Coping with type 2 diabetes: do race and gender matter?

OBJECTIVE: The aim of this study was to identify the coping methods of adults with type 2 diabetes, explore whether patient race (African-American vs. white, non-Latino) and gender (female vs. male) influenced coping style, and then analyze the relationship between coping and self-assessed diabetic control (self-management success). RESEARCH DESIGN AND METHODS: From an exploratory research design using a mixed-methodological approach, in-depth interviews were conducted with 34 interviewees--9 black females, 5 black males, 15 white females, and 5 white males--living in a large mid-South city. Interviews were audio-taped, transcribed, then unitized and codified for analysis. RESULTS: Interviewees reported 136 strategies, collapsed into 40 distinct coping methods. Race and gender differences first were observed in the frequency distributions of methods. Whites reported significantly more problem-focused methods than African-Americans. Males reported, overall, fewer methods, less emotion-focused, yet more problem-focused methods than females. Interviewees reporting emotion-focused methods were less likely to report problem-focused methods. Emotion-focused coping was associated with poorer self-assessed diabetic control; problem-focused coping was associated with better control. CONCLUSIONS: Findings suggest that adults with type 2 diabetes use a variety of coping methods, with their basic coping styles influenced by race and gender. This study also demonstrated the usefulness of the problem/emotion-focused dichotomy as a coping method classification system and how these basic styles correlate with interviewees' diabetic control. Lastly, findings emphasize the complexity and importance of psychosocial coping in diabetes and the need for greater attention by clinicians and researchers.     

Preventable hospitalization and medicaid managed care: does race matter?

This study examines the preventable hospitalization patterns of Medicaid patients by race/ethnicity to determine whether Medicaid managed care (MMC) has been more effective in some subgroups than others. It uses logistic models for three states, comparing preventable hospitalizations with marker admissions (urgent admissions, insensitive to primary care). Hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient database of the Agency for Health Care Research and Quality for New York, Pennsylvania, and Wisconsin residents aged 20-64 years is used. In a more urban state, New York, MMC was effective for Whites but not for minorities. In a more rural state, Wisconsin, MMC was effective for minorities. Overall, the evidence is not strong that any particular racial group consistently benefited from MMC, or that any state consistently showed a favorable impact of MMC across racial groups. However, racial/ethnic disparity associated with the risk of preventable hospitalization is significantly lower among Medicaid patients than among private fee-for-service patients.     

The recruitment and retention of speech and language therapists: what do university students find important?

Education of health professionals is costly to the general community and more specifically the educational sector. The increasing need for speech and language therapy (SLT) services, coupled with poor employment retention rates, poses serious cost-benefit considerations. The poor job retention rates among speech and language therapists are associated with high levels of job dissatisfaction. One factor known to influence job satisfaction is the congruence between one's career motivation and actual career experience. The current study sought to explore (1) why students choose to embark on an SLT degree, (2) what factors are important to maintain their long-term employment in SLT, and (3) how long they predicted they would remain in the workforce practicing in SLT. Students from two tertiary SLT courses, one in Australia (n=67) and one in the United Kingdom (n=84), completed an online questionnaire targeting these issues. Students' responses were consistent across cohorts, so they were combined into one data set. Three categories of responses emerged, relating to altruism (i.e., helping others), intellectual interest (i.e., interested in disease and disability), and professional issues (e.g., salary, desire for a professional career). There was good agreement in responses to questions focusing on why participants chose to study SLT and what they foresaw as important for their future career. Students who were motivated to enter SLT for professional reasons tended to report that they would remain in the profession for a shorter time than those students who chose the career with a primarily humanistic or intellectual motivation. The implications of these findings for educators and professional bodies are discussed.     

Gendering the migraine market: do representations of illness matter?

