprawl, Urban form,