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Objective. To examine the cost-effectiveness of a community-based Diabetes Prevention Program (DPP) for Medicaid beneficiaries from the perspective of the health care sector.Data Sources/Study Setting. A total of 847 Medicaid enrollees at high risk for type 2 diabetes participating in a community-based DPP.Study Design. Pre- and post clinical outcome and cost data were used as inputs into a validated diabetes simulation model. The model was used to evaluate quality-adjusted life years (QALYs) and health care costs over a 40-year time horizon from the perspective of the health care sector.Data Collection/Extraction Methods. Clinical outcome and cost data were derived from a study examining the effect of financial incentives on weight loss.Principal Findings. Study participants lost an average of 4.2 lb (p < .001) and increased high-density lipoprotein cholesterol by 1.75 mg/dl (p = .002). Intervention costs, which included financial incentives for participation and weight loss, were $915 per participant. The incremental cost-effectiveness ratio was estimated to be $14,011 per QALY but was sensitive to the time horizon studied.Conclusions. Widespread adoption of community-based DPP has the potential to reduce diabetes and cardiovascular-related morbidity and mortality for low-income persons at high risk for diabetes and may be a cost-effective investment for Medicaid programs.Key Words. Cost-effectiveness, Medicaid, health care costs, Diabetes is a common and costly chronic disease that disproportionally affects minority and low-income populations. In 2012, the 22.3 million U.S. residents with diabetes incurred an economic burden of $176 [...]

OBJECTIVE To determine the occurrence of extremely low HDL cholesterol (HDL-C) among participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid Trial and to examine the relationship [...]

OBJECTIVE This study uses novel methods to examine the frequency of diagnosis and treatment of prediabetes in real-world clinical settings using electronic health record (EHR) data. RESEARCH DESIGN AND METHODS [...]

OBJECTIVE--Comparative effectiveness research methods are used to compare the effect of four distinct glucose-control strategies on subsequent myocardial infarction and nephropathy in type 2 diabetes. RESEARCH DESIGN AND METHODS--A total [...]

Long considered an integral part of a school's support system, school counselors bring a wealth of insight and resources to a variety of student-centered issues. As part of a team [...]

OBJECTIVE--To assess the impact of early hypertension (HT) control on occurrence of subsequent major cardiovascular events in those with diabetes and recent-onset HT. RESEARCH DESIGN AND METHODS--Study subjects were 15,665 [...]

Background and Objective. Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting. Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design. The United Kingdom Prospective Diabetes Study Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality-adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings. Patients in the intervention group had significantly lowered A1c (0.26 percent, p = .014) relative to patients in the control arm. Intervention costs were $120 (SE = 45) per patient in the first year and $76 (SE = 45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE = 0.01) and increased lifetime costs by $112 (SE = 660), resulting in an incremental cost-effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two-way, and probabilistic sensitivity analyses. Conclusions. Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system., Diabetes is a common and costly chronic disease. In 2007, 17.9 million U.S. residents were diagnosed with diabetes at a cost to the economy of $174 billion (American Diabetes Association [...]

OBJECTIVE--Older adults with type 2 diabetes are at high risk of fractures and falls, but the effect of glycemic control on these outcomes is unknown. To determine the effect of [...]

OVERVIEW--Just as treatment guidelines for diabetes care were at the forefront of medical guideline development (1), diabetes has been a prominent focus of performance measurement and quality improvement initiatives for [...]

OBJECTIVE--Inexpensive and standardized methods to deliver medical education to primary care physicians (PCPs) are desirable. Our objective was to assess the impact of an individualized simulated learning intervention on diabetes [...]

In Brief Diabetes poses a major life stress that requires considerable physical, emotional, and psychological accommodation and coping. Mind-body therapies have drawn significant interest for their potential to assist in [...]

OBJECTIVE--To assess whether providing customized clinical information to patients and physicians improves safety or quality of diabetes care. RESEARCH DESIGN AND METHODS--Study subjects included 123 primary care physicians and 3,703 [...]

