Trends and Race/Ethnic Disparities in Diabetes-Related Hospital Use in Medicaid Enrollees: Analyses of Serial Cross-sectional State Data, 2008-2017.

BACKGROUND: Race/ethnic disparities in preventable diabetes-specific hospital care may exist among adults with diabetes who have Medicaid coverage. OBJECTIVE: To examine race/ethnic disparities in utilization of preventable hospital care by adult Medicaid enrollees with diabetes across nine states over time. DESIGN: Using serial cross-sectional state discharge records for emergency department (ED) visits and inpatient (IP) hospitalizations from the Healthcare Cost and Utilization Project, we quantified race/ethnicity-specific, state-year preventable diabetes-specific hospital utilization. PARTICIPANTS: Non-Hispanic Black, non-Hispanic White, and Hispanic adult Medicaid enrollees aged 18-64 with a diabetes diagnosis (excluding gestational or secondary diabetes) who were discharged from hospital care in Arizona, Iowa, Kentucky, Florida, Maryland, New Jersey, New York, North Carolina, and Utah for the years 2008, 2011, 2014, and 2017. MAIN MEASURES: Non-Hispanic Black-over-White and Hispanic-over-White rate ratios constructed using age- standardized state-year, race/ethnicity-specific ED, and IP diabetes-specific utilization rates. KEY RESULTS: The ratio of Black-over-White ED utilization rates for preventable diabetes-specific hospital care increased across the 9 states in our sample from 1.4 (CI 95, 1.31-1.50) in 2008 to 1.73 (CI 95, 1.68-1.78) in 2017. The cross-year-state average non-Hispanic Black-over-White IP rate ratio was 1.46 (CI 95, 1.42-1.50), reflecting increases in some states and decreases in others. The across-state-year average Hispanic-over-White rate ratio for ED utilization was 0.67 (CI 95, 0.63-0.71). The across-state-year average Hispanic-over-White IP hospitalization rate ratio was 0.72 (CI 95, 0.69-0.75). CONCLUSIONS: Hospital utilization by non-Hispanic Black Medicaid enrollees with diabetes was consistently greater and often increased relative to utilization by White enrollees within state programs between 2008 and 2017. Hispanic enrollee hospital utilization was either lower or indistinguishable relative to White enrollee hospital utilization in most states, but Hispanic utilization increased faster than White utilization in some states. Among broader patterns, there is heterogeneity in the magnitude of race/ethnic disparities in hospital utilization trends across states.

Estimating risk factor progression equations for the UKPDS Outcomes Model 2 (UKPDS 90).

OBJECTIVES: To estimate 13 equations that predict clinically plausible risk factor time paths to inform the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model version 2 (UKPDS-OM2). METHODS: Data from 5102 UKPDS participants from the 20-year trial, and the 4031 survivors with 10 years further post-trial follow-up, were used to derive equations for the time paths of 13 clinical risk factors: HbA1c , systolic blood pressure, LDL-cholesterol, HDL-cholesterol, BMI, micro- or macro-albuminuria, creatinine, heart rate, white blood cell count, haemoglobin, estimated glomerular filter rate, atrial fibrillation and peripheral vascular disease (PVD). The incidence of events and death predicted by the UKPDS-OM2 when informed by the new risk factor equations was compared with the observed cumulative rates up to 25 years. RESULTS: The new equations were based on 24 years of follow-up and up to 65,252 person-years of data. Women were associated with higher values of all continuous risk factors except for haemoglobin. Older age and higher BMI at diagnosis were associated with higher rates of PVD (HR 1.06 and 1.02), atrial fibrillation (HR 1.10 and 1.08) and micro- or macro-albuminuria (HR 1.01 and 1.18). Smoking was associated with higher rates of developing PVD (HR 2.38) and micro- and macro-albuminuria (HR 1.39). The UKPDS-OM2, informed by the new risk factor equations, predicted event rates for complications and death consistent with those observed. CONCLUSIONS: The new equations allow risk factor time paths beyond observed data, which should improve modelling of long-term health outcomes for people with type 2 diabetes when using the UKPDS-OM2 or other models.

A Feasibility Study of Supply and Demand for Diabetes Prevention Programs in North Carolina.

