Depression and All‐Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107493/1/jgs12833.pd

Process tracing in social psychology : information search and impression formation

A study was conducted for the purpose of demonstrating the effects of sex of subject, sex of target person, attributes of the target person, and search stage on the order and amount of information accession during the impression formation process. Equal numbers of male and female subjects were given the opportunity to access appearance, behavior, and trait information about either male or female targets. The targets and their attributes were represented in an information board, which is a matrix with each row representing a different target person, and each column representing either an appearance, behavior, or trait attribute of the target. Each cell contained cards with information regarding how the attribute in the column characterized the person in the row. Subjects were given the task of choosing which target impressed them most favorably by removing cards from the cells of their choice and reading the information printed on the cards. Two quadruple interactions were hypothesized. Male subjects were hypothesized to search a greater amount of appearance information about female targets in the first search stage than subjects in all other experimental conditions. Male subjects were also hypothesized to conduct a higher within-attribute search when searching appearance information about female targets in the first stage than subjects in all other conditions. Neither of these hypotheses was confirmed. It was found that subjects executed a higher within-target search in the second search stage than the first. The effect of subject sex on search sequence and the effect of attribute type on search depth were tested post hoc. It was found that females conducted a higher within-target search than males. Surprisingly, an overall preference for searching trait information than appearance or behavior information was also found. Results are discussed in light of existing models of information search.Includes bibliographical references (pages 62-65)California State University, Northridge. Department of Psychology

Physician Compensation from Salary and Quality of Diabetes Care

OBJECTIVE: To examine the association between physician-reported percent of total compensation from salary and quality of diabetes care. DESIGN: Cross-sectional analysis. PARTICIPANTS: Physicians (n = 1248) and their patients with diabetes mellitus (n = 4200) enrolled in 10 managed care plans. MEASUREMENTS: We examined the associations between physician-reported percent compensation from salary and processes of care including receipt of dilated eye exams and foot exams, advice to take aspirin, influenza immunizations, and assessments of glycemic control, proteinuria, and lipid profile, intermediate outcomes such as adequate control of hemoglobin A1c, lipid levels, and systolic blood pressure levels, and satisfaction with provider communication and perceived difficulty getting needed care. We used hierarchical logistic regression models to adjust for clustering at the health plan and physician levels, as well as for physician and patient covariates. We adjusted for plan as a fixed effect, meaning we estimated variation between physicians using the variance within a particular health plan only, to minimize confounding by other unmeasured health plan variables. RESULTS: In unadjusted analyses, patients of physicians who reported higher percent compensation from salary (>90%) were more likely to receive 5 of 7 diabetes process measures and more intensive lipid management and to have an HbA1c<8.0% than patients of physicians who reported lower percent compensation from salary (<10%). However, these associations did not persist after adjustment. CONCLUSIONS: Our findings suggest that salary, as opposed to fee-for-service compensation, is not independently associated with diabetes processes and intermediate outcomes

Entering and Exiting the Medicare Part D Coverage Gap: Role of Comorbidities and Demographics

Background: Some Medicare Part D enrollees whose drug expenditures exceed a threshold enter a coverage gap with full cost-sharing, increasing their risk for reduced adherence and adverse outcomes. Objective: To examine comorbidities and demographic characteristics associated with gap entry and exit. Design: We linked 2005-2006 pharmacy, outpatient, and inpatient claims to enrollment and Census data. We used logistic regression to estimate associations of 2006 gap entry and exit with 2005 medical comorbidities, demographics, and Census block characteristics. We expressed all results as predicted percentages. PATIENTS: 287,713 patients without gap coverage, continuously enrolled in a Medicare Advantage Part D (MAPD) plan serving eight states. Patients who received a low-income subsidy, could not be geocoded, or had no 2006 drug fills were excluded. Results: Of enrollees, 15.9% entered the gap, 2.6% within the first 180 days; among gap enterers, only 6.7% exited again. Gap entry was significantly associated with female gender and all comorbidities, particularly dementia (39.5% gap entry rate) and diabetes (28.0%). Among dementia patients entering the gap, anti-dementia drugs (donepezil, memantine, rivastigmine, and galantamine) and atypical antipsychoticmedications (risperidone, quetiapine, and olanzapine) together accounted for 40% of pre-gap expenditures. Among diabetic patients, rosiglitazone accounted for 7.2% of pre-gap expenditures. Having dementia was associated with twice the risk of gap exit. Conclusions: Certain chronically ill MAPD enrollees are at high risk of gap entry and exposure to unsubsidized medication costs. Clinically vulnerable populations should be counseled on how to best manage costs through drug substitution or discontinuation of specific, non-essential medications. © 2010 Society of General Internal Medicine

Patient-provider communication regarding drug costsin Medicare Part D beneficiaries with diabetes: a TRIAD Study

<p>Abstract</p> <p>Background</p> <p>Little is known about drug cost communications of Medicare Part D beneficiaries with chronic conditions such as diabetes. The purpose of this study is to assess Medicare Part D beneficiaries with diabetes' levels of communication with physicians regarding prescription drug costs; the perceived importance of these communications; levels of prescription drug switching due to cost; and self-reported cost-related medication non-adherence.</p> <p>Methods</p> <p>Data were obtained from a cross-sectional survey (58% response rate) of 1,458 Medicare beneficiaries with diabetes who entered the coverage gap in 2006; adjusted percentages of patients with communication issues were obtained from multivariate regression analyses adjusting for patient demographics and clinical characteristics.</p> <p>Results</p> <p>Fewer than half of patients reported discussing the cost of medications with their physicians, while over 75% reported that such communications were important. Forty-eight percent reported their physician had switched to a less expensive medication due to costs. Minorities, females, and older adults had significantly lower levels of communication with their physicians regarding drug costs than white, male, and younger patients respectively. Patients with < $25 K annual household income were more likely than higher income patients to have talked about prescription drug costs with doctors, and to report cost-related non-adherence (27% vs. 17%, p < .001).</p> <p>Conclusions</p> <p>Medicare Part D beneficiaries with diabetes who entered the coverage gap have low levels of communication with physicians about drug costs, despite the high perceived importance of such communication. Understanding patient and plan-level characteristics differences in communication and use of cost-cutting strategies can inform interventions to help patients manage prescription drug costs.</p

