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1.
J Health Care Poor Underserved ; 32(4): 2258-2266, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34803075

RESUMEN

The COVID-19 pandemic has worsened economic precarity and nearly doubled food insecurity in the United States. We describe how a free produce market at a Massachusetts health center adapted to exponentially increase its reach and offerings while continuing to safely distribute food to a low-income community during the pandemic.


Asunto(s)
COVID-19 , Asistencia Alimentaria , Atención a la Salud , Abastecimiento de Alimentos , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiología
2.
Am J Manag Care ; 27(12 Suppl): S231-S237, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34382759

RESUMEN

A virtual key opinion leader (KOL) and payer discussion was held on December 5, 2020. In attendance were 2 KOLs, both specialists in amyotrophic lateral sclerosis (ALS) at leading clinics in the United States, and 6 managed care executives from US regional health plans. The objective of this panel was to share opinions, ideas, and information around the treatment of ALS with edaravone, gaps in management and guidelines, and potential solutions. The panel concluded that coverage criteria for edaravone may need to be reassessed and treatment guidelines could be revisited to include a determination of place in therapy for edaravone.


Asunto(s)
Esclerosis Amiotrófica Lateral , Esclerosis Amiotrófica Lateral/tratamiento farmacológico , Edaravona , Depuradores de Radicales Libres , Humanos , Programas Controlados de Atención en Salud , Especialización , Estados Unidos
3.
J Nutr Educ Behav ; 53(7): 573-582, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34246412

RESUMEN

OBJECTIVE: To examine participant perceptions of a free, monthly produce market at a health center in Massachusetts. DESIGN: Participants were recruited at a produce market between June 2019 and January 2020 and engaged in a 30-65-minute focus group (n = 3 English language; n = 2 Spanish; n = 2 Arabic) conducted by trained facilitators using a semistructured guide. PARTICIPANTS: Adults (n = 49) who had attended the market at least twice in the previous 6 months. MAIN OUTCOME MEASURES: Participant-reported facilitators, barriers, perceived benefits, and opportunities for improvement. ANALYSIS: Conventional content analysis. RESULTS: Reported facilitators included accessibility (eg, convenient location and timing), program experience (eg, positive volunteer interactions), and characteristics of goods and services (eg, acceptable variety of produce). Barriers fell under similar themes and included transportation challenges, poor weather, and insufficient quantity of produce for larger households. Participants perceived the market as improving diet and finances and offered suggestions for improvement: distributing nonproduce foods (eg, meat) or nonfood items (eg, toiletries) and augmenting existing initiatives aimed to help attendees make use of the produce (eg, handing out recipe cards). CONCLUSIONS AND IMPLICATIONS: The produce market was widely accepted, and targeted areas for improvement were identified. Findings may improve existing and future charitable produce markets among diverse populations.


Asunto(s)
Asistencia Alimentaria , Abastecimiento de Alimentos , Adulto , Dieta , Humanos , Percepción , Pobreza
4.
BMC Med Res Methodol ; 20(1): 41, 2020 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-32103725

RESUMEN

BACKGROUND: A Core Outcomes Set (COS) is an agreed minimum set of outcomes that should be reported in all clinical studies related to a specific condition. Using prostate cancer as a case study, we identified, summarized, and critically appraised published COS development studies and assessed the degree of overlap between them and selected real-world data (RWD) sources. METHODS: We conducted a scoping review of the Core Outcome Measures in Effectiveness Trials (COMET) Initiative database to identify all COS studies developed for prostate cancer. Several characteristics (i.e., study type, methods for consensus, type of participants, outcomes included in COS and corresponding measurement instruments, timing, and sources) were extracted from the studies; outcomes were classified according to a predefined 38-item taxonomy. The study methodology was assessed based on the recent COS-STAndards for Development (COS-STAD) recommendations. A 'mapping' exercise was conducted between the COS identified and RWD routinely collected in selected European countries. RESULTS: Eleven COS development studies published between 1995 and 2017 were retrieved, of which 8 were classified as 'COS for clinical trials and clinical research', 2 as 'COS for practice' and 1 as 'COS patient reported outcomes'. Recommended outcomes were mainly categorized into 'mortality and survival' (17%), 'outcomes related to neoplasm' (18%), and 'renal and urinary outcomes' (13%) with no relevant differences among COS study types. The studies generally fulfilled the criteria for the COS-STAD 'scope specification' domain but not the 'stakeholders involved' and 'consensus process' domains. About 72% overlap existed between COS and linked administrative data sources, with important gaps. Linking with patient registries improved coverage (85%), but was sometimes limited to smaller follow-up patient groups. CONCLUSIONS: This scoping review identified few COS development studies in prostate cancer, some quite dated and with a growing level of methodological quality over time. This study revealed promising overlap between COS and RWD sources, though with important limitations; linking established, national patient registries to administrative data provide the best means to additionally capture patient-reported and some clinical outcomes over time. Thus, increasing the combination of different data sources and the interoperability of systems to follow larger patient groups in RWD is required.