INTRODUCTION: Diabetes Prevention Programs (DPPs) have shown that healthy eating and moderate physical activity are effective ways of delaying and preventing type 2 diabetes in people with impaired glucose tolerance. We assessed willingness to pay for DPPs from the perspective of potential recipients and the cost of providing these programs from the perspective of community health centers and local health departments in North Carolina. METHODS: We used contingent valuation to determine how much potential recipients would be willing to pay to participate in DPPs under 3 different models: delivered by registered professionals (traditional model), by community health workers, or online. By using information on the minimum reimbursement rate at which public health agencies would be prepared to provide the 3 models, we estimated the marginal costs per person of supplying the programs. Matching supply and demand, we estimated the degree of cost sharing between recipients and providers. RESULTS: Potential program recipients (n = 99) were willing to pay more for programs led by registered professionals than by community health workers, and they preferred face-to-face contact to an online format. Socioeconomic status (measured by education and employment) and age played the biggest roles in determining willingness to pay. Leaders of public health agencies (n = 27) reported up to a 40% difference in the cost of providing the DPP, depending on the delivery model. CONCLUSION: By using willingness to pay to understand demand for DPPs and computing the provider's marginal cost of providing these services, we can estimate cost sharing and market coverage of these services and thus compare the viability of alternate approaches to scaling up and sustaining DPPs with available resources.

Relationship among obesity, depression, and emotional eating in young adults.

Depressive symptoms are often associated with obesity, and emotional eating may play a considerable role in weight gain. This study aimed to examine the association among depression symptoms, emotional eating, and body mass index (BMI) in Mexican college students; and to assess emotional eating as mediator between depressive symptoms and BMI. A total of 1453 students at a public university in Mexico City completed the scale Self-Efficacy in Emotion- and Stress- Related Eating of the Eating and Appraisal Due to Emotions and Stress Questionnaire (EADES) to assess emotional eating, and the scale created by the Center for Epidemiologic Studies (CES-D) to identify depressive symptoms. Weight and height were measured to calculate BMI. Structural equation models (SEM) were used to assess emotional eating as mediator between depressive symptoms and BMI by sex. Depressive symptoms were associated with emotional eating in both men (Beta = -0.33, p < 0.001) and women (Beta = -0.46, p < 0.001). Emotional eating, in turn, was associated with BMI in men (Beta = -0.08, p < 0.001) as well as in women (Beta = -0.09, p < 0.001). Emotional eating was a mediator between depression and BMI, adjusted for age in both sexes. This finding suggests that emotion management should be taken into consideration in obesity prevention and treatment strategies applied to young adults.

The effect of diabetes complications on health-related quality of life: the importance of longitudinal data to address patient heterogeneity.

We estimate the impact of six diabetes-related complications (myocardial infarction, ischaemic heart disease, stroke, heart failure, amputation and visual acuity) on quality of life, using seven rounds of EQ-5D questionnaires administered between 1997 and 2007 in the UK Prospective Diabetes Study. The use of cross-sectional data to make such estimates is widespread in the literature, being less expensive and easier to collect than repeated-measures data. However, analysis of this dataset suggests that cross-sectional analysis could produce biased estimates of the effect of complications on QoL. Using fixed effects estimators, we show that variation in the quality of life between patients is strongly influenced by time-invariant patient characteristics. Our results highlight the importance of studying quality-of-life changes over time to distinguish between time-invariant determinants of QoL and the effect on QoL of specific events such as diabetes complications.

Cost-Effectiveness of Sotagliflozin in SOLOIST-WHF.

BACKGROUND: The efficacy of sotagliflozin in patients with diabetes and recent worsening of heart failure was shown in the SOLOIST-WHF trial. However, the cost-effectiveness of sotagliflozin in these patients has not been previously investigated. OBJECTIVES: The authors sought to determine the cost-effectiveness of sotagliflozin in patients with diabetes and recent worsening of heart failure. METHODS: Based on SOLOIST-WHF trial data (N = 1,222), the authors constructed a Markov model to estimate the lifetime impact of sotagliflozin from a U.S. health care sector perspective. Cost data were sourced from the National Inpatient Sample. Life expectancy was modeled from census data and modified by the mortality rate in SOLOIST-WHF. Fatal and nonfatal event rates were carried forward from the trial data. Utility was assessed from the published reports. RESULTS: Lifetime quality-adjusted life-years (QALYs) were 4.43 and 4.04 in the sotagliflozin and placebo groups, respectively, and lifetime costs were $220,113 and $188,198 in the sotagliflozin and placebo groups, respectively. The point estimate incremental cost-effectiveness ratio was $81,823 per QALY gained. The probability of being cost-effective was 3.6%, 67.5%, and 89.4% at willingness-to-pay thresholds of $50,000, $100,000, and $150,000, respectively, per QALY gained. CONCLUSIONS: In patients with diabetes and recent worsening of heart failure, sotagliflozin is cost-effective in the U.S. using commonly accepted willingness-to-pay thresholds. (Effect of Sotagliflozin on Cardiovascular Events in Participants With Type 2 Diabetes Post Worsening Heart Failure [SOLOIST-WHF]; NCT03521934).