OBJECTIVE--To assess two physician learning interventions designed to improve safety and quality of diabetes care delivered by primary care physicians (PCPs). RESEARCH DESIGN AND METHODS--This group randomized clinical trial included [...]

OBJECTIVE--The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practices. RESEARCH [...]

OBJECTIVE--To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes. RESEARCH DESIGN AND METHODS--This study included a prospective [...]

Over the last 10 years, numerous clinical trials have provided consistent and strong evidence that adequate control of glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL) levels significantly reduces [...]

An attempt was made to compare three physical activity (PA) measures in pregnant women and examine mood correlates of physical activity changes during pregnancy. Evidence for the validity of the 7-d PAR and accelerometer as measures of physical activity in pregnancy were provided and found that health women who maintain an above average level of physical activity during second and third trimesters could enjoy mood stability.

OBJECTIVE--To assess the impact of a quality improvement (QI) intervention on the quality of diabetes care at primary care clinics. RESEARCH DESIGN AND METHODS--Twelve primary care medical practices were matched [...]

OBJECTIVE--The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes. RESEARCH DESIGN AND METHODS--A [...]

OBJECTIVE--To test the hypothesis that patient readiness to change (RTC) predicts future changes in glycemic control in adults with diabetes. RESEARCH DESIGN AND METHODS--We linked survey data with [HbA.sub.1c] data [...]

Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) improve cardiorenal outcomes in patients with type 2 diabetes. Equitable use of SGLT2i and GLP-1 RA has the potential to reduce racial and ethnic health disparities. We evaluated trends in pharmacy dispensing of SGLT2i and GLP-1 RA by race and ethnicity.

ABSTRACTObjectiveFeelings of fatigue and low energy compromise quality of life in college students and are influenced by sleep quality, sedentary time, and physical activity (PA) in an interactive manner and differentially by sex, warranting further investigation.MethodCollege students (n = 693; 78% female) were assessed for sleep quality (Pittsburgh Sleep Quality Index), sedentary time (Sedentary Behavior Questionnaire), and PA (Godin Leisure-Time Exercise Questionnaire). State mental and physical energy and fatigue were assessed via the Mental and Physical State and Trait Energy and Fatigue Scales. Structural equation modeling was used to explore associations among variables of interest in the complete sample and by sex after controlling for anxiety, depression, and perceived stress.ResultsIn the complete sample, PA predicted all outcomes in expected directions (βrange = −.103 – .119; all p < .05); however, sleep quality and sedentary time were not predictors (p > .05). For males, only sleep quality predicted mental and physical energy and physical fatigue (all p < .05) whereas among females, only physical activity predicted mental fatigue and physical energy and fatigue (all p < .05). Sedentary time did not significantly predict any outcomes in males or females.ConclusionsPA is related to mental and physical energy and fatigue among college students. Sex differences were evident with sleep quality for males and PA for females, being more closely related to energy and fatigue outcomes. Research targeting these health behaviors and interactive effects on feelings of energy and fatigue in this cohort are warranted.

Results reveal that anxiety reducing, cycling activity does not change emotional responsiveness in college women. However, cycling decreases baseline activity of facial muscles involved in the expression of emotion. Further, the data indicate that seated rest and decreased startle magnitude are associated.

Results reveal that perceived exertion ratings increase during repeated eccentric muscle actions at constant intensities with elbow flexor eccentric action in women being less effortful than men. Further. the intensity of eccentric exercise and RPE are positively correlated in both women and men.

* OBJECTIVES Our study compared 2 whole grain oat-based cereals with 2 refined grain wheat-based cereals to determine their effects on the need for antihypertensive medications in people with high [...]

This article investigates the factors involved in producing and controlling muscle pain in the quadriceps during a cycle ergometry test. Findings indicate that the young female participants were able to produce moderate-intensity pain during while cycling and maintain the pain intensity through high levels of exertion.

Results indicate that retinal exposure to 1,411 to 6,434 lux bright light conditions do not influence bicycle ergometric performance over 20 minute period.

