Inclusion Toward Transformation: Psychosocial Disability Advocacy and Global Mental Health

The Movement for Global Mental Health (MGMH) has been met with criticism for reifying Western conceptions of mental disorders and diverting resources from the investigation, intervention, and education regarding the social determinants of mental health. Advocates identifying as a person with a psychosocial disability are organizing to transform the MGMH from a top-down, individualized, and universal approach toward a rights-based conception that accounts for the cultural, political, and economic conditions that produce distress and disability. Using a qualitative, hermeneutic, interpretative-phenomenological analysis (IPA), this research study focused on how people with a lived experience of mental distress and treatment come to question the mainstream discourses of the psy-disciplines, identify as people with psychosocial disabilities, and engage in advocacy both within and against the MGMH. The results contribute to debates on how to conceptualize madness/distress, reveal the emergence of the psychosocial disability identity as a major force in mental health advocacy. and point to the transformative potential of an integrated psychosocial disability framework for a more rights-based approach. Recommendations are made for mental health researchers, practitioners, and activists to promote and enhance the inclusion of people with lived experience

Glycemic Control, Complications, and Death in Older Diabetic Patients: The Diabetes and Aging Study

OBJECTIVE—To identify the range of glycemic levels associated with the lowest rates of complications and mortality in older diabetic patients. RESEARCH DESIGN AND METHODS—We conducted a retrospective cohort study (2004–2008) of 71,092 patients with type 2 diabetes, aged $60 years, enrolled in Kaiser Per-manente Northern California. We specified Cox proportional hazards models to evaluate the relationships between baseline glycated hemoglobin (A1C) and subsequent outcomes (nonfatal complications [acute metabolic, microvascular, and cardiovascular events] and mortality). RESULTS—The cohort (aged 71.06 7.4 years [means6 SD]) had a mean A1C of 7.06 1.2$11.0%). Mortality had a U-shaped relationship with A1C. Compared with the risk with A1C,6.0%, mortality risk was lower for A1C levels between 6.0 and 9.0 % (e.g., 0.83 [0.76–0.90] for A1C 7.0–7.9%) and higher at A1C$11.0$8.0%. Patterns generally were consistent across age-groups (60–69, 70–79, and $80 years). CONCLUSIONS—Observed relationships between A1C and combined end points suppor

Heterogeneity of diabetes outcomes among asians and pacific islanders in the US: the diabetes study of northern california (DISTANCE).

ObjectiveEthnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated.Research design and methodsWe performed a prospective cohort study (1996-2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites (n = 40,286), blacks (n = 8,668), Latinos (n = 7,763), Filipinos (n = 3,572), Chinese (n = 1,823), Japanese (n = 951), Pacific Islanders (n = 593), and South Asians (n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA(1c), hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted.ResultsPacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites.ConclusionsIncidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research

Stimulants for enhancement purposes: perceptions attitudes, usage among university students

Objective: Determine perceptions, attitudes, and usage of non medical prescription stimulants among students at a Midwestern technology focused university. Participants: 241 university students. Methods: Data was collected in March 2015 through an anonymous web survey. A logistic regression model evaluated predictors. T-test was used to evaluate differences between groups. Results: 9.5% had used prescription stimulants without a valid prescription. Primary motives were academic preparation (78%) and recreation (61%). Nicotine use (OR = 8.99, CI 2.40, 33.77, p \u3c .01), peer\u27s suggestion (OR = 6.95, C12.21, 21.84, p \u3c .01), and positive attitudes toward use (OR = 1.99, CI 1.06, 3.72, p \u3c .05) increased odds of nonmedical use. Users and non-users differed in estimations of nonmedical use within peers (t (239) = 3.17, p \u3c .01) and in their field (t (239) = 3.22, p \u3c .01). Conclusions: Administrators should acknowledge student use and develop strategies to address it

Barriers to Insulin Initiation: The Translating Research Into Action for Diabetes Insulin Starts Project

OBJECTIVE Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription. RESEARCH DESIGN AND METHODS We surveyed insulin-naïve patients with poorly controlled type 2 diabetes, already treated with two or more oral agents who were recently prescribed insulin. We compared responses for respondents prescribed, but never initiating, insulin (n = 69) with those dispensed insulin (n = 100). RESULTS Subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death), plans to instead work harder on behavioral goals, sense of personal failure, low self-efficacy, injection phobia, hypoglycemia concerns, negative impact on social life and job, inadequate health literacy, health care provider inadequately explaining risks/benefits, and limited insulin self-management training. CONCLUSIONS Primary adherence for insulin may be improved through better provider communication regarding risks, shared decision making, and insulin self-management training

Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study.

BackgroundMedication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between use of mail order pharmacy delivery and better medication adherence, but little is known about the barriers and facilitators to mail order pharmacy use in diabetes patients. This qualitative study examined factors related to mail order pharmacy use versus traditional "brick and mortar" pharmacies to refill prescriptions.MethodsWe conducted four 90-min focus groups in 2016 among 28 diabetes patients in the Hawaii and Northern California regions of Kaiser Permanente, a large integrated health care delivery system. We queried participants on their preferred mode for refilling prescriptions and perceived barriers and facilitators of mail order pharmacy use. One researcher independently coded each focus group transcript, with two of these transcripts double-coded by a second researcher to promote reliability. We employed thematic analysis guided by the Capability, Opportunity, Motivation, and Behavior (COM-B) framework using NVivo 11 software.ResultsA total of 28 diabetes patients participated. Participants' average age was 64.1 years; 57% were female; and racial/ethnic backgrounds included Asian/Native Hawaiian/Pacific Islander (36%), Black/African-American (21%) Hispanic/Latino (7%), and non-Hispanic White (36%). Analysis uncovered 26 themes related to the decision to use mail order pharmacy, with each theme representing a barrier or facilitator mapped to the COM-B framework. Most themes (20/26) fell into the COM-B category of 'Opportunity.' Opportunity barriers to mail order pharmacy use included unpredictability of medication delivery date, concerns about mail security, and difficulty coordinating refill orders for multiple prescriptions. In contrast, facilitators included greater access and convenience (e.g., no need to wait in line or arrange transportation) compared to traditional pharmacies. Motivational facilitators to mail order pharmacy use included receiving a pharmacy benefit plan incentive of a free one-month supply of prescriptions.ConclusionsThis study found that while patients with diabetes may benefit from mail order pharmacy use, they perceive numerous barriers to using the service. These findings will inform the design of interventions and quality improvement initiatives to increase mail order pharmacy use, which in turn may improve medication adherence and outcomes in diabetes patients, across health care systems

Depression and All‐Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107493/1/jgs12833.pd