Migraine is a common, debilitating and costly disorder. Yet help-seeking for and rates of diagnosis of migraine are low. Drawing on ethnographic observations of pharmaceutical marketing practices at professional headache conferences and a content analysis of migraine advertising, principally in the USA, this paper demonstrates: (1) that the pharmaceutical industry directs its marketing of migraine medication to women; and (2) as part of this strategy, pharmaceutical advertisements portray women as the prototypical migraine sufferer, through representations that elicit hegemonic femininity. This strategy creates the impression that migraine is a "women's disorder", which, in turn, exacerbates gender bias in help seeking and diagnosis of migraine and reifies presumptions about the epidemiology of the disorder. I conclude that these pharmaceutical marketing practices have a paradoxical effect: even as they educate and raise awareness about migraine, they also create barriers to help seeking and diagnosis.     

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.     

Quality: how do we define it?

When U.S. industry, in the 1980s, woke up to the fact they were losing ground to foreign companies, their first attempts to woo consumers back to the fold revolved around cutting costs to lower prices. It didn't work. But someone finally took notice of the work Edwards Deming and Joseph Jurand were doing to add quality to the value formula for products and services in Japan. A few U.S. companies tried this approach, and it worked. Today everybody is on the quality bandwagon. Pick up any publication--from national news weeklies to small trade newsletters--and there it is.     

Accreditation of Undergraduate and Graduate Medical Education: How do the Standards Contribute to Quality?

Accreditation organizations such as the Liaison Committee for Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council for Graduate Medical Education (ACGME) are charged with the difficult task of evaluating the educational quality of medical education programs in North America. Traditionally accreditation includes a more quantitative rather than qualitative judgment of the educational facilities, resources and teaching provided by the programs. The focus is on the educational process but the contributions of these to the outcomes are not at all clear. As medical education moves toward outcome-based education related to a broad and context-based concept of competence, the accreditation paradigm should change accordingly.     

Sex education and adolescent sexual behavior: do community characteristics matter?

BackgroundStudies point to variation in the effects of formal sex education on sexual behavior and contraceptive use by individual and community characteristics.Study DesignUsing the 2002 National Survey of Family Growth, we explored associations between receipt of sex education and intercourse by age 15, intercourse by the time of the interview and use of effective contraception at first sex among 15–19-year-olds, stratified by quartiles of three community characteristics and adjusted for demographics.ResultsAcross all quartiles of community characteristics, sex education reduced the odds of having sex by age 15. Sex education resulted in reduced odds of having sex by the date of the interview and increased odds of using contraception in the middle quartiles of community characteristics.ConclusionVariation in the effects of sex education should be explored. Research might focus on programmatic differences by community type and programmatic needs in various types of communities.     

Quality of life in lung cancer patients: does socioeconomic status matter?

Background  

As part of a prospective study on quality of life in newly diagnosed lung cancer patients an investigation was carried out to examine whether there were differences among patients' quality of life scores and their socioeconomic status.     

Technical efficiency of nursing homes: do five-star quality ratings matter?

This study investigates associations between five-star quality ratings and technical efficiency of nursing homes. The sample consists of a balanced panel of 338 nursing homes in California from 2009 through 2013 and uses two-stage data envelopment (DEA) analysis. The first-stage applies an input oriented variable returns to scale DEA analysis. The second-stage uses a left censored random-effect Tobit regression model. The five-star quality ratings i.e., health inspections, quality measures, staffing available on the Nursing Home Compare website are divided into two categories: outcome and structure form of quality. Results show that quality measures ratings and health inspection ratings, used as outcome form of quality, are not associated with mean technical efficiency. These quality ratings, however, do affect the technical efficiency of a particular nursing home and hence alter the ranking of nursing homes based on efficiency scores. Staffing rating, categorized as a structural form of quality, is negatively associated with mean technical efficiency. These findings show that quality dimensions are associated with technical efficiency in different ways, suggesting that multiple dimensions of quality should be included in the efficiency analysis of nursing homes. They also suggest that patient care can be enhanced through investing more in improving care delivery rather than simply raising the number of staff per resident.     

Social dimensions of mortality from external causes in Lithuania: do education and place of residence matter?