Asunto(s)
Medicina Basada en la Evidencia/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Neoplasias de la Próstata/terapia , Publicaciones/estadística & datos numéricos , Proyectos de Investigación , Medicina Basada en la Evidencia/estadística & datos numéricos , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Neoplasias de la Próstata/diagnóstico , Análisis de Supervivencia
5.
BMC Public Health ; 19(1): 690, 2019 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-31164109

RESUMEN

BACKGROUND: Lung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution's associations with lung function. METHODS: Data are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV1) and standardised to the percentage of expected FEV1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV1%). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution's associations with FEV1%. RESULTS: SEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution. CONCLUSION: The findings suggest that disadvantaged SEP in childhood may make people's lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation.


Asunto(s)
Envejecimiento/fisiología , Pulmón/fisiopatología , Exposición Profesional/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Fumar/fisiopatología , Contaminación por Humo de Tabaco/efectos adversos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Factores Socioeconómicos , Reino Unido , Adulto Joven
6.
PLoS One ; 14(2): e0212955, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30818377

RESUMEN

OBJECTIVE: To characterize the relationship between potentially preventable hospitalizations (PPHs) for diabetes and behavioral health conditions in commercially insured working-age persons with diabetes in the United States. RESEARCH DESIGN AND METHODS: We retrospectively analyzed medical and pharmacy claims from services rendered between 2011 and 2013 for 229,039 adults with diabetes. Diabetes PPHs were identified using the Agency for Healthcare Research and Quality's Prevention Quality Indicators v6.0 logic. We used negative binomial-logit hurdle regression models to explore the adjusted relationships between diabetes PPHs and schizophrenia, bipolar, depression, anxiety, adjustment disorder, alcohol use disorder, and drug use disorder. RESULTS: A total of 4,521 diabetes PPHs were experienced by 3,246 of the persons in the sample. The 20.83% of persons with one or more behavioral health conditions experienced 43.62% (1,972/4,521; 95% CI 42.18%-45.07%) of all diabetes PPHs, and the 7.14% of persons with more than one diagnosed behavioral health condition experienced 24.77% (1,120/4,521; 95% CI 23.54%-26.05%) of all diabetes PPHs. After adjusting for sociodemographic and physical health covariates, patients with depression, schizophrenia, drug or alcohol use disorders, or multiple behavioral health conditions were at significantly increased risk of experiencing at least one diabetes PPH, while patients with depression, drug use disorder, or multiple behavioral health conditions were at significantly increased risk of experiencing recurring diabetes PPHs over time. CONCLUSIONS: A number of behavioral health conditions are associated with diabetes PPHs, which are often preventable with timely, high-quality outpatient care. The results of this study will enable clinicians, payers, and policy-makers to better focus outpatient care interventions and resources within the population of persons with diabetes.


Asunto(s)
Diabetes Mellitus/psicología , Diabetes Mellitus/terapia , Conductas Relacionadas con la Salud , Hospitalización , Adulto , Atención Ambulatoria , Complicaciones de la Diabetes/prevención & control , Complicaciones de la Diabetes/psicología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/complicaciones , Salud Mental , Persona de Mediana Edad , Servicios Preventivos de Salud , Estudios Retrospectivos , Factores de Riesgo , Trastornos Relacionados con Sustancias/complicaciones , Estados Unidos , Adulto Joven
7.
Clin Transplant ; 32(12): e13408, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30218994

