Geographic disparity of severe vision loss - United States, 2009-2013.

Vision loss and blindness are among the top 10 disabilities in the United States, causing substantial social, economic, and psychological effects, including increased morbidity, increased mortality, and decreased quality of life.* There are disparities in vision loss based on age, sex, race/ethnicity, socioeconomic status, and geographic location. Current surveillance activities using national and state surveys have characterized vision loss at national and state levels. However, there are limited data and research at local levels, where interventions and policy decisions to reduce the burden of vision loss and eliminate disparities are often developed and implemented. CDC analyzed data from the American Community Survey (ACS) to estimate county-level prevalence of severe vision loss (SVL) (being blind or having serious difficulty seeing even when wearing glasses) in the United States and to describe its geographic pattern and its association with poverty level. Distinct geographic patterns of SVL prevalence were found in the United States; 77.3% of counties in the top SVL prevalence quartile (≥4.2%) were located in the South. SVL was significantly correlated with poverty (r = 0.5); 437 counties were in the top quartiles for both SVL and poverty, and 83.1% of those counties were located in southern states. A better understanding of the underlying barriers and facilitators of access and use of eye care services at the local level is needed to enable the development of more effective interventions and policies, and to help planners and practitioners serve the growing population with and at risk for vision loss more efficiently.

The relationship between county-level contextual characteristics and use of diabetes care services.

OBJECTIVES: To examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes. To inform future diabetes prevention strategies. METHODS: Data are from the Behavioral Risk Factor Surveillance System (BRFSS) 2004 and 2005 surveys, the National Diabetes Surveillance System, and the Area Resource File. Use of diabetes care services was defined by self-reported receipt of 7 preventive care services. Our study sample included 46 806 respondents with self-reported diagnosed diabetes. Multilevel models were run to assess the association between county-level characteristics and receipt of each of the 7 preventive diabetes care service after controlling for characteristics of individuals. Results were considered significant if P < .05. RESULTS: Controlling for individual-level characteristics, our analyses showed that 7 of the 8 county-level factors examined were significantly associated with use of 1 or more preventive diabetes care services. For example, people with diabetes living in a county with a high uninsurance rate were less likely to have an influenza vaccination, visit a doctor for diabetes care, have an A1c test, or a foot examination; people with diabetes living in a county with a high physician density were more likely to have an A1c test, foot examination, or an eye examination; and people with diabetes living in a county with more people with less than high-school education were less likely to have influenza vaccination, pneumococcal vaccination, or self-care education (all P < .05). CONCLUSIONS: Many of the county-level factors examined in this study were found to be significantly associated with use of preventive diabetes care services. County policy makers may need to consider local circumstances to address the disparities in use of these services.

Six Action Steps to Address Global Disparities in Parkinson Disease: A World Health Organization Priority.

Importance: The Global Burden of Disease study conducted between 1990 and 2016, based on a global study of 195 countries and territories, identified Parkinson disease (PD) as the fastest growing neurological disorder when measured using death and disability. Most people affected by PD live in low- and middle-income countries (LMICs) and experience large inequalities in access to neurological care and essential medicines. This Special Communication describes 6 actions steps that are urgently needed to address global disparities in PD. Observations: The adoption by the 73rd World Health Assembly (WHA) of resolution 73.10 to develop an intersectoral global action plan on epilepsy and other neurological disorders in consultation with member states was the stimulus to coordinate efforts and leverage momentum to advance the agenda of neurological conditions, such as PD. In April 2021, the Brain Health Unit at the World Health Organization convened a multidisciplinary, sex-balanced, international consultation workshop, which identified 6 workable avenues for action within the domains of disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research. Conclusions and Relevance: The dramatic increase of PD cases in many world regions and the potential costs of PD-associated treatment will need to be addressed to prevent possible health service strain. Across the board, governments, multilateral agencies, donors, public health organizations, and health care professionals constitute potential stakeholders who are urged to make this a priority.

Current and projected future economic burden of Parkinson's disease in the U.S.