Evaluation of a Workplace Diabetes Prevention Program Delivered via Distance Learning: A Qualitative Study.

Little is known about how distance learning impacts delivery of the National Diabetes Prevention Program (DPP) despite a rapid shift to this platform during the coronavirus disease 2019 (COVID-19) public health emergency. We explored how a workplace DPP, delivered via distance learning, impacted knowledge, motivation, and behavioral skills of participants throughout the program. We conducted repeated qualitative interviews with distance learning participants at baseline, 6 months, and 12 months from September 2020 to July 2022. Three study team members coded interview data using individual responses as the unit of analysis. We used a thematic approach, using the information-motivation-behavioral skills framework, to analyze responses and generate understanding of the program's impact. The 27 individuals who participated in the interviews (89% women, mean age 56 years) reported the distance learning platform was effective in changing their behavior. The program's focus on food logging and setting limits on specific types of caloric intake was perceived as essential. Education on ideal levels of fat and sugar consumption, lessons on how to read food labels, and dissemination of recipes with healthy food substitutions allowed participants to initiate and sustain healthy decision-making. Strategies to increase physical activity, including breaking up exercise throughout the day, made reaching their goals more feasible. Participants reported food logging and weight reporting, as well as group support during sessions, either sustained or increased their motivation to adhere to the program over time. A workplace DPP delivered via distance learning successfully prompted improvements in the knowledge, motivation, and behavioral skills necessary to increase healthy eating and physical activity among participants.

Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study.

Physical activity is essential for healthy aging. This study aimed to identify an association between physical performance, body fat percentage (%BF), and the perception of oral health-related quality of life (OHRQoL) in independent older adults. METHOD: A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained. RESULTS: This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance. CONCLUSION: OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.

Depression symptoms and sweet foods consumption in Mexican college men: the role of emotional eating.

Introduction: Objective: to evaluate the association between depression symptoms and frequency of unhealthy food consumption, and to explore the mediation effect of emotional eating in this relationship in college men. Method: a cross-sectional study was performed on 764 men at a public university in Mexico City. To assess emotional eating (EE), a validated Spanish-language version of the Eating and Appraisal Due to Emotions and Stress Questionnaire (EADES) was applied. Depression symptoms were evaluated using the scale elaborated by the Center for Epidemiologic Studies (CES-D) and a Questionnaire of Frequency of Food Consumption was used to measure frequency of food consumption. Path and mediation analysis were applied. Results: one-fifth (20.42 %) of college men reported depression symptoms (CES-D ≥ 16). Students with depression symptoms had a higher mean EE score (p < 0.001), a higher frequency of fried food (p = 0.049), sweetened beverages (p = 0.050), and sweet foods consumption (p = 0.005) than students with low CES-D score. According to the mediation analysis, the effect of depression symptoms on the frequency of sweet foods consumption was partially mediated by EE (23.11 % of the total effect). Conclusion: the prevalence of depression symptoms was high. EE is an important mediator in the relationship between depression symptoms and the consumption of sweet foods. Understanding the manifestation of eating behaviors in men and their relationship with depression symptoms may help clinicians and health authorities develop treatment and prevention programs aimed to decrease the risk of obesity and eating disorders.