RESUMEN

BACKGROUND: A better understanding of the consequences of being turned down for living kidney donation could help transplant professionals to counsel individuals considering donation. METHODS: In this exploratory study, we used survey instruments and qualitative interviews to characterize nonmedical outcomes among individuals turned down for living kidney donation between July 1, 2010 and December 31, 2013. We assembled a comparator group of kidney donors. RESULTS: Among 83 turned-down donors with contact information at a single center, 43 (52%) participated in the study (median age 53 years; 53% female; 19% black). Quality of life, depression, financial stress, and provider empathy scores were similar between individuals turned down for donation (n = 43) and donors (n = 128). Participants selected a discrete choice response to a statement about the overall quality of their lives; 32% of turned-down donors versus 7% of donors (P < 0.01) assessed that their lives were worse after the center's decision about whether they could donate a kidney. Among turned-down donors who reported that life had worsened, 77% had an intended recipient who was never transplanted, versus 36% among individuals who assessed life as the same or better (P = 0.02). In interviews, the majority of turned-down donors reported emotional impact, including empathy, stress, and other challenges, related to having someone in their lives with end-stage kidney disease. CONCLUSIONS: Generic instruments measuring quality of life, depression, financial stress, and provider empathy revealed no significant differences between kidney donors and turned-down donors. However, qualitative interviews revealed preliminary evidence that some turned-down donors experienced emotional consequences. These findings warrant confirmation in larger studies.


Asunto(s)
Trasplante de Riñón/psicología , Donadores Vivos/psicología , Nefrectomía/psicología , Calidad de Vida , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Conducta Social
8.
BMC Public Health ; 18(1): 385, 2018 03 21.
Artículo en Inglés | MEDLINE | ID: mdl-29562880

RESUMEN

BACKGROUND: Grip strength in early adulthood and midlife is an important predictor of disability, morbidity and mortality in later life. Understanding social patterning in grip strength at different life stages could improve insight into inequalities in age-related decline and when in the life course interventions could prevent the emergence of inequalities. METHODS: Using United Kingdom Household Longitudinal Study (UKHLS) data on 19,292 people aged 16 to 99, fractional polynomial models were fitted to identify which function of age best described its association with grip strength. Linear regressions were used to establish whether socio-economic position (SEP), as measured by maternal education, highest educational qualification and income, was associated with grip strength. To test whether the association between age and grip strength was modified by SEP, interactions between SEP and the age terms were added. Differentiation was used to identify the age at which grip strength was highest for men and women and predicted levels of grip strength at peak were compared. RESULTS: SEP is significantly associated with grip strength on all SEP measures, except education for men. Grip strength is highest at a younger age, and less strong for all measures of disadvantage for women and most measures for men. Interaction terms were not statistically significant indicating that the association between age and grip strength was not modified by SEP. Grip strength peak was 29.3 kg at age 33 for women with disadvantaged childhood SEP compared with 30.2 kg at age 35 for women with advantaged childhood SEP. CONCLUSION: The SEP differences in age and level of peak grip strength could be indicative of decline in muscle strength beginning earlier and from a lower base for disadvantaged groups. This could impact on the capacity for healthy ageing for those with disadvantaged SEP.


Asunto(s)
Fuerza de la Mano , Disparidades en el Estado de Salud , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Reino Unido , Adulto Joven
9.
Aging (Albany NY) ; 9(4): 1153-1185, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28373600

RESUMEN

Hallmarks of aging include loss of protein homeostasis and dysregulation of stress-adaptive pathways. Loss of adaptive homeostasis, increases accumulation of DNA, protein, and lipid damage. During acute stress, the Cnc-C (Drosophila Nrf2 orthologue) transcriptionally-regulated 20S proteasome degrades damaged proteins in an ATP-independent manner. Exposure to very low, non-toxic, signaling concentrations of the redox-signaling agent hydrogen peroxide (H2O2) cause adaptive increases in the de novo expression and proteolytic activity/capacity of the 20S proteasome in female D. melanogaster (fruit-flies). Female 20S proteasome induction was accompanied by increased tolerance to a subsequent normally toxic but sub-lethal amount of H2O2, and blocking adaptive increases in proteasome expression also prevented full adaptation. We find, however, that this adaptive response is both sex- and age-dependent. Both increased proteasome expression and activity, and increased oxidative-stress resistance, in female flies, were lost with age. In contrast, male flies exhibited no H2O2 adaptation, irrespective of age. Furthermore, aging caused a generalized increase in basal 20S proteasome expression, but proteolytic activity and adaptation were both compromised. Finally, continual knockdown of Keep1 (the cytosolic inhibitor of Cnc-C) in adults resulted in older flies with greater stress resistance than their age-matched controls, but who still exhibited an age-associated loss of adaptive homeostasis.