Results indicate that in premenarcheal gymnasts bone mineral density (BMD) was higher than the control subjects and fat mass was higher in controls than gymnasts. Research also showed that higher BMD in gymnasts independent of age, height and weight.

ABSTRACTObjective:Lack of mental energy is one of the leading reasons adults turn to dietary supplements, with three out of ten supplement users hoping to improve their energy level; even more consume caffeine-containing products for the same reason. Despite this interest from consumers, there is no consensus scientific definition of mental energy or sole validated instrument for measuring it. We performed this review to summarize main findings from research regarding the influence of natural dietary compounds on three aspects of mental energy: cognition (vigilance), motivation (to do mental work), and mood (feelings of energy and/or absence of feelings of fatigue).Methods:A narrative review of key papers.Results:In addition to caffeine, a number of other compounds, including the polyphenols, which are found in all plant-derived products, and the phytochemicals in culinary herbs and herbal products such as Panaxginseng and Ginkgo biloba, have been shown in animal models to modulate neurotransmitter activity potentially relevant to mental energy. Inadequate intake of B vitamins could also potentially have a negative effect on mental energy due to their role in overall energy production, as precursors of key cofactors in the citric acid cycle, as well as their role in brain function and neurotransmitter synthesis. Consumption of some of these products may have direct or indirect effects on one or more elements of mental energy.Conclusion:Large, prospective clinical trials of these products using appropriate, validated instruments designed to measure mental energy may be worthwhile if sufficient evidence exists to justify such trials.

BACKGROUND. We investigated whether having a regular health care provider for diabetes was related to the intensity of care, use of preventive services, or glycemic control in a well-defined population [...]

In today's competitive health care market, only innovators who demonstrate improvements in both quality and price will survive. Primary care physicians can survive, and even thrive, in this environment if [...]

BACKGROUND. We conducted an historical cohort study to evaluate the relative effectiveness of niacin and lovastatin in the treatment of dyslipidemias in patients enrolled in a health maintenance organization (HMO). [...]

The purpose of this investigation was to describe eating disorder symptoms in 36.6 [+ or -] 3.8-y-old former college gymnasts as well as relations between body dissatisfaction and body composition. Former college gymnasts (n = 22) and age ([bar x] [+ or -] SE difference: 0.05 [+ or -] 0.26 y), height- (0.47 [+ or -] 0.75 cm), and weight-matched (2.20 [+ or -] 0.30 kg) control subjects (n = 22) participated. Current and past symptoms were assessed by using the Eating Disorders Inventory-2 (EDI-2) and visual analog scales. EDI-2 body-dissatisfaction scores were correlated with assessments of body composition by dual-energy X-ray absorptiometry. Weight preoccupation was stable across the life span for control subjects but was lower before former gymnasts had begun gymnastics training and higher for former gymnasts when they were participating in college gymnastics (P = 0.03). Current levels of body dissatisfaction were more strongly related to actual minus ideal body-weight discrepancy scores (r = 0.77) than to percentage fat (r = 0.50) for the former gymnasts whereas the opposite was true for the control subjects (r = 0.51 and 0.77, respectively). These results suggest that symptoms of eating disorders abate after retirement from gymnastics and that concerns about achieving an ideal body may be a more important determinant of body dissatisfaction than percentage body fat for gymnasts.

Purpose: Examine the associations of occupational and leisure-time physical activity with job stress, burnout, and well-being among healthcare industry workers.Design: Quantitative; cross-sectional.Setting: Healthcare Industry.Sample: US Amazon Mechanical Turk participants (n = 550) employed in the healthcare industry, worked 35 hours or more per week, had ≥ 1 supervisor and ≥ 1 co-worker, and were ≥ 18 years old.Measures: Self-reported measures of occupational physical activity (OPA) and leisure-time physical activity (LTPA), employee well-being, job stress, and burnout operationalized as exhaustion and disengagement.Analysis: Associations between OPA and LTPA with employee well-being, job stress, exhaustion and disengagement were assessed with separate multiple linear regression models.Results: OPA had positive significant associations with job stress (β = 0.10, Pvalue = .003) and exhaustion (β = 0.21, Pvalue < .0001). No significant associations were found between OPA with other psychological outcomes. A significant inverse association was found between LTPA and exhaustion (β = −0.04, Pvalue = .007).Conclusion: In a sample of U.S. health care workers, and consistent with prior epidemiological studies, greater LTPA was associated with lower feelings of exhaustion. In contrast, health care workers with greater OPA reported higher perceptions of job stress and exhaustion. The findings underscore the need for more research aimed at understanding relationships between OPA and psychological health among healthcare workers.