Schools, families, and social reproduction

Neoliberal educational discourse across the Global North is marked by an increasing homogeneity, but this masks significant socio-spatial differences in the enactment of policy. The authors focus on four facets of roll-out neoliberalism in English education policy that have expanded the function of primary schools, and redrawn the boundary between state and family responsibilities. Specifically, these are increased state support for: (1) working parenthood through provision of wraparound childcare; (2) parent-child relationships through school-led provision of parenting classes; (3) parental involvement in children’s learning; and (4) child development through schools’ fostering of extracurricular activities. The politics of policies that both enhance state responsibility for, and influence in, matters that were previously within the purview of families are complex. The collective impact of these developments has been both to reform how the work of daily and generational social reproduction is done, and to reshape the social reproduction of a classed and gendered society

Age and work-related motives: Results of a meta-analysis

Item does not contain fulltextAn updated literature review was conducted and a meta-analysis was performed to investigate the relationship between age and work-related motives. Building on theorizing in life span psychology, we hypothesized the existence of age-related differences in work-related motives. Specifically, we proposed an age-related increase in the strength of security and social motives, and an age-related decrease in the strength of growth motives. To investigate life span developmental theory predictions about age-related differences in control strategies, we also examined the relationship between age and intrinsic and extrinsic motives. Consistent with our predictions, meta-analytic results showed a significant positive relationship between age and intrinsic motives, and a significant negative relationship between age and strength of growth and extrinsic motives. The predicted positive relation between age and strength of social and security motives was only found among certain subgroups. Implications of these findings for work motivation and life span theories and future research are discussed

Neurosurgical education in Europe and the United States of America

Training in neurological surgery is one of the most competitive and demanding specializations in medicine. It therefore demands careful planning in both the scientific and clinical neurosurgery arena to finally turn out physicians that can be clinically sound and scientifically competitive. National and international training and career options are pointed out, based on the available relevant literature, with the objective of comparing the neurosurgical training in Europe and the USA. Despite clear European Association of Neurosurgical Societies guidelines, every country in Europe maintains its own board requirements, which is reflected in an institutional curriculum that is specific to the professional society of that particular country. In contrast, the residency program in the USA is required to comply with the Accreditation Council for Graduate Medical Education guidelines. Rather similar guidelines exist for the education of neurosurgical residents in the USA and Europe; their translation into the practical hospital setting and the resulting clinical lifestyle of a resident diverges enormously. Since neurosurgical education remains heterogeneous worldwide, we argue that a more standardized curriculum across different nations would greatly facilitate the interaction of different centers, allow a direct comparison of available services, and support the exchange of vital information for quality control and future improvements. Furthermore, the exchange of residents between different training centers may improve education by increasing their knowledge base, both technically as well as intellectually

Assessing associations between symptoms and survivorship care plans among long-term cancer survivors.

246 Background: Nearly 14 million Americans are cancer survivors, and numbers are increasing. Common long-term and late effects reported by survivors include anxiety, depression, fatigue, pain, and others. In order to address potential long-term and late effects of cancer and its treatment, the IOM recommends that patients receive a Survivorship Care Plan (SCP), a record of care received and important disease characteristics and a follow-up care plan incorporating available evidence-based standards of care. Our aims were to assess prevalence of self-reported moderate-severe symptoms and worry, and test for associations with SCP receipt. Methods: We used data from CanCORS II, a national study of lung and colorectal cancer patients. Long term survivors were diagnosed in 2004, and showed no sign of disease seven years post-diagnosis. We included 888 lung and colorectal cancer survivor respondents to the CanCORS II Long Term Survivor Survey. We examined moderate-severe pain (3, 4, or 5 on the SF-36 pain interference item), fatigue (less than 40 on the SF-36 vitality score), depressive symptoms ( &gt; 6 on CESD-8), and worry about recurrence. SCP receipt was defined as receipt of a treatment summary, follow-up care plan, or both. Multivariable logistic regression was used to test for associations between SCP and symptoms and worry. Results: In all, 27% of survivors had 0, and 26% had both SCP components. Moderate-severe pain was reported by 32% of colorectal and 42% of lung cancer survivors, and fatigue by 15% of colorectal and 30% of lung cancer survivors. Moderate-severe depressive symptoms were reported by 12% of colorectal cancer and 16% of lung cancer survivors. Less than ¼ (23%) reported worry about recurrence sometimes, often or always. In analyses adjusting for demographics and health status, receipt of both SCP components was associated with lower odds of moderate-severe pain (OR = 0.78, p = 0.004), fatigue OR = 0.42, p = 0.006), and depressive symptoms (OR = 0.48, p = 0.03). Conclusions: Receipt of a complete SCP was associated with lower odds of moderate-severe pain, fatigue, and depressive symptoms. We found no association with worry. However, only 26% of survivors reported receipt of both SCP components as recommended. </jats:p