Asunto(s)
Adaptación Fisiológica/genética , Proteínas de Drosophila/biosíntesis , Proteínas de Drosophila/genética , Estrés Oxidativo/genética , Complejo de la Endopetidasa Proteasomal/genética , Proteínas Represoras/biosíntesis , Proteínas Represoras/genética , Transducción de Señal/genética , Adenosina Trifosfato/metabolismo , Envejecimiento , Animales , Drosophila melanogaster , Femenino , Regulación del Desarrollo de la Expresión Génica/genética , Técnicas de Silenciamiento del Gen , Peróxido de Hidrógeno/farmacología , Proteína 1 Asociada A ECH Tipo Kelch , Masculino , Carbonilación Proteica , Caracteres Sexuales
10.
Curr Biol ; 27(1): 1-15, 2017 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-27916526

RESUMEN

Multiple human diseases involving chronic oxidative stress show a significant sex bias, including neurodegenerative diseases, cancer, immune dysfunction, diabetes, and cardiovascular disease. However, a possible molecular mechanism for the sex bias in physiological adaptation to oxidative stress remains unclear. Here, we report that Drosophila melanogaster females but not males adapt to hydrogen peroxide stress, whereas males but not females adapt to paraquat (superoxide) stress. Stress adaptation in each sex requires the conserved mitochondrial Lon protease and is associated with sex-specific expression of Lon protein isoforms and proteolytic activity. Adaptation to oxidative stress is lost with age in both sexes. Transgenic expression of transformer gene during development transforms chromosomal males into pseudo-females and confers the female-specific pattern of Lon isoform expression, Lon proteolytic activity induction, and H2O2 stress adaptation; these effects were also observed using adult-specific transformation. Conversely, knockdown of transformer in chromosomal females eliminates the female-specific Lon isoform expression, Lon proteolytic activity induction, and H2O2 stress adaptation and produces the male-specific paraquat (superoxide) stress adaptation. Sex-specific expression of alternative Lon isoforms was also observed in mouse tissues. The results develop Drosophila melanogaster as a model for sex-specific stress adaptation regulated by the Lon protease, with potential implications for understanding sexual dimorphism in human disease.


Asunto(s)
Drosophila melanogaster/fisiología , Mitocondrias/enzimología , Estrés Oxidativo , Proteasa La/metabolismo , Adaptación Fisiológica , Factores de Edad , Animales , Drosophila melanogaster/efectos de los fármacos , Drosophila melanogaster/genética , Drosophila melanogaster/crecimiento & desarrollo , Femenino , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Herbicidas/farmacología , Peróxido de Hidrógeno/farmacología , Masculino , Mitocondrias/efectos de los fármacos , Mitocondrias/patología , Oxidantes/farmacología , Paraquat/farmacología , Proteasa La/genética , Factores Sexuales
11.
J Gen Intern Med ; 31(4): 402-10, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26585957