Introducción: Objetivo: evaluar la asociación entre los síntomas de depresión y la frecuencia de consumo de alimentos no saludables y explorar el efecto de la alimentación emocional como variable mediadora en esta relación en hombres universitarios. Método: se realizó un estudio transversal en 764 hombres de una universidad pública en la Ciudad de México. Se aplicó la versión validada en español del Eating and Appraisal Due to Emotions and Stress Questionnaire (EADES) para evaluar la alimentación emocional (AE). Los síntomas de depresión fueron evaluados mediante la escala elaborada por el Centro de Estudios Epidemiológicos (CES-D) y el consumo de alimentos se evaluó con el Cuestionario de Frecuencia de Consumo de Alimentos. Se llevó a cabo un análisis de senderos y de mediación. Resultados: una quinta parte (20,42 %) de los hombres universitarios reportaron síntomas de depresión (CES-D ≥ 16). Los estudiantes con síntomas de depresión tuvieron una puntuación media de AE más alta (p < 0,001), mayor frecuencia de consumo de frituras (p = 0,049), de bebidas azucaradas (p = 0,050) y de alimentos dulces (p = 0,005) que aquellos con baja puntuación en la escala de CES-D. De acuerdo con el análisis de mediación, el efecto de los síntomas de depresión sobre la frecuencia de consumo de alimentos dulces fue mediado parcialmente por la AE (23,11 % del efecto total). Conclusión: la prevalencia de síntomas de depresión fue alta. La alimentación emocional es un mediador importante en la relación entre síntomas de depresión y consumo de alimentos dulces. Conocer la conducta alimentaria en los hombres y su relación con los síntomas de depresión puede ayudar a los médicos y autoridades de salud a desarrollar tratamientos y programas preventivos destinados a disminuir el riesgo de obesidad y trastornos alimentarios.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico.

Introduction: The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI). Methods: A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed. Results: The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%. Discussion: A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

The Diabetes Prevention Gap And Opportunities To Increase Participation In Effective Interventions.

To understand the current state of prediabetes burden and treatment in the US, we examined recent trends in prediabetes prevalence, testing, and access to preventive resources. We estimated 13.5 percent prevalence of diagnosed prediabetes in the overall US adult population, using national survey data. Although prediabetes prevalence increased by 4.8 percentage points from 2010 to 2020, access to preventive resources remained low. The most effective intervention for diabetes prevention, known as the National Diabetes Prevention Program, remained woefully undersupplied and underused. There are only 2,098 National Diabetes Prevention Program-recognized providers nationally, and only 3 percent of adults with prediabetes have participated in the program. We suggest three actions to augment prevention efforts: increase payment for prevention interventions to avoid supply distortions, improve data integration and patient follow-up, and extend coverage and broaden access for preventive interventions. These actions, which would require policy-level changes, could lower the barriers to prevention.

Comparison of body fat percentage assessments by bioelectrical impedance analysis, anthropometrical prediction equations, and dual-energy X-ray absorptiometry in older women.

Background: Individuals with high body fat have a higher risk of mortality. Numerous anthropometric-based predictive equations are available for body composition assessments; furthermore, bioelectrical impedance analysis (BIA) estimates are available. However, in older adults, the validity of body fat estimates requires further investigation. Objective: To assess the agreement between percentage body fat (BF%) estimates by BIA and five predictive equations based on anthropometric characteristics using dual X-ray absorptiometry (DXA) as reference method. A secondary objective was to identify whether excluding short-stature women improves the agreement of BF% estimates in a group of community-dwelling, older Mexican women. Methods: A concordance analysis of BF% was performed. A total of 121 older women participated in the study. Anthropometric information, BIA, and DXA body composition estimates were obtained. Five equations using anthropometric data were evaluated in order to determine body fat percentage (BF%) using DXA as reference method. Paired t-test comparisons and standard error of estimates (SEE) were obtained. The Bland-Altman plot with 95% limits of agreement and the concordance correlation coefficient (CCC) were used to evaluate the BF% prediction equations and BIA estimates. Results: The mean age of the study participants was 73.7 (±5.8) years old. BIA and the anthropometric based equations examined showed mean significant differences when tested in the entire sample. For the taller women (height > 145 cm), no significant difference in the paired comparison was found between DXA and BIA of BF% estimates. The mean BF% was 40.3 (±4.8) and 40.7 (±6.2) for DXA and BIA, respectively. The concordance between methods was good (CCC 0.814), (SEE 2.62). Also, in the taller women subset, the Woolcott equation using waist-to-height ratio presented no significant difference in the paired comparison; however, the error of the estimates was high (SEE 3.37) and the concordance was moderate (CCC 0.693). Conclusion: This study found that BIA yielded good results in the estimation of BF% among women with heights over 145 cm. Also, in this group, the Woolcott predictive equation based on waist circumference and height ratio showed no significant differences compared to DXA in the paired comparison; however, the large error of estimates observed may limit its application. In older women, short stature may impact the validity of the body fat percentage estimates of anthropometric-based predictive equations.

Vitamin D Deficiency is Associated with Handgrip Strength, Nutritional Status and T2DM in Community-Dwelling Older Mexican Women: A Cross-Sectional Study.

