The Associations Between Medical and Mental Health Conditions and Health Care Utilization in US Adults with Past-Year Criminal Legal Involvement.

BACKGROUND: Every year, millions of US adults return home from prison or jail, and they visit the emergency department and experience hospitalizations at higher rates than the general population. Little is known about the primary conditions that drive this acute care use. OBJECTIVE: To determine the individual and combined associations between medical and mental health conditions and acute health care utilization among individuals with recent criminal legal involvement in a nationally representative sample of US adults. DESIGN: We examined the association between having medical or mental, or both, conditions (compared to none), and acute care utilization using negative binomial regression models adjusted for relevant socio-demographic covariates. PARTICIPANTS: Adult respondents to the National Survey of Drug Use and Health (2015-2019) who reported past year criminal legal involvement. MAIN MEASURES: Self-reported visits to the emergency department and nights spent hospitalized. RESULTS: Among 9039 respondents, 12.4% had a medical condition only, 34.6% had a mental health condition only, and 19.2% had both mental and medical conditions. In adjusted models, incident rate ratio (IRR) for ED use for medical conditions only was 1.32 (95% CI 1.05, 1.66); for mental conditions only, the IRR was 1.36 (95% CI 1.18, 1.57); for both conditions, the IRR was 2.13 (95% CI 1.81, 2.51). For inpatient use, IRR for medical only: 1.73 (95% CI 1.08, 2.76); for mental only, IRR: 2.47 (95% CI 1.68, 3.65); for both, IRR: 4.26 (95% CI 2.91, 6.25). CONCLUSION: Medical and mental health needs appear to contribute equally to increased acute care utilization among those with recent criminal legal involvement. This underscores the need to identify and test interventions which comprehensively address both medical and mental health conditions for individuals returning to the community to improve both health care access and quality.

The relationship between C-Reactive protein and mortality in adults with diabetes: Influences of demographic characteristics, lifestyle behaviors, and medications.

BACKGROUND AND AIMS: This study assesses the influence of demographic, lifestyle, and medication in the association between CRP and mortality in a national sample of adults with diabetes. METHODS AND RESULTS: Cross-sectional study of data from 1999 to 2010 National Health and Nutrition Examination Survey (unweighted n = 3952; Weighted n = 19,064,710). Individuals were categorized as having diabetes if told by a provider they had diabetes, were taking insulin or other diabetes medications, or had a glycosylated hemoglobin A1c (HbA1c) ≥ 6.5%. CRP was classified into four categories: normal (≤0.1 mg/dL); moderate risk (0.11-0.3 mg/dL); high-risk (0.31-1.0 mg/dL); very high-risk (>1.0 mg/dL). Higher risk for mortality was associated with a very high-risk of CRP (HR = 1.88 (95% CI: 1.27-2.78), being a current (HR = 1.49 (95% CI: 1.10-2.01) or former (HR = 1.34 (95% CI: 1.03-1.73) smoker, and taking insulin (HR = 1.60 (95% CI: 1.25-2.05), taking anti-hypertensives (HR = 1.50 (95% CI: 1.22-1.85), and having co-morbidities such as cancer (HR = 1.32 (95% CI: 1.05-1.66) and hepatitis infection (HR = 1.76 (95% CI: 1.07-2.91), while taking Metformin (HR = 0.62 (95% CI: 0.50-0.76) had a lower risk of mortality. CONCLUSION: In this sample of adults with diabetes, demographic, lifestyle, and medication factors influenced the association between CRP and mortality. Interventions should focus on these factors to reduce mortality in adults with diabetes.

Differences by race in the associations between neighborhood crime and violence and glycemic control among adults with type 2 diabetes.