RESUMEN

BACKGROUND: Medication nonadherence is an important obstacle to cardiovascular disease management. OBJECTIVE: To improve adherence through real-time feedback based on theories of how social forces influence behavior. DESIGN: Two randomized controlled pilot trials called PROMOTE and SUPPORT. Participants stored statin medication in wireless-enabled pill bottles that transmitted adherence data to researchers. PARTICIPANTS: Adults with diabetes and a history of low statin adherence based on pharmacy refills (i.e., Medication Possession Ratio [MPR] <80% in the pre-randomization screening period). INTERVENTION: In PROMOTE, each participant was randomized to 1) weekly messages in which that participant's statin adherence was compared to that of other participants (comparison), 2) weekly summaries of that participant's statin adherence (summary), or 3) control. In SUPPORT, each participant identified another person (the Medication Adherence Partner [MAP]) to receive reports about that participant's adherence, and was randomized to 1) daily reports to MAP, 2) weekly reports to MAP, 3) reports to MAP only if dose was missed, or 4) control. MAIN OUTCOMES MEASURE: Adherence measured by pill bottle. KEY RESULTS: Among 45,000 health plan members contacted by mail, <1% joined the trial. Participants had low baseline MPRs (median = 60%, IQR 41-72%) but high pill-bottle adherence (90% in PROMOTE, 92% in SUPPORT) during the trial. In PROMOTE (n = 201) and SUPPORT (n = 200), no intervention demonstrated significantly better adherence vs. CONTROL: In a subgroup of PROMOTE participants with the lowest pre-study MPR, pill-bottle-measured adherence in the comparison arm (89%) was higher than the control (86%) and summary (76%) arms, but differences were non-significant (p = 0.10). CONCLUSIONS: Interventions based on social forces did not improve medication adherence vs. control over a 3-month period. Given the low percentage of invited individuals who enrolled, the studies may have attracted participants who required little encouragement to improve adherence other than study participation.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/psicología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación/psicología , Apoyo Social , Anciano , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto
12.
Psychosom Med ; 68(5): 684-91, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17012521

RESUMEN

OBJECTIVE: Rarely has validated information on chronic medical comorbidity been presented for persons with bipolar disorder. To deliver appropriate health services, it is important to understand the prevalence of chronic medical conditions in this population. This study examines chronic medical comorbidity using validated methodology in persons with bipolar disorder. METHODS: This is a retrospective study of a 100% sample of administrative claims (1996-2001) from Wellmark Blue Cross Blue Shield. Three thousand five hundred fifty-seven subjects had bipolar I disorder and did not have claims for schizophrenia or schizoaffective disorder. Controls had no documented claims for psychiatric conditions. Using validated methodology, inpatient and outpatient claims were used to determine prevalence of 44 chronic medical conditions. Odds ratios (ORs) were adjusted for age, gender, residence, and nonmental healthcare utilization. RESULTS: Persons with bipolar disorder were young (mean age, 38.8 years) and significantly more likely to have medical comorbidity, including three or more chronic conditions (41% versus 12%, p < .001) compared with controls. Elevated ORs were found for conditions spanning all organ systems. Hyperlipidemia, lymphoma, and metastatic cancer were the only conditions less likely to occur in persons with bipolar disorder. CONCLUSION: Bipolar disorders are associated with substantial chronic medical burden. Familiarity with conditions affecting this population may assist in programs aimed at providing medical care for the chronically mentally ill.


Asunto(s)
Trastorno Bipolar/epidemiología , Accidentes/estadística & datos numéricos , Adolescente , Adulto , Trastornos Relacionados con Alcohol/epidemiología , Trastorno Bipolar/tratamiento farmacológico , Planes de Seguros y Protección Cruz Azul/estadística & datos numéricos , Enfermedades Cardiovasculares/epidemiología , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Grupos Diagnósticos Relacionados , Enfermedades del Sistema Endocrino/epidemiología , Femenino , Agonistas del GABA/efectos adversos , Agonistas del GABA/uso terapéutico , Humanos , Hiperlipidemias/epidemiología , Iowa/epidemiología , Compuestos de Litio/efectos adversos , Compuestos de Litio/uso terapéutico , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Obesidad/inducido químicamente , Obesidad/epidemiología , Oportunidad Relativa , Estudios Retrospectivos , Conducta Sexual , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
13.
J Gen Intern Med ; 21(11): 1133-7, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17026726