Parkinson's disease (PD) is one of the world's fastest growing neurological disorders. Much is unknown about PD-associated economic burdens in the United States (U.S.) and other high-income nations. This study provides a comprehensive analysis of the economic burdens of PD in the U.S. (2017) and projections for the next two decades. Multiple data sources were used to estimate the costs of PD, including public and private administrative claims data, Medicare Current Beneficiary Survey, Medical Expenditure Panel Survey, and a primary survey (n = 4,548) designed for this study. We estimated a U.S. prevalence of approximately one million individuals with diagnosed Parkinson's disease in 2017 and a total economic burden of $51.9 billion. The total burden of PD includes direct medical costs of $25.4 billion and $26.5 billion in indirect and non-medical costs, including an indirect cost of $14.2 billion (PWP and caregiver burden combined), non-medical costs of $7.5 billion, and $4.8 billion due to disability income received by PWPs. The Medicare program bears the largest share of excess medical costs, as most PD patients are over age 65. Projected PD prevalence will be more than 1.6 million with projected total economic burden surpassing $79 billion by 2037. The economic burden of PD was previously underestimated. Our findings underscore the substantial burden of PD to society, payers, patients, and caregivers. Interventions to reduce PD incidence, delay disease progression, and alleviate symptom burden may reduce the future economic burden of PD.

Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012.

Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a plateau or slowed around 2008, and that this change coincided with obesity plateaus and increases in physical activity. However, national estimates can obscure important variations in geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes, obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to smooth these estimates over time, we estimated the average annual percentage point change (APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity prevalence in each county. Compared to 2004-2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008-2012 (diabetes APPC difference = 0.16, 95%CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors remained high with most counties merely slowing rather than reversing, which suggests that all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to identify high risk areas and populations for preventive interventions. Awareness of how these factors are changing might assist local policy makers in targeting and tracking the impact of efforts to reduce diabetes, obesity and physical inactivity.

Does priming for mastery goals improve the performance of students with an entity view of ability?

BACKGROUND: There is evidence that an entity view of ability (where ability is viewed as a fixed entity that cannot be changed) is linked with social comparison goals and poor performance. On the other hand, an incremental view of ability (where ability is viewed as an acquirable skill) is linked with a mastery goal orientation and positive achievement outcomes. On these bases, the present study sought evidence that priming students with an entity view of ability to pursue mastery goals would result in improved performance. SAMPLE: Participants were 48 students with an entity view of ability, and 48 students with an incremental view of ability. METHOD: We used a 2 (views of ability: entity, incremental) x 2 (performance feedback: success, failure) x 2 (goal priming: mastery, social comparison) between-subjects factorial design to examine the effects of goal priming on performance for students with either an incremental or entity view of ability following either success or failure feedback. Prior to, and following, performance feedback, participants completed parallel measures of state anxiety. Participants were then primed for either social comparison goals prior to attempting to solve 16 Unicursal (tracing puzzle) tasks. Their performance on a subsequent set of Unicursal tasks was then examined. Finally participants completed a State Goals Scale assessing their degree of endorsement of social comparison/mastery goals whilst working on the Unicursal tasks. RESULTS: The performance of students with an incremental view of ability was comparable irrespective of whether they were initially exposed to success and failure feedback and irrespective of whether they were primed for mastery or social comparison goals. However the performance of students with an entity view of ability improved when they were primed for mastery relative to social comparison goals irrespective of whether they were initially exposed to success or failure. CONCLUSIONS: These findings confirm the performance-limiting consequences of social comparison goals for participants with an entity view of ability, suggesting benefits in encouraging these students to pursue mastery goals.

Optimal allocation of resources across four interventions for type 2 diabetes.

BACKGROUND: Several interventions can be applied to prevent complications of type 2 diabetes. This article examines the optimal allocation of resources across 4 interventions to treat patients newly diagnosed with type 2 diabetes. The interventions are intensive glycemic control, intensified hypertension control, cholesterol reduction, and smoking cessation. METHODS: A linear programming model was designed to select sets of interventions to maximize quality-adjusted life years (QALYs), subject to varied budget and equity constraints. RESULTS: For no additional cost, approximately 211,000 QALYs can be gained over the lifetimes of all persons newly diagnosed with diabetes by implementing interventions rather than standard care. With increased availability of funds, additional health benefits can be gained but with diminishing marginal returns. The impact of equity constraints is extensive compared to the solution with the same intervention costs and no equity constraint. Under the conditions modeled, intensified hypertension control and smoking cessation interventions were provided most often, and intensive glycemic control and cholesterol reduction interventions were provided less often. CONCLUSIONS: A resource allocation model identifies trade-offs involved when imposing budget and equity constraints on care for individuals with newly diagnosed diabetes.

Re-examining the effects of noncontingent success on self-handicapping behaviour.