BACKGROUND: Limited data exist on the differential association between neighborhood characteristics such as crime and violence and diabetes outcomes by race. OBJECTIVE: To examine racial differences in the relationship between neighborhood characteristics (crime and violence) and glycemic control in a sample of adults with type 2 diabetes (T2DM). DESIGN: A cross-sectional study. PARTICIPANTS: 601 adults with T2DM from the Southeastern United States. MEASUREMENTS: Outcome was glycemic control. Neighborhood violence and crime were the primary independent variable, and previously validated scales and indices were used to assess neighborhood crime and violence. Covariates included age, gender, education, marital status, income, hours of work per week, duration of diabetes, comorbidity, health status, and site of recruitment. Multiple linear regression was used to assess the relationship between neighborhood characteristics (violence and crime) and glycemic control adjusting for relevant covariates. RESULTS: Approximately 66% of the sample population was Black with ages ranging between 49-71 years. The unadjusted mean hemoglobin A1c (HbA1c) was significantly higher for Black adults compared to White adults (8.0 ± 2.0 vs. 7.8 ± 1.6; p = 0.002). In the fully adjusted stratified model, glycemic control was significantly associated with neighborhood crime (ß-coefficient: 0.36; 95% CI 0.07, 0.65) and neighborhood violence (ß-coefficient: 0.14; 95% CI 0.003, 0.28) for White adults in the fully adjusted model; these relationships were not significant for Black adults. CONCLUSION: In this sample of adults with T2DM, neighborhood crime and violence were significantly associated with glycemic control for White adults, but not for Black adults. Additional research is needed to understand perceptions of neighborhood crime and violence between White adults and Black adults with T2DM.

A Case of Drug-Induced Stevens-Johnson Syndrome.

INTRODUCTION: Stevens-Johnson syndrome is a rare but consequential and often life-threatening disorder that is most often drug-induced. CASE PRESENTATION: An 81-year-old Black man presented with 5 days of dysphagia, odynophagia, and rash. He said he had begun a course of trimethoprim-sulfamethoxazole 6 days prior for a presumed urinary tract infection. Owing to the cutaneous lesions and punch biopsy findings, he was diagnosed with drug-induced Stevens-Johnson syndrome. DISCUSSION: Stevens-Johnson syndrome is associated with a relatively high mortality rate. It is most commonly drug-induced and presents with extensive erythema, erosions, and blisters throughout the body. CONCLUSIONS: Stevens-Johnson syndrome is a rare and often life-threatening disease. Early diagnosis and management is important for delivering high-quality patient care.

The association between history of incarceration and heart disease: Adults from the 1979 National Longitudinal Survey of Youth.

Heart disease affects over 30.3 million adults in the United States and is a leading cause of mortality, morbidity, and disability. However, little is known about the relationship between exposure to incarceration and chronic disease. Therefore, the aim of this study was to assess the relationship between prior incarceration and heart disease. This was a study of 12,686 adults from the National Longitudinal Survey of Youth (NLSY) 1979 dataset. History of incarceration was the predictor and defined as any episode of incarceration in a correctional institution. The outcome, heart disease, was defined as self-reported diagnosis of heart disease. Covariates included: Demographic factors (age, race, sex, place of residence, and marital status), lifestyle and clinical factors (drug use, body mass index (BMI), early life health limitation, cigarette smoking, and binge drinking), and socioeconomic factors (poverty status, educational attainment, and employment status). Pooled logistic regression models with generalized estimating equation approach (GEE) were used to model the relationship between history of incarceration and heart disease. In the unadjusted analyses, a history of incarceration was significantly associated with an increased odds of heart disease (OR 2.29; 95% CI 1.40, 3.75). This relationship persisted after adjusting for demographic (OR 3.46; 95% CI 2.06, 5.85) and lifestyle and clinical factors (OR 3.46; 95% CI 2.03, 5.88) and socioeconomic factors (OR 2.14; 95% CI 1.25, 3.67). In this sample of adults, a history of incarceration was significantly associated with heart disease, after adjusting for demographic, lifestyle and clinical factors, and socioeconomic factors. These findings suggest that exposure to incarceration may heighten susceptibility to heart disease. Further research is needed to elucidate the mechanisms through which incarceration impacts cardiovascular health.

Influences of Demographic, Social Determinants, Clinical, Knowledge, and Self-Care Factors on Quality of Life in Adults With Type 2 Diabetes: Black-White Differences.

