Prescription medication use among patients with type 2 diabetes in the United States: 1999-2020.

AIMS: We aimed to examine trends in overall prescription medication use among patients with type 2 diabetes in the United States to provide insights for patient care. MATERIALS AND METHODS: We used nationally representative data from the National Health and Nutrition Examination Survey from 1999 to 2020 and included adult patients with type 2 diabetes. We examined the use of prescription drugs, overall and by drug class, polypharmacy (use of ≥5 medications), and number of medications attributed to specific classes. RESULTS: In the period 2015-2020, the mean patient age was 59.6 (51.0-70.0) years, with 46.8% (43.6-49.9) being female and 57.8% (52.8-62.8) being non-Hispanic White. Among 9489 adults with type 2 diabetes, the prevalence of polypharmacy was high and increased from 35.1% (31.6-38.6) in 1999-2002 to 47.2% (43.7-50.7) in 2003-2006, and further to 51.1% (48.3-53.9) in 2015-2020 (p for trend <0.001). Increasing trends of polypharmacy were found across all population subgroups and across the majority of therapeutic classes. Use of non-cardiometabolic medications was common. Among them, the most common were antidepressants (19.8%), proton pump inhibitors (19.0%) and analgesics (16.2%). Among patients with polypharmacy, approximately 40% of medication use was attributed to non-cardiometabolic medications. CONCLUSIONS: Prescription medication burden and complexity increased substantially among patients with type 2 diabetes, with more than 50% of patients with polypharmacy. Attention should be paid to this escalating medication use and regimen complexity, which requires multidisciplinary and coordinated care.

Trends in Number and Appropriateness of Prescription Medication Utilization Among Community-Dwelling Older Adults in the United States: 2011-2020.

BACKGROUND: Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in the number and appropriateness of prescription medication use among older adults in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used, and 6 336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blockers [ARBs] plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria). RESULTS: There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011-2012 to 43.8% in 2017-2020, p for trend = .32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017-2020) and approximately 50% of patients with albuminuria received ACEI/ARBs (54.0% in 2017-2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status were generally associated with greater use of PIM but lower use of recommended medications. CONCLUSIONS: The medication burden remained high among older adults in the United States and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.

Are We Justified in Modeling Human Exposure to Chlorinated Paraffin Mixtures Using the Average Properties of Congeners and Homologues?

Concern over human exposure to chlorinated paraffin (CP) mixtures keeps increasing. The absence of a comprehensive understanding of how human exposure varies with the physicochemical properties of CP constituents has hindered the ability to determine at what level of aggregation exposure to CPs should be assessed. We answer this question by comparing exposure predicted with either a "complex" method that utilizes isomer-specific properties or "simplified" methods that rely on median properties of congener, homologue, or short-/medium-/long-chain CP groups. Our results demonstrate the wide range of physicochemical properties across CP mixtures and their dependence on molecular structures. Assuming unit emissions in the environment, these variances translate into an extensive disparity in whole-body concentrations predicted for different isomers, spanning ∼11 orders of magnitude. CPs with 13-19 carbons and 6-10 chlorines exhibit the highest human exposure potential, primarily owing to moderate to high hydrophobicity and slow environmental degradation and biotransformation. Far-field exposure is dominant for most CP constituents. Our study underscores that using average properties of congener, homologue, or S/M/LCCP groups yields results that are consistent with those derived from isomer-based modeling, thus offering an efficient and practical framework for future risk assessments and human exposure studies of CPs and other complex chemical mixtures.

Association between obesity and urinary incontinence in older adults from multiple nationwide longitudinal cohorts.

BACKGROUND: Obesity and urinary incontinence (UI) among older adults, particularly older men, are yet to be fully explored. Utilizing multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men. METHODS: We derived the data from multiple longitudinal cohorts that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months or within the past six months. The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualized the associations by using restricted cubic spline curves. RESULTS: A total of 200,717 participants with 718,822 observations are included in the baseline analysis. Compared to those without UI, both female and male participants with UI demonstrate a higher BMI and WC. Among females, the fully adjusted models show linear associations between BMI, WC, and UI (Ps < 0.001). However, we observe U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI is found among male participants with a BMI between 24 and 35 kg/m2. CONCLUSIONS: Interventions aimed at preventing UI among older adults must take sex into account. Weight loss intervention could be an effective treatment among older females who are overweight and with obesity as well as older males with obesity rather than all older males.

It is not well known if being obese poses a risk of urinary incontinence (UI) in older adults, especially in older men. We aim to address this question by analyzing three nationwide long-term studies conducted in the UK, Europe and USA. We found there was a direct link between increasing body weight and the likelihood of experiencing UI in older females. Whereas, older males who are considered clinically obese were more prone to experiencing UI. This suggests that weight loss intervention can be effective for treating UI in older females carrying extra weight and older males who are considered clinically obese. Our study highlights that sex should be taken into consideration when developing interventions for UI treatment in older adults.