The aim of this study was to evaluate the association between handgrip strength, nutritional status and vitamin D deficiency in Mexican community-dwelling older women. A cross sectional study in women ≥ 60 years-old was performed. Plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured by a quantitative immunoassay technique. Handgrip strength was assessed using a dynamometer, while nutritional status was assessed through the Full Mini Nutritional Assessment (Full-MNA). A total of 116 women participated in the study, their mean age was 70.3 ± 5.8 years; 49.1% of the study group had plasma 25(OH)D levels lower than 40 nmol/L [16 ng/mL]. Meanwhile, 28.45% of participants had low handgrip strength (<16 kg), and 23.1% were identified at risk of malnutrition/malnourished according with Full-MNA score. Women with 25(OH)D deficiency (<40 nmol/L [16 ng/mL]) were more likely to have low handgrip strength (OR = 2.64, p = 0.025) compared with those with higher 25(OH)D values. Additionally, being malnourished or at risk of malnutrition (OR = 2.53, p = 0.045) or having type 2 diabetes mellitus (T2DM) (OR = 2.92, p = 0.044) was also associated with low 25(OH)D. The prevalence of low plasma 25(OH)D concentrations was high among Mexican active older women. Low handgrip strength, being at risk of malnutrition/malnourished, or diagnosed with T2DM was also associated with Vitamin D deficiency.

Co-occurrence of diabetes and depression in the U.S.

Evidence exists that depression interacts with physical illness to amplify the impact of chronic conditions like diabetes. The co-occurrence of these two conditions leads to worse health outcomes and higher healthcare costs. This study seeks to understand what demographic and socio-economic indicators can be used to predict co-occurrence at both the state and the individual level. Diabetes and depression are modeled as a bivariate normal distribution using data from the Behavioral Risk Factor Surveillance System 2016-2017 cohorts. The tetrachoric (latent) correlation between diabetes and depression is 17.2% and statistically significant, however the likelihood of any person being diagnosed with both conditions is small-as high as 4.3% (Arizona) and as low as 2.3% (Utah). We find that demographic characteristics (sex, age, and race) operate in opposite directions in predicting diabetes and depression diagnosis. Behavioral indicators (BMI≥30, smoking, and exercise); and life outcomes, (schooling attainment, marital and veteran status) work in the same direction to produce co-occurrence and as such are more powerful predictors of co-occurrence than demographic characteristics. It is important to have a rapid and efficient instrument to diagnoses co-occurrence. Simple questions about lifestyle choices, educational attainment and family life could help bridge the gap between primary care and psychological services with beneficial spillovers for patient-doctor communication.

Sarcopenia, nutritional status and type 2 diabetes mellitus: A cross-sectional study in a group of Mexican women residing in a nursing home.

AIM: To evaluate the prevalence of sarcopenia and its association with nutritional status and type 2 diabetes mellitus (T2DM) in older women living in a nursing home. METHODS: This cross-sectional study assessed nutritional status using the Mini Nutritional Assessment (MNA). Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People; hand grip strength and physical performance were determined by dynamometry and gait speed, respectively. Muscle mass was assessed using calf circumference. RESULTS: The mean age of the 114 participants was 84.1 ± 7.0 years. The prevalence of sarcopenia and T2DM was 30.7% and 10.5%, respectively. The majority (66.7%) had a normal nutritional status, 29.8% were at risk of malnutrition, and 3.5% were undernourished. The prevalence of sarcopenia in participants at risk of malnutrition and those who were undernourished was higher compared with participants with a normal NS (P < 0.0001). A statistically significant difference was observed in the Barthel Index (BI) between women with and without sarcopenia (P = 0.048). The multivariate logistic regression model, adjusted by age (p = 0.007) showed an association between sarcopenia and nutritional status. Women with a poor nutritional status were more likely to have sarcopenia (OR 4.97, P = 0.003) whilst those with T2DM showed a higher probability of sarcopenia (OR 5.52, P = 0.019) than women without T2DM. CONCLUSIONS: Sarcopenia was highly prevalent in women with a poor nutritional status and T2DM. It is necessary to implement intervention programs to reduce adverse outcomes.

Effect of Income Level and Perception of Susceptibility and Severity of COVID-19 on Stay-at-Home Preventive Behavior in a Group of Older Adults in Mexico City.

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (ß = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (ß = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.

Prevalence of Malnutrition and Depression in Older Adults Living in Nursing Homes in Mexico City.