RESUMEN

BACKGROUND: Persons with persistent mental illness are at risk for failure to receive medical services. In order to deliver appropriate preventive and primary care for this population, it is important to determine which chronic medical conditions are most common. OBJECTIVE: We examined chronic medical comorbidity in persons with schizophrenia using validated methodologies. DESIGN: Retrospective analysis of longitudinal administrative claims data from Wellmark Blue Cross/Blue Shield of Iowa. PARTICIPANTS: Subjects with schizophrenia or schizoaffective disorder (N=1,074), and controls (N=726,262) who filed at least 1 claim for medical services, 1996 to 2001. MEASUREMENTS: Case subjects had schizophrenia as the most clinically predominant psychotic disorder, based on psychiatric hospitalization, psychiatrist diagnoses, and outpatient care. Controls had no claims for any psychiatric comorbidity. Using a modified version of the Elixhauser Comorbidity Index, inpatient and outpatient claims were used to determine the prevalence of 46 common medical conditions. Odds ratios (ORs) were adjusted for age, gender, residence, and nonmental health care utilization using logistic regression. RESULTS: Subjects with schizophrenia were significantly more likely to have 1 or more chronic conditions compared with controls. Adjusted OR (95% confidence interval [CI]) were 2.62 (2.09 to 3.28) for hypothyroidism, 1.88 (1.51 to 2.32) for chronic obstructive pulmonary disease, 2.11 (1.36 to 3.28) for diabetes with complications, 7.54 (3.55 to 15.99) for hepatitis C, 4.21 (3.25 to 5.44) for fluid/electrolyte disorders, and 2.77 (2.23 to 3.44) for nicotine abuse/dependence. CONCLUSIONS: Schizophrenia is associated with substantial chronic medical burden. Familiarity with conditions affecting persons with schizophrenia may assist programs aimed at providing medical care for the mentally ill.


Asunto(s)
Seguro de Salud , Esquizofrenia/epidemiología , Adulto , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Iowa/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/economía , Enfermedades del Sistema Nervioso/epidemiología , Grupos de Población , Estudios Retrospectivos , Esquizofrenia/economía
14.
J Gen Intern Med ; 21(10): 1097-104, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16970559

RESUMEN

BACKGROUND: Women with mental illness may be at risk for failure to receive recommended preventive services such as mammography. Little is known about whether the type or severity of mental illness influences receipt of preventive services. OBJECTIVE: To measure the influence of type and severity of mental illness on receipt of mammography. DESIGN: Retrospective study of administrative claims data, 1996 to 2001. SUBJECTS: Privately insured women age 40 to 64 years, with and without claims for mental illness, and who were eligible for mammography between 1996 and 2001. MEASUREMENT: Odds ratios (OR) for receipt of screening mammography, any mammography, and follow-up mammography, adjusted for age, rural location, utilization of nonmental health services, and severity and type of the mental disorder. Severity measures were based on utilization of outpatient and inpatient mental health services and presence of comorbid substance use disorder. RESULTS: Women with any mental disorder were significantly less likely to receive mammography than controls. This was strongly influenced by severity of mental illness (any mammography: moderate severity OR 0.62; confidence interval [CI] 0.59 to 0.66: high severity OR 0.38; CI 0.33 to 0.43). Whereas severity contributed to lower receipt of mammography among women with mood and anxiety disorders, women with psychotic, alcohol, and substance abuse disorders had decreased odds for receipt of mammography regardless of severity. CONCLUSIONS: Women with mental disorders are at risk for failure to receive mammography, a recommended preventive service. Women with severe mental illness or psychotic and substance abuse disorders should be targeted to ensure delivery of mammography.


Asunto(s)
Accesibilidad a los Servicios de Salud , Mamografía/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
15.
Ann Clin Psychiatry ; 18(3): 149-55, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16923652

RESUMEN

BACKGROUND: An increased risk for metabolic syndrome has been described for persons with psychotic and mood disorders. Our objectives were to determine whether the odds for metabolic syndrome (MetSyn) were increased among insured adults with and without mental illness, and to determine whether this risk extends beyond psychotic and affective disorders. METHOD: This was a retrospective analysis of a 100% sample of Blue Cross/Blue Shield of Iowa claims data. Three definitions of MetSyn were examined: 1) presence of any 3 or more components of MetSyn (obesity, hypertriglyceridemia, hypercholesterolemia, hypertension, and glucose intolerance/diabetes mellitus), 2) criteria #1 and/or claim for glucose intolerance/diabetes mellitus, and 3) criteria #1, criteria #2, and/or claim for obesity. ICD-9 codes were used to define obesity, hypertriglyceridemia, hypercholesterolemia, hypertension, and glucose intolerance/diabetes mellitus. Multivariate logistic regression was used to investigate the association between mental illness and MetSyn. RESULTS: Prevalence of MetSyn for subjects with any mental illness as compared to those without was 4.9% vs. 2.0% (criteria #1), 8.1% vs. 4.2% (criteria #2), and 13.2% vs. 6.2% (criteria #3). MetSyn was more common (OR = 1.3-1.5) for subjects with any mental illness as compared to those without, regardless of which definition of MetSyn was used. Subjects with sexual disorders (OR = 1.7-1.8), sleep disorders (OR = 1.2-1.7), and mood disorders (OR = 1.3-1.6) had significantly higher odds of MetSyn compared to those without claims for mental disorders, regardless of which definition of MetSyn was used. CONCLUSIONS: These results suggest that MetSyn is not only problematic among persons with psychosis and affective disorders, but that it also affects patients with other forms of mental illness. Clinicians should have a heightened awareness of metabolic risk factors, particularly when mental illness is present.