BACKGROUND: Self-handicapping refers to the practice on the part of certain individuals to handicap their performance when poor performance is likely to reveal low ability. Noncontingent success (feedback that is inflated relative to performance) is more likely to promote self-handicapping behaviour than noncontingent failure (failure feedback based on false or misleading information). However, the reasons for the differing effects of these forms of performance feedback on self-handicapping behaviour remain obscure. AIMS: The present study sought an explanation for the differing effects of these forms of performance feedback, testing the assumption that students high in self-handicapping behaviour would react more negatively following noncontingent success, reporting more unstable and external attributions, higher anxiety, and a greater propensity to claim handicaps than those low in self-handicapping behaviour. No differences were expected on any of these measures for high relative to low self-handicappers following either noncontingent failure or success. SAMPLE: Participants were 72 undergraduate students, divided equally between high and low self-handicapping groups. METHOD: High and low self-handicappers were assigned to one of three performance feedback conditions: noncontingent failure, success and noncontingent success. High and low self-handicappers were then given an opportunity to claim handicaps prior to completing measures of attributions and state anxiety. Subsequently, they completed 12 remote associate tasks, serving as an assessment of performance, and 16 unicursal tasks, assessing practice effort. RESULTS: Following noncontingent success, high self-handicappers reported greater anxiety, more unproductive attributions and claimed more handicaps than low self-handicappers. However no differences were evident for high and low self-handicappers following either noncontingent failure or success. High self-handicappers also performed poorly on the remote associates tasks and reduced practice effort on the unicursal tasks. CONCLUSIONS: These findings confirm the adverse effects of noncontingent success for high self-handicappers, while failing to provide evidence that noncontingent failure has any more adverse effects on high relative to low self-handicappers.

Causal uncertainty, claimed and behavioural self-handicapping.

BACKGROUND: Causal uncertainty beliefs involve doubts about the causes of events, and arise as a consequence of non-contingent evaluative feedback: feedback that leaves the individual uncertain about the causes of his or her achievement outcomes. Individuals high in causal uncertainty are frequently unable to confidently attribute their achievement outcomes, experience anxiety in achievement situations and as a consequence are likely to engage in self-handicapping behaviour. AIMS: Accordingly, we sought to establish links between trait causal uncertainty, claimed and behavioural self-handicapping. SAMPLE: Participants were N=72 undergraduate students divided equally between high and low causally uncertain groups. METHOD: We used a 2 (causal uncertainty status: high, low) x 3 (performance feedback condition: success, non-contingent success, non-contingent failure) between-subjects factorial design to examine the effects of causal uncertainty on achievement behaviour. Following performance feedback, participants completed 20 single-solution anagrams and 12 remote associate tasks serving as performance measures, and 16 unicursal tasks to assess practice effort. Participants also completed measures of claimed handicaps, state anxiety and attributions. RESULTS: Relative to low causally uncertain participants, high causally uncertain participants claimed more handicaps prior to performance on the anagrams and remote associates, reported higher anxiety, attributed their failure to internal, stable factors, and reduced practice effort on the unicursal tasks, evident in fewer unicursal tasks solved. CONCLUSIONS: These findings confirm links between trait causal uncertainty and claimed and behavioural self-handicapping, highlighting the need for educators to facilitate means by which students can achieve surety in the manner in which they attribute the causes of their achievement outcomes.

Construction and initial validation of the self-worth protection scale.

BACKGROUND: The self-worth theory of achievement motivation holds that in certain circumstances students stand to gain by deliberately withdrawing effort. When failure occurs despite effort, students are likely to conclude that failure resulted from lack of ability. Thus, withdrawing effort offers a defence against conclusions of low ability, thereby protecting self-worth. AIM: We undertook to assess the psychometric properties of the Self-Worth Protection Scale (SWPS). SAMPLE: Data were obtained from 243 participants (Study 1) and 411 participants (Study 2) enrolled in undergraduate psychology courses at a university in the United States. METHOD: We administered a number of scales, including the SWPS and scales assessing a fear of negative evaluation, academic self-esteem, uncertain global self-evaluations, self-handicapping, and causal uncertainty. RESULTS: Exploratory factor analysis indicated a three-factor solution (ability doubts, the importance of ability as a criterion of self-worth, and an avoidance orientation) utilising 33 of the original 44 items. A confirmatory factor analysis indicated that this three-factor solution was a poor fit of the data. After modifying the model, a confirmatory factor analysis indicated that a three-factor solution with 26 of the original items and a higher order factor of self-worth protection was an adequate fit of the data. Reliability measures were acceptable for the three subscales and total score. The total score of the SWPS was positively correlated with theoretically related constructs, demonstrating construct validity. CONCLUSIONS: The SWPS appears to be a psychometrically sound scale to assist in identifying individuals who manifest self-worth protection in achievement situations.