This study evaluated the association between nutritional status, depressive symptoms, and the number of prescription drugs taken by older adults living in nursing homes in Mexico City. In a cross-sectional study, 262 participants were subjected to anthropometric and nutritional (Mini Nutritional Assessment (MNA)) evaluations; additionally, their depression (Geriatric Depression Scale (GDS)) and functional status were assessed. Multiple logistic regression was used for identifying factors associated with the risk of malnutrition/malnourishment. The mean age of participants was 83.1 ± 8.6 years. A total of 59.9% and 21.1% were at risk of malnutrition and malnourished, respectively. With respect to depression, 27.9% of the participants had mild depression, while 11.4% showed severe depression. An inverse correlation between MNA evaluations and depression scores was found (Spearman's ρ = -0.4624, p < 0.001); residents with a better nutritional status had lower depression scores. Individuals with depressive symptoms were approximately five times more likely to be at risk of malnutrition or malnourished (OR = 5.82, 95% CI = 2.27-14.89) than individuals without depression. Residents taking three or more prescription drugs daily (OR = 1.83, 95% CI = 1.27-2.63, p < 0.001) were more likely to be at risk of malnutrition or malnourished. In summary, poor nutritional status was associated with depression, while the intake of numerous prescription drugs was associated with being at risk of malnutrition or malnourished.

How Much Does Attendance Impact Weight Loss and Health Care Spending in a Diabetes Prevention Program Serving Older Adults?

PURPOSE: Measure attendance to the Young Men's Christian Association (YMCA) of the USA (Y-USA) diabetes prevention program (DPP) and show how attendance impacts weight loss and medical spending in a population of Medicare beneficiaries. DESIGN: Observational study using a pre- and post-specification. SETTING: A total of 17 participating YMCAs nationwide. PARTICIPANTS: 3317 Medicare beneficiaries with prediabetes. INTERVENTION: Community-based trainings of lifestyle intervention (National DPP). MEASURES: We used weight measurements from the Y-USA DPP participants, and Medicare fee-for-service part A and B claims data (January 2011-December 2016) from Chronic Conditions Data Warehouse. ANALYSIS: We used multivariate regression models to test the impact of class attendance on weight loss and Medicare expenditures. RESULTS: From a maximum of 24 classes, participants on average attended 14 (standard deviation: 6). The relationship between attendance and both weight loss and savings were approximately linear. During each weekly class, participants lost an average of 0.72 (confidence interval [CI]: 0.67-0.77) pounds and saved on average $58 (CI: $38-78) in medical expenses per class attended. CONCLUSIONS: Attendance to diabetes prevention programs is often challenging. To obtain both clinically relevant changes (weight loss greater than 5% of one's initial body weight) and economically relevant savings, completing at least 14 core sessions is essential. Steps to increase attendance and motivation across vulnerable groups may be an essential consideration for policymakers.

Impact of Financial Incentives on Diabetes Prevention Class Attendance and Program Completion: Evidence From Minnesota, Montana, and New York.

PURPOSE: To test the role of financial incentives to motivate engagement in diabetes prevention programs (DPPs). DESIGN: Minnesota, Montana, and New York randomized 3 different approaches to providing incentives: incentivizing class attendance and weight loss (all states), class attendance only (NY), and weight loss only (NY). We used New York to test how different approaches to providing incentives influence DPP completion and attendance. SETTING: Health-care facilities and local young men's Christian association. PARTICIPANTS: Eight hundred thirty one Medicaid enrollees in Minnesota, 204 in Montana, and 560 in New York. INTERVENTION MEASURE: Impact of the financial incentives on DPP program completion rates. We measured completion of DPP classes in 2 ways: completing 9 or more or 16 or more DPP classes. ANALYSIS: Multivariate logistic model to compare completion of DPP classes between participants randomized into receiving financial incentives and controls. RESULTS: Receipt of incentives was associated with higher odds at attending 9 or more classes (odds ratio [OR]: 2.2; P < .01) in Minnesota, Montana (OR: 2.2; P < .05), and New York (OR: 1.9; P < .01) as well as attending 16 or more classes in Minnesota (OR: 3.1; P < .01), Montana (OR: 2.1; P < .01), and New York (OR: 2.9; P < .01). In New York, individuals paid to attend classes attended more classes than individuals paid based on results only. CONCLUSION: Among Medicaid beneficiaries, financial incentives improve DPP class attendance.