Diabetes Distress in Young Adults with Youth-onset Type 2 Diabetes: TODAY2 Study Results

Objectives<b>:</b> To assess prevalence of high diabetes distress and associated factors in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort of young adults with youth-onset type 2 diabetes. <p>Methods<b>:</b> Participants completed the Diabetes Distress Scale (DDS) at end-of-study visits. Factors examined for association with high distress were demographic (gender, race/ethnicity, age, education, income), medical (HbA1c, BMI, complications), psychological (depressive and anxiety symptoms), and social (number in household, have offspring, healthcare coverage, established with diabetes care provider). Univariate logistic regressions identified factors associated with high distress that were controlled for in multivariate logistic regressions.</p> <p><a>Results<b>:</b></a> Of 438 participants, 66% were female, mean age=26.8 years, 18% non-Hispanic white, 37% non-Hispanic Black, 38% Hispanic. High distress (DDS ≥2) was reported by 105 (24%) participants. Subscales identified 40% with high “Regimen Distress,” 29.7% with high “Emotional Burden.” <a>A greater percentage of those with high distress were female (p=0.002), diagnosed with hypertension (p=0.037) and retinopathy (p=0.005), insulin treated, had higher HbA1c, and moderate-to-severe depressive and anxiety symptoms (all p’s <0.001). </a>In multivariate analyses, female gender, HbA1c (p<0.001 for both), anxiety symptoms (p=0.036), and lack of healthcare coverage (p=0.019) were associated with high distress, controlling for potential confounders. Reporting moderate-to-severe depressive symptoms was associated with high regimen distress (p=0.018) and emotional burden (p<0.001); insulin treatment was associated with high emotional burden (p=0.027).</p> <p>Conclusion: Future research should identify modifiable factors associated with high diabetes distress in those with youth-onset type 2 diabetes that may inform distress interventions with this medically vulnerable group.</p>

Diabetes Distress in Young Adults with Youth-onset Type 2 Diabetes: TODAY2 Study Results

Objectives<b>:</b> To assess prevalence of high diabetes distress and associated factors in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort of young adults with youth-onset type 2 diabetes. <p>Methods<b>:</b> Participants completed the Diabetes Distress Scale (DDS) at end-of-study visits. Factors examined for association with high distress were demographic (gender, race/ethnicity, age, education, income), medical (HbA1c, BMI, complications), psychological (depressive and anxiety symptoms), and social (number in household, have offspring, healthcare coverage, established with diabetes care provider). Univariate logistic regressions identified factors associated with high distress that were controlled for in multivariate logistic regressions.</p> <p><a>Results<b>:</b></a> Of 438 participants, 66% were female, mean age=26.8 years, 18% non-Hispanic white, 37% non-Hispanic Black, 38% Hispanic. High distress (DDS ≥2) was reported by 105 (24%) participants. Subscales identified 40% with high “Regimen Distress,” 29.7% with high “Emotional Burden.” <a>A greater percentage of those with high distress were female (p=0.002), diagnosed with hypertension (p=0.037) and retinopathy (p=0.005), insulin treated, had higher HbA1c, and moderate-to-severe depressive and anxiety symptoms (all p’s <0.001). </a>In multivariate analyses, female gender, HbA1c (p<0.001 for both), anxiety symptoms (p=0.036), and lack of healthcare coverage (p=0.019) were associated with high distress, controlling for potential confounders. Reporting moderate-to-severe depressive symptoms was associated with high regimen distress (p=0.018) and emotional burden (p<0.001); insulin treatment was associated with high emotional burden (p=0.027).</p> <p>Conclusion: Future research should identify modifiable factors associated with high diabetes distress in those with youth-onset type 2 diabetes that may inform distress interventions with this medically vulnerable group.</p>

Assessing the relationship between measures of healthcare access and functional limitations among individuals with Chronic Obstructive Pulmonary Disease (COPD)

Objectives: Functional limitation from COPD manifests more from physical rather than respiratory impairment. To what extent health access affects the functional limitation among individuals with COPD is yet to be known. This study aims to assess the relationship between healthcare access and functional limitations among individuals with COPD. Study Design: Retrospective analysis of a cross-sectional population-based survey Methods: This study pooled 11 years of (2008 to 2018) data from the Integrated Public Use Microdata Series, National Health Interview Survey (IPUMS NHIS). We restricted the data to respondents with self reported COPD, aged 40 years and older. The independent variables were sociodemographic and behavioral characteristics. The exploratory variables were measures of healthcare access ( healthcare coverage, delayed appointment, affordable care, and a usual place for care). The outcome variable was the presence or absence of functional limitations. Results: The age, race, educational attainment, marital status, smoking status, and poverty income ratio had a significant association with functional limitation (p<0.001) We found statistically significant associations between functional limitation and healthcare coverage, delayed appointment, affordable care, and a usual place for care. Poverty modified the relationship between functional limitations and the four measures of healthcare access, with the odds of functional limitation increased among the poor with no healthcare coverage, delayed appointment, unaffordable care, and no usual place for care. Conclusions: A strong relationship exists between the quartet of healthcare coverage, delayed appointment, affordable care, and usual place for care and self reported functional limitation among individuals with COPD. Poverty was an effect modifier, with the odds of functional limitation worse among the poor.

Black maternal mortality in the media: How journalists cover a deadly racial disparity

Through semi-structured interviews with four women news journalists, this study explores how journalists who specialize in women’s issues and health cover Black maternal mortality. Discussions include the role of advocacy in journalism and the struggle of covering the complex, long-standing systemic issue of maternal mortality associated with race in American society. Six themes consider the inclusion of race in healthcare coverage, a need for in-depth, nuanced coverage, the role of advocacy in journalism, complications of reporting on race, the importance of citing sources of color, and celebrity influence. Findings show the need for media advocacy in public health crises, and how journalistic norms can pressure journalists into citing inappropriate sources or diluting the story.