Summary. Objectives To assess inequalities in mortality from external causes by the level of education and the place of residence during the period of socio-economic transition in Lithuania. Methods Information on deaths, place of residence, and the level of education of persons aged 25 and older was derived from the National Database of Lithuania and censuses for 1989 (n = 3537) and 2001 (n = 4790). Results Mortality from external causes of Lithuanian urban and rural populations was strongly associated with the level of education. Educational inequalities increased throughout the period of socio-economic transition. In urban areas, mortality among the least educated population was 3.20 times higher in 1989 and 3.37 times higher in 2001, compared to those with university-level education. In rural areas the educational mortality rate ratios reached 3.47 and 4.33, respectively. The greatest educational inequalities were observed in suicide mortality, especially among males. Conclusions The results of this study disclosed increasing inequalities in mortality from external causes. Less educated populations, especially in rural areas, should receive particular attention in the development of strategies for the prevention of mortality from external causes. Submitted: 29 June 2004; Accepted: 8 March 2006     

Carbohydrate for weight and metabolic control: Where do we stand?

Changes in lifestyle are considered to play an important role in the etiology of obesity and type 2 diabetes, and improvements in diet and physical activity are the first-choice treatment for these metabolic diseases. Since the dietary recommendations of almost 40 y ago that fat should be decreased and that carbohydrate should be increased, recommendations for a healthy diet, except for minor amendments, have not changed that much. It is generally considered that caloric restriction is more important than changes in the macronutrient composition of the diet for weight loss and body weight control. Although this is true, there is increasing evidence that changes in the macronutrient composition of the diet (decreasing carbohydrate and increasing unsaturated fats and/or protein) play a role that facilitates weight loss, increases insulin sensitivity and glucose tolerance, and improves cardiovascular risk factors, such as blood pressure, blood lipid profile, and inflammatory markers, often independent of weight loss. Low-carbohydrate diets, whether they be high in unsaturated fats and/or protein, are not recommended by the American Diabetes Association; however, despite this the Joslin Diabetes Center currently advocates a diet composition of ～40% carbohydrate, 30% fat, and 30% protein energy for overweight and obese adults with type 2 diabetes or prediabetes or those at high risk of developing type 2 diabetes. Hopefully, future studies will indicate whether diets with a more equilibrated macronutrient composition than presently recommended are more appropriate for body weight and metabolic control.     

Cost efficiency of nursing homes: do five-star quality ratings matter?

Nursing homes may respond to the pressure to reduce costs by reducing quality of care, so the two are related. This study examines the determinants of nursing home costs and cost efficiency, and investigates how various measures of nursing home care quality influence both of these. It applies a one-step stochastic frontier approach to a large panel of California nursing homes surveyed between 2009 and 2013. Quality is measured by three different ratings available on the Nursing Home Compare website: rating on quality measures, rating on the health inspection, and rating on staffing levels. Results show that the rating on quality measures, an outcome-based measure of quality, is inversely related to costs but unrelated to mean cost efficiency. In other words, a better rating on quality measures is associated with lower nursing home costs. The health inspection rating is not associated with either costs or mean cost efficiency. The rating for staffing levels, a structural measure of quality, is negatively associated with cost efficiency. These findings reveal that different measures of quality have different relationships with costs and cost efficiency. The findings suggest that better quality outcomes in nursing homes may be achievable with fewer resources and/or improved care procedures, which in turn should reduce nursing home costs.     

MeNZB vaccine and epidemic control: when do you stop vaccinating?

New Zealand developed a strain-specific group B meningococcal vaccine to control an epidemic. Following a mass vaccination campaign of three doses to the population under 20 years of age, commencing in July 2004, the vaccine continued to be offered routinely as a four-dose schedule from 6 weeks of age. There is little international data on when to cease epidemic vaccination campaigns. The decision to stop using this vaccine needed to take into account a range of factors. These included epidemiology, vaccine effectiveness and duration of immunity, vaccine coverage, concomitant use with other vaccinations being added to the infant schedule, vaccine supply and cost-benefit criteria. This paper discusses these issues, along with the potential challenges for communication to both health professionals and the public.