Medical insurance, health risks, and household financial asset allocation: evidence from China household finance survey.

There is a lack of micro evidence on whether medical insurance may optimize the household financial asset allocation by transferring health risk, despite the fact that health risk is a significant component driving families' precautionary savings. This article empirically examines the impact of health risk and social medical insurance on household risky financial asset allocation using a Probit model, based on data from the 2015-2019 China Household Finance Survey (CHFS). The findings indicate that social medical insurance, with its lower level of security, reduces the likelihood, but it can alter households' preferences for risk by lowering marginal effect of health risk. According to the findings of the heterogeneity analysis, people who live in rural and less developed areas are more likely to experience the risk-inhibiting effects of social medical insurance and health risk. The eroding and risk-suppressing impacts of social medical insurance are likewise less pronounced for households headed by women and older people, as is the health risk's suppressive influence on household involvement in risky financial markets. Compared with social medical insurance, commercial medical insurance with a higher level of coverage can dramatically increase household participation in riskier financial markets. This article provides micro-empirical evidence for the household asset allocation effect of medical insurance.

Community public health safety emergency management and nursing insurance service optimization for digital healthy urban environment construction.

The purpose of this paper is to promote the construction of digital healthy cities and improve the living standards of urban residents. Based on this, this paper analyzes the development of healthy cities, and studies community public health safety emergency management and nursing insurance service optimization methods for healthy urban environment construction. First, the concept of digital healthy urban environment construction is discussed. Then, the role of environmental health is discussed. Finally, two methods are designed to study the emergency management of public health safety and nursing insurance services in urban communities under the condition of environmental health. The results show that in the environmental health score of the city, the scores of X1 (the urban air quality excellent rate) and X6 (citizens' satisfaction with the environmental quality) were relatively low between 2016 and 2018, below 0.5 points. The scores for the remaining 3 years were relatively high, above 0.5. The scores of X2 (green coverage rate of built-up area), X3 (average grade sound effect of environmental noise in urban area), X4 (harmless treatment rate of domestic waste) and X5 (centralized treatment rate of domestic sewage) were relatively high from 2016 to 2018, above 0.5 points, and relatively low in the remaining 3 years, below 0.5 points. Meanwhile, residents are very satisfied with information collection and information management in public health and safety emergency management, and the number of very satisfied people is basically more than 40%. Satisfaction with resource allocation and privacy management is high, and the number of very satisfied people is basically above 30%. However, the satisfaction with risk perception and management measures is very low, and the number of very satisfied people is basically below 20%. It shows that the current construction of the community's public health and safety emergency management system is relatively poor in terms of X2-X5, while the development of X1 and X6 is relatively mature. The research not only provides a reference for the construction and improvement of a digital healthy city, but also contributes to the improvement of the healthy life of urban residents.

Nutrition improvement program for rural compulsory education students and individual health.

We use the county-by-county rollout of the program and employ the difference-in-difference (DID) methodology to identify the effects of the implementation of the nutrition improvement program for rural compulsory education students on adolescent health. The results show that the nutrition improvement program reduces the frequency and probability of illness and improves the students' health status. The heterogeneity analysis indicates that the children in western regions and children left behind have a greater marginal improvement. It finds that the nutrition improvement program for rural compulsory education students improves adolescent health through diversifying nutrition intake to alleviate malnutrition and developmental delay in impoverished areas. The program can promote adolescent health in impoverished areas, which has a role in improving regional health disparities and alleviating the intergenerational entrenchment of poverty.

Optimization of Work Environment and Community Labor Health Based on Digital Model-Empirical Evidence from Developing Countries.

As far as we know, for large manufacturing enterprises, there is often a community of labor gathered around such enterprises, which is especially used as a place for the enterprise to place the labor force. This paper aimed to update the industry model of Chinese Manufacturing Enterprises (CMEs) to improve workers' health management. This work first discusses the value, mode, and process of Enterprise Digital Transformation (EDT) and Worker Health and Safety Management (WHSM). Then, it proposes the CMEs-oriented EDT model and WHSM system based on Big Data Technology (BDT) and the Internet of Things (IoT). The proposed model and system are verified through a case study on the Shanghai BYD manufacturing enterprise (short for BYD) using the Fuzzy Comprehensive Evaluation Method (CFEM). The EDT model verification considers the adaptation and performance of enterprises after EDT. The WHSM system considers workers' oxygen inhalation status to evaluate their heart and cardiovascular health. The results show that EDT improves the enterprise's revenue and reshuffles the revenue structure. The EDT model has absolute adaptability to BYD. It has greatly improved BYD's indexes, especially financial performance, market capability, and technical capability.