Asunto(s)
Trastornos Mentales/epidemiología , Síndrome Metabólico/epidemiología , Adulto , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Estadística como Asunto
16.
J Am Geriatr Soc ; 54(1): 104-9, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16420205

RESUMEN

OBJECTIVES: To compare the medical comorbidity of older patients with and without dementia in primary care. DESIGN: Cross-sectional study. SETTING: Wishard Health Services, which includes a university-affiliated, urban public hospital and seven community-based primary care practice centers in Indianapolis. PARTICIPANTS: Three thousand thirteen patients aged 65 and older attending seven primary care centers in Indianapolis, Indiana. MEASUREMENTS: An expert panel diagnosed dementia using International Classification of Diseases, 10th Revision, criteria. Comorbidity was assessed using 10 physician-diagnosed chronic comorbid conditions and the Chronic Disease Score (CDS). RESULTS: Patients with dementia attending primary care have on average 2.4 chronic conditions and receive 5.1 medications. Approximately 50% of dementia patients in this setting are exposed to at least one anticholinergic medication, and 20% are prescribed at least one psychotropic medication. After adjusting for patients' age, race, and sex, patients with and without dementia have a similar level of comorbidity (mean number of chronic medical conditions, 2.4 vs 2.3, P=.66; average CDS, 5.8 vs 6.2, P=.83). CONCLUSION: Multiple medical comorbid conditions are common in older adults with and without dementia in primary care. Despite their cholinergic deficit, a substantial proportion of patients with dementia are exposed to anticholinergic medications. Models of care that incorporate this medical complexity are needed to improve the treatment of dementia in primary care.


Asunto(s)
Enfermedad Crónica/epidemiología , Demencia/epidemiología , Atención Primaria de Salud , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Antagonistas Colinérgicos/uso terapéutico , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Polifarmacia
17.
Qual Life Res ; 14(10): 2303-14, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16328909

RESUMEN

PURPOSE: To examine the patterns of coexisting (comorbid) mental disorders and whether comorbidity influences quality of life ratings in a sample of U.S. veterans. PATIENTS AND METHODS: The Iowa Gulf War Study Case Validation study evaluated 602 military personnel, two-thirds of whom had symptoms of depression, cognitive dysfunction, or chronic widespread pain, who were activated or on active duty sometime during the first Gulf War (GW). Mental health disorders were defined using the SCID-IV, and the Health Utilities Index Mark 3 (HUI3) was used to measure health-related quality of life (HRQoL). Comorbidity was defined as having two or more mental disorders that spanned across at least two separate categories (e.g., depressive disorders and anxiety disorders). RESULTS: Over 35% of veterans with a current mental disorder had at least one other comorbid mental disorder. Those with mental disorder comorbidity had lower HUI scores than veterans with only one or less mental disorders (mean 0.41 +/- 0.30 vs. 0.72 +/- 0.25, p < 0.0001). CONCLUSION: The co-occurrence of mental disorders that span at least two mental disorder categories is associated with impaired HRQoL in this veteran population. Early identification of mental health comorbidity may lead to interventions to enhance HRQoL among military personnel.