The Impact of Having a Child With Special Healthcare Needs on Length of Military Service

ABSTRACT Introduction In 2010, the National Survey of Children with Special Healthcare Needs revealed that parents of children with special healthcare needs (CSHCN) report employment decisions are influenced by healthcare coverage needs. The U.S. military healthcare system arguably offers service member parents of CSHCN with the most comprehensive, inexpensive, long-term healthcare in the country—potentially increasing their incentive to remain in the military. This study explored the effect of having a CSHCN on the length of parental military service. Materials and Methods A retrospective cohort was formed using the Military Health System database from 2008 to 2018. Included children were &lt;10 years in 2010 and received ≥1 year of military healthcare between 2008 and 2010. The Pediatric Medical Complexity Algorithm categorized children as having special healthcare needs via ICD 9/10 codes as having complex chronic (C-CD), non-complex chronic (NC-CD), or no chronic disease (CD). Families were classified by the child with the most complex healthcare need. Duration of military healthcare eligibility measured parental length of service (LOS). ANOVA and linear regression analysis compared LOS by category. Logistic regression determined odds of parental LOS lasting the full 8-year study length. Adjusted analyses controlled for child age and sex, and military parent sex, rank, and marital status. Results Over 1.45 million children in 915,584 families were categorized as per the algorithm. Of individual children included, 292,050 (20.1%) were CSHCN including those with complex chronic and non-complex chronic conditions. After grouping by family, 80,909 (8.8%) families had a child/children with C-CD (mean LOS 6.39 years), 170,787 (18.7%) families had a child/children with NC-CD (mean LOS 6.41 years), and 663,888 (72.5%) families had children with no CD (mean LOS 5.7 years). In adjusted analysis, parents of children with C-CD and NC-CD served 0.4 [0.37-0.42] and 0.33 [0.31-0.34] years longer than parents of children with no CD; odds of parents serving for the full study period were increased 33% (1.33 [1.31-1.36]) in families of children with C-CD and 27% (1.27 [1.26-1.29]) in families of children with NC-CD. Conclusions Findings indicate that military parents of CSHCN serve longer military careers than parents of children with no chronic conditions. Continued provision of free, high-quality healthcare coverage for dependent children may be important for service member retention. Retaining trained and experienced service members is key to ensuring a ready and lethal U.S. military.

Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review

IntroductionEven in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access.Ethics and disseminationNo primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.

Epidemic Compartmental Models and Their Insurance Applications

Our society’s efforts to fight pandemics rely heavily on our ability to understand, model and predict the transmission dynamics of infectious diseases. Compartmental models are among the most commonly used mathematical tools to explain reported infections and deaths. This chapter offers a brief overview of basic compartmental models as well as several actuarial applications, ranging from product design and reserving of epidemic insurance, to the projection of healthcare demand and the allocation of scarce resources. The intent is to bridge classical epidemiological models with actuarial and financial applications that provide healthcare coverage and utilise limited healthcare resources during pandemics.

Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

Background Tuberculosis (TB) presents a high burden of disease and is considered a global emergency by the World Health Organization (WHO), as the leading cause of death from infectious disease in adults. TB incidence is related directly to access to health services and socioeconomic determinants and inequality. Providing primary care settings can lead to improved access, shorter waiting times for patients, and enhanced TB case detection. The article aims to identify the spatial and temporal risk areas for TB and the relationship between TB cure and primary healthcare coverage from 2012 to 2014 in Rio de Janeiro, Brazil. Methods A cross-sectional study was conducted in Rio de Janeiro, Brazil. All cases of TB reported to the Information System on Diseases of Notification (SINAN) from 2012 to 2014 were included. Socioeconomic variables from the 2010 Brazilian national census were also added. Socioeconomic variables were selected from multivariate analysis using principal factors analysis. Spatial association was verified with generalized additive model (GAM). It was possible to identify areas at higher risk of failure to cure TB. Results TB rates showed strong positive spatial autocorrelation. TB cure rate varied according to schooling (individuals with complete secondary schooling had higher cure rates than illiterate individuals; OR 1.72, 95% CI 1.30–2.29), alcohol consumption (OR 0.47, 95% CI 0.35–0.64), contact investigation (OR 2.00, 95% CI 1.56–2.57), positive HIV serology (OR 0.31, 95% CI 0.23–0.42), and census tracts with higher elderly rates (OR 9.39, 95% CI 1.03–85.26). Individuals who had been covered by primary healthcare (PHC) for 35 to 41 months had 1.64 higher odds of cure, compared to those with no PHC coverage (95% CI 1.07–2.51). Conclusion A comprehensive risk map was developed, allowing public health interventions. Spatial analysis allowed identifying areas with lower odds of TB cure in the city of Rio de Janeiro. TB cure was associated statistically with time of coverage by primary healthcare. TB cure rate also varied according to sociodemographic factors like schooling, alcohol abuse, and population density. This methodology can be generalized to other areas and/or other public health problems. Highlights We studied standardized municipal TB cure rates in an area of social inequality in Brazil. TB rates showed strong positive spatial autocorrelation. Higher rates were associated with population density and socioeconomic conditions. Illiterate individuals were less likely to achieve TB cure. TB cure was less likely in individuals with HIV and alcohol abuse. TB cure was greater in areas with high primary healthcare coverage.