The psychological effects of low-dose caffeine combined with polyphenols from apples have rarely been explored scientifically yet synergistic effects are plausible. A randomized, double-blind, placebo-controlled cross-over experiment was used to test the psychological effects of apple extract beverages combined with 10, 20, 37.5, and 75 mg caffeine. Comparisons were made to both a placebo drink that was artificially sweetened and colored to mimic the test beverages and a positive control drink with 75 mg caffeine but without apple extract. Compared to placebo, it was hypothesized that dose-dependent improvements in cognitive performance, mood, and motivation would be realized after consuming the beverage with apple extract containing added caffeine. Outcomes were assessed before, 60 to 110, and 125 to 175 min post-beverage. The positive control beverage resulted in more serial seven subtractions, greater motivation to perform cognitive tasks, and reduced feelings of fatigue (all p< .005). The study found that psychological effects (i) were not observed for beverages containing apple extract and 10 or 20 mg caffeine, (ii) of the apple extract beverage containing 75 mg caffeine generally mimicked the effects of the positive control drink and significantly increased serial seven processing speed, and (iii) of the apple extract beverage containing 37.5 mg improved feelings of alertness and mental fatigue. In sum, effects of apple extract combined with caffeine were not dose-dependent; the apple extract beverage containing 75 mg caffeine improved information processing speed and the apple extract beverage with 37.5 mg caffeine improved feelings of alertness and mental fatigue.

OBJECTIVE--We tested the hypothesis that intensive (systolic blood pressure [SBP] < 120 mmHg) rather than standard (SBP 130-139 mmHg) blood pressure (BP) control improves health-related quality of life (HRQL) in [...]

A classic report by T. Franklin Williams et al. (1) in 1967 documented glaring deficiencies in diabetes care that went largely uncorrected for the next 30 years. It is only [...]

Early versions of electronic health records (EHRs) were developed in the 1980s. The potential to use such technology to improve care--especially preventive care and outpatient chronic disease care--has been widely [...]

From the 1960s to 2000, there was very little improvement in diabetes care in the United States. However, since 2000, there has been substantial improvement. Median A1C reached 7.18% nationally [...]

Early diagnosis and treatment of breast cancer improves survival. It is recommended that women who are over 50 years of age have a mammogram (X-ray of the breast) once a year. It is unlikely that terminally ill or severely debilitated nursing home residents would benefit from results obtained during routine mammography, or in the event that breast cancer is detected, that they would survive cancer treatment. However, since not all nursing home residents are severely ill, many of them could still benefit from routine breast cancer screening. The use of routine mammograms in long-term nursing care facilities has not been studied. The utilization of routine screening mammograms as it relates to the mental function (orientation) and physical functional status (requirement for help walking, eating, toileting and dressing) of nursing home residents was studied in 139 women over 50 years of age. The numbers of mammograms and of routine chest X-rays (commonly used to detect tuberculosis) that were ordered were compared. Only one woman had a routine mammogram, whereas 129 women had routine chest X-rays. The functional status of the residents did not relate to the ordering of routine mammograms. Based on these results, it is concluded that mammograms are underutilized in nursing home facilities. Residents were more likely to have routine chest X-rays, which are easily performed with mobile units, are reimbursed by insurance companies, and are less expensive than routine mammograms. Factors dissuading mammogram use are lack of skilled technicians, lack of insurance coverage, and staff attitudes; staff may favor chest X-rays because tuberculosis detection helps to prevent transmission of disease to the employees. (Consumer Summary produced by Reliance Medical Information, Inc.), A cross-section study was performed to estimate the utilization of screening mammography in a nursing home population. Included in the study were 139 women over 50 years of age who had been residing in a skilled nursing home in Connecticut for at least 1 year. Charts were reviewed to estimate screening mammography and chest x-ray examination use. Functional status of each subject was assessed by supervisory nurses using set criteria. One of the 139 subjects had received a mammogram, whereas 129 subjects (93%) had received chest x-ray examinations. Average length of stay in the nursing home was 6.5 years. No association was noted between functional status and use of mammography. It was concluded that in this clinical setting mammography appears to be underutilized as a screening test for breast cancer. The comparative data on chest x-ray examination use suggest strategies that may be useful in increasing compliance with current screening recommendations for mammography in the institutional setting., Prevalence of Mammography Use in a Nursing Home Population The American Cancer Society and the American College of Physicians recommend an annual screening mammogram for asymptomatic women aged over 50 [...]