Asunto(s)
Comorbilidad/tendencias , Guerra del Golfo , Trastornos Mentales/epidemiología , Calidad de Vida , Veteranos/psicología , Adulto , Femenino , Humanos , Iowa/epidemiología , Masculino , Persona de Mediana Edad
18.
Psychosomatics ; 46(6): 529-39, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16288132

RESUMEN

The prevalence and correlates of illness worry in the general population were investigated in a representative sample. The authors screened residents of the United States by telephone, and more detailed interviews were conducted with 123 respondents who reported at least 1 month of worry about serious illness in the past 12 months and an equal number of randomly selected persons without such worry. Data on demographic characteristics, medical and psychiatric conditions, functional impairment, and health care utilization were collected. At least 1 month of worry was endorsed by 13.1% of the screened population. Correlates of worry included a cluster of psychiatric conditions (major depressive episode, panic attacks, and generalized anxiety disorder) and three clusters of physical conditions (heart disease, cancer, and other diseases). Worry about serious illness was associated with functional impairment and health care utilization.


Asunto(s)
Ansiedad/epidemiología , Ansiedad/psicología , Actitud Frente a la Salud , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Ansiedad/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia
19.
Psychosomatics ; 46(6): 517-22, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16288130

RESUMEN

Despite attention to depression and cognitive disorders, the prevalence of other mental disorders following breast cancer chemotherapy has not been well described. The authors undertook a pilot study using insurance claims data to compare the prevalence of mental disorders other than depression in a population of breast cancer surgery patients who did versus did not receive postsurgical chemotherapy treatment. Women receiving chemotherapy in addition to surgery were more likely to be diagnosed with adjustment disorders (odds ratio=2.01, 95% CI=1.04-3.87). Prevalence of depression, anxiety, cognitive, and sleep disorders were not dependent on receipt of post-surgical chemotherapy treatment. These findings support the need for heightened awareness for mental conditions following chemotherapy.


Asunto(s)
Trastornos de Adaptación/epidemiología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/psicología , Trastornos Mentales/epidemiología , Trastornos de Adaptación/diagnóstico , Trastornos de Adaptación/etiología , Adolescente , Adulto , Anciano , Concienciación , Neoplasias de la Mama/cirugía , Terapia Combinada , Quimioterapia/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/etiología , Persona de Mediana Edad , Proyectos Piloto , Prevalencia
20.
Mil Med ; 170(7): 612-8, 2005 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16130644

RESUMEN

OBJECTIVE: This study investigated the prevalence of incarceration and the association with deployment among veterans of the first Persian Gulf War (GW). METHODS: A structured telephone interview of military personnel from Iowa deployed to the Persian Gulf and a comparison sample of nondeployed military personnel was conducted. The interview consisted of validated questions, validated instruments, and investigator-derived questions to assess relevant medical and psychiatric conditions. A total of 4,886 subjects were randomly drawn from one of four study domains, i.e., GW regular military, GW National Guard/Reserve, non-GW regular military, or non-GW National Guard/Reserve. Symptoms of medical conditions, psychiatric disorders, and health care utilization were the main outcome measures. RESULTS: Nearly one-quarter (845 of 3,695 subjects, 22.9%) had been incarcerated at some point before the interview ("ever incarcerated"). Ever incarcerated veterans had a higher frequency of psychiatric and medical comorbidity and higher rates of health care utilization. Ever incarcerated status was associated with male gender, enlisted rank, lower educational levels, low levels of military preparedness, discharge from service, cigarette smoking, antisocial traits, court martial and/or other military discipline, having seen a mental health professional, and having used illegal drugs. GW veterans who participated in combat had a modestly higher risk for incarceration after the GW than did noncombatants (odds ratio, 1.6; 95% confidence interval, 1.0-2.5). CONCLUSIONS: Military recruits with a history of incarceration more often displayed problematic behaviors, more often developed psychiatric/medical conditions, and had high rates of health care utilization. A history of incarceration may be a behavioral marker for substance abuse, antisocial behavior, and mental illness. Importantly, GW deployment carried no increased risk of subsequent incarceration overall.


Asunto(s)
Guerra del Golfo , Trastornos Mentales/epidemiología , Medicina Militar , Personal Militar/psicología , Prisiones/estadística & datos numéricos , Veteranos/clasificación , Adulto , Estudios de Casos y Controles , Femenino , Encuestas de Atención de la Salud , Humanos , Entrevistas como Asunto , Iowa/epidemiología , Masculino , Personal Militar/clasificación , Prevalencia , Encuestas y Cuestionarios , Teléfono , Estados Unidos/epidemiología , Veteranos/psicología
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