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Objective: To examine ethnic differences in appointment-keeping in a managed care setting.Data Sources/study Setting: Kaiser Permanente Diabetes Study of Northern California (DISTANCE), 2005-2007, n = 12,957.Study Design: Cohort study. Poor appointment-keeping (PAK) was defined as missing >1/3 of planned, primary care appointments. Poisson regression models were used to estimate ethnic-specific relative risks of PAK (adjusting for demographic, socio-economic, health status, and facility effects).Data Collection/extraction Methods: Administrative/electronic health records and survey responses.Principal Findings: Poor appointment-keeping rates differed >2-fold across ethnicities: Latinos (12 percent), African Americans (10 percent), Filipinos (7 percent), Caucasians (6 percent), and Asians (5 percent), but also varied by medical center. Receiving >50 percent of outpatient care via same-day appointments was associated with a 4-fold greater PAK rate. PAK was associated with 20, 30, and 40 percent increased risk of elevated HbA1c (>7 percent), low-density lipoprotein (>100 mm/dl), and systolic blood pressure (>130 mmHg), respectively.Conclusions: Latinos and African Americans were at highest risk of missing planned primary care appointments. PAK was associated with a greater reliance on same-day visits and substantively poorer clinical outcomes. These results have important implications for public health and health plan policy, as primary care rapidly expands toward open access to care supported by the patient-centered medical home model. [ABSTRACT FROM AUTHOR]

Objective: Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated.Research Design and Methods: We performed a prospective cohort study (1996-2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites (n = 40,286), blacks (n = 8,668), Latinos (n = 7,763), Filipinos (n = 3,572), Chinese (n = 1,823), Japanese (n = 951), Pacific Islanders (n = 593), and South Asians (n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA(1c), hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted.Results: Pacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites.Conclusions: Incidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research. [ABSTRACT FROM AUTHOR]

In 2005, the new legislation for pharmaceuticals came into effect. Since then environmental risk assessments are required for all new marketing authorisation applications. The German Federal Environment Agency has been assessing the environmental impact of 136 veterinary and 134 human pharmaceuticals. The authorisation of pharmaceuticals has shown that the authorisation of some groups of substances have to be combined with risk mitigation measures. Environmental risks may also arise from those pharmaceuticals which were authorised before the environmental risk assessment was added to the requirements of authorisation. Four examples of "existing" pharmaceuticals, i.e. diclofenac, ethinyl estradiol, ivermectin, and florfenicol are highlighted in this article. Risk management options for veterinary and human pharmaceuticals are discussed. [ABSTRACT FROM AUTHOR]

Two pathways by which socioeconomic factors result in health disparities are the material and the psychosocial. Recently, Macleod and colleagues reported on data showing that a subjective measure of workplace status was not as strongly related to mortality as were objective indicators and that another psychosocial measure, perceived stress, did not mediate the impact of these indicators [Macleod et al., 2005. Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Social Science & Medicine, 61(9), 1916-1929]. They suggest that the failure of these variables is indicative of the relative insignificance of psychosocial influences on health. This commentary argues for a different approach to examining these pathways. Efforts to demonstrate the failure of variables to predict health have the usual difficulties of trying to prove the null hypothesis. In this instance, problems in the conceptualization and measurement of psychosocial variables may account for the null results. Psychosocial and material factors are not mutually exclusive but, rather, are complementary. Unexplained variation in health when material factors are accounted for may be explained in part by psychosocial factors and vice verse. Collaboration between researchers who understand each of these domains will yield the greatest benefit in terms of understanding the processes leading to health disparities and providing multiple approaches for eliminating them. [ABSTRACT FROM AUTHOR]

Objectives: To examine the amount of time adolescents waited to have intercourse with post partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). Methods: Adolescent STD clinic attendees were approached before clinical appointments to participate in on interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. Results: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ² = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (1= 3.47, p<0.001 0; medians of 2 weeks v 1 month (casual) (t=6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. Conclusions: Implications for designing interventions for adolescent males and females are discussed. [ABSTRACT FROM AUTHOR]