High blood pressure (hypertension) is a common health problem in this country, affecting up to 58 million people at risk for illness or death associated with this condition. Many with hypertension go undiagnosed, and of those who are diagnosed, many are untreated or the condition remains uncontrolled. A questionnaire was completed by 2,939 adults living in a rural community to assess the efficacy of their community-oriented primary care in treating hypertension. Hypertension was defined as an average diastolic blood pressure of greater than or equal to 95 mm Hg; the condition was considered to be under control with a blood pressure of less than 95 mm Hg. Individuals who were already being treated for hypertension were also included. Out of those who responded, 20 percent (587 individuals) met the study definition of hypertension. Analysis of the data revealed that individuals who were treated at community health centers were more likely to have their hypertension diagnosed, treated and controlled, than patients who sought health care from other sources. Out of the total of 587 individuals with hypertension, 191 attended a neighborhood health center; 65 percent were treated successfully, 14 percent were treated unsuccessfully, 9 percent did not receive treatment, and 12 percent were unaware of their condition before this survey. Among those who had hypertension and who received another type of health care service, 52 percent were treated and controlled and 21 percent were undetected prior to this study. These results support the efficacy of the community-oriented primary care system in the treatment of hypertension, and have significant clinical implications and are important in assessing public policies related to health care services. (Consumer Summary produced by Reliance Medical Information, Inc.), To determine the effectiveness of a community-oriented primary care approach for the detection, treatment, and control of hypertension, data were analyzed from a survey of all 3094 adults living in a geographically well-defined rural community. Among the 2939 (96.1%) persons who completed the survey, 587 (20%) were found to meet study criteria for the diagnosis of hypertension. Hypertensive adults who identified a neighborhood health center with a community-oriented primary care philosophy as their source of care were more likely to have their disease detected, treated, and controlled than were hypertensive adults who identified other sources of care. The improved control was most evident for men and for blacks, but in every race-sex stratum, hypertensive patients of the neighborhood health center were more likely to be under control. Even when controlling in logistic models for age, race, and sex, identification of the neighborhood health center was associated with better control of hypertension ([bate] = 0.591, P = .004). In this rural community, oommunity-oriented primary care delivered through a neighborhood health center appears to be associated with increased likelihood of detection, treatment, and control of hypertension. J FAM PRACT 1990; 30:42G-424., Present estimates are that as many as 58 million Americans are at risk of morbidity or premature mortality associated with high blood pressure and warrant some kind of monitoring or [...]

The Brenlin Group implemented a literacy training program for its employees after discovering that most of them did not have the essential skills required for learning new work procedures. Recognizing that worker literacy has an impact on a company's bottom line, Benlin established learning centers at four of its plants to improve the concern of employees for life-long education, to increase their educational levels and to upgrade their thinking, communication and mathematics abilities. To encourage employees to participate, compensatory time off and gift certificates were offered as incentives. Privacy was also considered of utmost importance. The training programs included sessions on literacy, job skills and total quality management. The plans were also changed regularly to suit the needs and preferences of participants. The Brenlin Group cited higher sales, increased productivity and a stable workforce as the rewards of the programs.