BACKGROUND: This study evaluated racial differences in the contribution of demographic, social determinants, clinical, and self-care factors on quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). METHODS: A total of 615 adults with T2DM in Southeastern United States were recruited. Linear regression models were used to assess the contribution of demographic, social determinants, clinical, and self-care factors on the mental (MCS) and physical components (PCS) of QOL, after stratifying by race. RESULTS: For the entire sample, there were significant relationships between PCS and psychological distress (ß = 0.02, p < 0.01), neighborhood aesthetics (ß = 0.05, p < 0.01), neighborhood walking environment (ß = -0.02, p < 0.05), access to healthy food (ß = 0.01, p < 0.05), neighborhood crime (ß = -0.15, p < 0.05), and neighborhood comparison (ß = 0.13, p < 0.05); and MCS and depression (ß = -0.06, p < 0.05), psychological distress (ß = -0.09, p < 0.001), perceived stress (ß = -0.12, p < 0.01), and perceived health status (ß = -0.33, p < 0.01). In the regression models stratified by race, notable differences existed in the association between PCS, MCS, and demographic, psychosocial, built environment, and clinical factors among Whites and Blacks, respectively. CONCLUSION: In this sample, there were racial differences in demographic, social determinants, built environment, and clinical factors associated with PCS and MCS components of QOL. Interventions may need to be tailored by race or ethnicity to improve quality of life in adults with T2DM.

Trends in Obesity and Medical Expenditure among Women with Diabetes, 2008-2016: Differences by Race/Ethnicity.

Objectives: Diabetes results in $327 billion in medical expenditures annually, while obesity, a risk factor for type 2 diabetes, leads to more than $147 billion in expenditure annually. The aims of this study were: 1) to evaluate racial/ethnic trends in obesity and medical expenditures; and 2) to assess incremental medical expenditures among a nationally representative sample of women with diabetes. Methods: Nine years of data (2008-2016) from the Medical Expenditure Panel Survey Full Year Consolidated File (unweighted = 11,755; weighted = 10,685,090) were used. The outcome variable was medical expenditure. The primary independent variable was race/ethnicity defined as non-Hispanic Black (NHB), Hispanic, or non-Hispanic White (NHW). Covariates included age, education, marital status, income, insurance, employment, region, comorbidity, and year. Cochran-Armitage tests determined statistical significance of trends in obesity and mean expenditure. Two-part modeling using Probit and gamma distribution was used to assess incremental medical expenditure. Data were clustered to 2008-2010, 2011-2013, 2014-2016. Results: Trends in medical expenditures differed significantly between NHB and NHW women between 2008-2016 (P<.001). Hispanic women paid $1,291 less compared with NHW women, after adjusting for relevant covariates. There were no significant differences in obesity trends from 2008-2016 between NHB (P=.989) or Hispanic women with diabetes (P=.938) compared with NHW women with diabetes. Conclusions: These findings suggest the need to further understand the factors associated with differences in trends for medical expenditures between NHB and NHW women with diabetes and incremental medical expenditures in Hispanic women with diabetes compared with NHW women with diabetes.

Pattern and medical care of child victims of sexual abuse in Ekiti, south-western Nigeria.

BACKGROUND: Child sexual assault (CSA) is a global health problem which affects many children and is often under-reported in developing countries. Data on CSA are few in these countries. AIMS AND OBJECTIVES: This study aimed to review the pattern and medical care of victims of CSA in a tertiary hospital over a 39-month period. METHODS: This is a retrospective, descriptive study. Case files of 28 cases of CSA were retrieved from those of 6535 patients seen in the paediatric out-patient department of Ekiti State University Teaching Hospital between 1 January 2010 and 31 March 2013. RESULTS: Victims of CSA accounted for 0.43% of new patients seen during the period under review with a yearly increase over that time. Victims were all female with a median age of 11.5 years and the age range was 4-17. They all had genito-urinary findings and 3.6% had an anal tear. The assailants were all male, mostly adults. A school-teacher and school-friends were the perpetrators in 3.6% and 10.8% of cases, respectively. All were screened for HIV, but only 60.7% were screened for hepatitis B and C. Only 60.7% received HIV post-exposure prophylaxis and none was given prophylaxis against viral hepatitis B and C. Of those eligible for post-exposure emergency contraception, only 43.8% received it. Antibiotics and analgesics were routinely given in 89.3% cases. Only one of the patients attended for follow-up. None had repeat serological screening tests. The police were involved in 60.7% of cases but there was no prosecution. CONCLUSION: Perpetrators of CSA are protean and, in the study area, there are gross inadequacies in the care provided for victims. Standard treatment protocols and additional training for health-care providers involved in the management of CSA victims are required.