Amy M Bauer,1 Melissa M Parker,2 Howard H Moffet,2 Dean Schillinger,3,4 Nancy E Adler,5 Alyce S Adams,2 Julie A Schmittdiel,2 Wayne J Katon,1,† Andrew J Karter2 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 2Kaiser Permanente Northern California, Oakland, 3Division of General Internal Medicine, University of California, San Francisco, 4Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center, 5Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, CA, USA †Dr Wayne J Katon passed away on March 1, 2015 Objective: Among adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults with diabetes newly prescribed cardiometabolic medications are associated with early and long-term nonadherence. Patients and methods: An observational follow-up of 4,018 adults with type 2 diabetes who completed a survey in 2006 and were newly prescribed oral antihyperglycemic, antihypertensive, or lipid-lowering agents within the following year at Kaiser Permanente Northern California was conducted. Depressive symptoms were examined based on Patient Health Questionnaire-8 scores. Pharmacy utilization data were used to identify nonadherence by using validated methods: early nonadherence (medication never dispensed or dispensed once and never refilled) and long-term nonadherence (new prescription medication gap [NPMG]: percentage of time without medication supply). These analyses were conducted in 2016. Results: Patients with moderate-to-severe depressive symptoms had poorer adherence than nondepressed patients (8.3% more patients with early nonadherence, P=0.01; 4.9% patients with longer NPMG, P=0.002; 7.8% more patients with overall nonadherence [medication gap >20%], P=0.03). After adjustment for confounders, the models remained statistically significant for new NPMG (3.7% difference, P=0.02). There was a graded association between greater depression severity and nonadherence for all the models (test of trend, P

Background: The authors' previous research has shown that in cross-sectional analysis, partner-specific perceptions of risk for gonorrhea and chlamydial and HIV infection correlated with partner-specific intentions to use condoms.Goal: The goal was to determine whether partner-specific measures of perception of risk for STDs (PRSTD) predict partner-specific condom use 6 months later among high-risk and low-risk youth.Study Design: Youths aged 14 to 19 years were recruited from an STD clinic (n = 236) and an HMO teen clinic (n = 306) and were interviewed at baseline and at 6 months about PRSTD, attitudes about condoms, self-efficacy, normative expectations, and condom use.Results: PRSTD with a main sex partner was an independent predictor of condom use with a main sex partner in the STD clinic cohort (odds ratio = 2.5; 95% CI = 1.1-6.2). There was no association between PRSTD with a casual sex partner and condom use in this cohort or between PRSTD for main or casual sex partners and condom use in the HMO teen clinic cohort.Conclusion: Interventions that target high-risk adolescents should focus on PRSTD with a main sex partner. [ABSTRACT FROM AUTHOR]

Reviews studies of the psychological responses of United States women after they obtained legal, nonrestrictive abortions, which indicate that distress is generally greatest before the abortion, and the incidence of severe negative responses is low. Increased negative response risk factors; Other stressful events factors.

Examines whether women overestimate the desirability of thin figures among female peers as well as male preferences for thin female figures, as recent studies have demonstrated. Method; Results; Discussion.

The subversion of psychiatric intervention for political purposes in the USSR during the 1970s and 1980s resulted in both intra-psychic and subsequent adaptational dysfunction in those dissidents who physically survived it. Incarceration in special psychiatric hospitals subjected the inmates to a sense of helplessness under the control of a malevolent power, futility, despair, danger from close and contentious contact with hardened criminals and the violently insane, overdosage with mind-altering and body-distorting neuroleptic drugs, and a Kafkaesque ambiguity concerning the specific terms of instutionalisation. Discharge did not bring release from continued threats and the eroded social networks to which the inmates returned subjected them to a new set of stressors. While some families remained intact and provided necessary support during the re-entry period, many families had been destroyed either by the circumstances of the family member's incarceration or by the length of the victim's stay in the psychiatric hospital. Wives left, people died, friends deserted, jobs evaporated, and often there was not even a home to accept them. Social agencies were either hostile or indifferent to their plight. Many felt like they had been thrown overboard from a prison ship without a life preserver. It was the proverbial transition from the frying pan into the fire. [ABSTRACT FROM AUTHOR]