1
|
Wong JJ, Hanes SJ, Flores H, Ngo J, Hood KK. Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives. Diabet Med 2024; 41:e15254. [PMID: 38010056 PMCID: PMC11021166 DOI: 10.1111/dme.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
AIMS Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. METHODS Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. RESULTS Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. CONCLUSION Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah J Hanes
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Haley Flores
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Ngo
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K Hood
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Abstract
AIMS This study examined the psychosocial impact of Loop, an open-source automated insulin dosing system that has emerged from the diabetes technology "Do-It-Yourself" (DIY) movement. METHODS Subsamples of 239 adults, 115 children, and 243 parents completed data collection at the time of Loop initiation and 3 and 6 months later. Surveys collected demographic and clinical information, percent time-in-range, HbA1c, and validated psychosocial measures. Analyses included paired t tests and McNemar's tests to compare psychosocial functioning at 3 and 6 months and regression models to assess baseline predictors of psychosocial outcomes at 6 months. RESULTS Adults reported significant improvements in diabetes distress (t = -7.20 P < .001; t = -8.01, P < .001), sleep quality (t = 6.81, P < .001; t = 2.98, P = .003), fear of hypoglycemia (t = -4.42, P < .001; t = -4.97, P < .001), and hypoglycemia confidence (t = 8.68, P < .001; t = 7.96 P < .001) from baseline to 3 months and 6 months, respectively. Significant improvements in parents' and children's sleep quality and parents' fear of hypoglycemia were also observed. Several baseline characteristics were associated with psychosocial outcomes at 6 months. CONCLUSIONS The current findings support the broad and sustained benefits of Loop across multiple aspects of psychosocial well-being. Advancement and dissemination of such technologies has the potential to improve mental and physiological health among people living with type 1 diabetes.
Collapse
Affiliation(s)
- Jessie J. Wong
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
| | - Korey K. Hood
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah J. Hanes
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
| | - Rayhan A. Lal
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
- Division of Endocrinology, Gerontology,
& Metabolism, Department of Medicine, Stanford University School of Medicine,
Stanford, CA, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
3
|
Jacobsen LM, Sherr JL, Considine E, Chen A, Peeling SM, Hulsmans M, Charleer S, Urazbayeva M, Tosur M, Alamarie S, Redondo MJ, Hood KK, Gottlieb PA, Gillard P, Wong JJ, Hirsch IB, Pratley RE, Laffel LM, Mathieu C. Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. Commun Med (Lond) 2023; 3:132. [PMID: 37794113 PMCID: PMC10550996 DOI: 10.1038/s43856-023-00358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care. METHODS Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years). RESULTS We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact. CONCLUSIONS Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Selma Alamarie
- Stanford University School of Medicine, Stanford, CA, USA
| | - Maria J Redondo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Peter A Gottlieb
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jessie J Wong
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
4
|
Tobias DK, Merino J, Ahmad A, Aiken C, Benham JL, Bodhini D, Clark AL, Colclough K, Corcoy R, Cromer SJ, Duan D, Felton JL, Francis EC, Gillard P, Gingras V, Gaillard R, Haider E, Hughes A, Ikle JM, Jacobsen LM, Kahkoska AR, Kettunen JLT, Kreienkamp RJ, Lim LL, Männistö JME, Massey R, Mclennan NM, Miller RG, Morieri ML, Most J, Naylor RN, Ozkan B, Patel KA, Pilla SJ, Prystupa K, Raghavan S, Rooney MR, Schön M, Semnani-Azad Z, Sevilla-Gonzalez M, Svalastoga P, Takele WW, Tam CHT, Thuesen ACB, Tosur M, Wallace AS, Wang CC, Wong JJ, Yamamoto JM, Young K, Amouyal C, Andersen MK, Bonham MP, Chen M, Cheng F, Chikowore T, Chivers SC, Clemmensen C, Dabelea D, Dawed AY, Deutsch AJ, Dickens LT, DiMeglio LA, Dudenhöffer-Pfeifer M, Evans-Molina C, Fernández-Balsells MM, Fitipaldi H, Fitzpatrick SL, Gitelman SE, Goodarzi MO, Grieger JA, Guasch-Ferré M, Habibi N, Hansen T, Huang C, Harris-Kawano A, Ismail HM, Hoag B, Johnson RK, Jones AG, Koivula RW, Leong A, Leung GKW, Libman IM, Liu K, Long SA, Lowe WL, Morton RW, Motala AA, Onengut-Gumuscu S, Pankow JS, Pathirana M, Pazmino S, Perez D, Petrie JR, Powe CE, Quinteros A, Jain R, Ray D, Ried-Larsen M, Saeed Z, Santhakumar V, Kanbour S, Sarkar S, Monaco GSF, Scholtens DM, Selvin E, Sheu WHH, Speake C, Stanislawski MA, Steenackers N, Steck AK, Stefan N, Støy J, Taylor R, Tye SC, Ukke GG, Urazbayeva M, Van der Schueren B, Vatier C, Wentworth JM, Hannah W, White SL, Yu G, Zhang Y, Zhou SJ, Beltrand J, Polak M, Aukrust I, de Franco E, Flanagan SE, Maloney KA, McGovern A, Molnes J, Nakabuye M, Njølstad PR, Pomares-Millan H, Provenzano M, Saint-Martin C, Zhang C, Zhu Y, Auh S, de Souza R, Fawcett AJ, Gruber C, Mekonnen EG, Mixter E, Sherifali D, Eckel RH, Nolan JJ, Philipson LH, Brown RJ, Billings LK, Boyle K, Costacou T, Dennis JM, Florez JC, Gloyn AL, Gomez MF, Gottlieb PA, Greeley SAW, Griffin K, Hattersley AT, Hirsch IB, Hivert MF, Hood KK, Josefson JL, Kwak SH, Laffel LM, Lim SS, Loos RJF, Ma RCW, Mathieu C, Mathioudakis N, Meigs JB, Misra S, Mohan V, Murphy R, Oram R, Owen KR, Ozanne SE, Pearson ER, Perng W, Pollin TI, Pop-Busui R, Pratley RE, Redman LM, Redondo MJ, Reynolds RM, Semple RK, Sherr JL, Sims EK, Sweeting A, Tuomi T, Udler MS, Vesco KK, Vilsbøll T, Wagner R, Rich SS, Franks PW. Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nat Med 2023; 29:2438-2457. [PMID: 37794253 PMCID: PMC10735053 DOI: 10.1038/s41591-023-02502-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.
Collapse
Affiliation(s)
- Deirdre K Tobias
- Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jordi Merino
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Catherine Aiken
- Department of Obstetrics and Gynaecology, The Rosie Hospital, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Jamie L Benham
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dhanasekaran Bodhini
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - Amy L Clark
- Division of Pediatric Endocrinology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Kevin Colclough
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Rosa Corcoy
- CIBER-BBN, ISCIII, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sara J Cromer
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Daisy Duan
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamie L Felton
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | | | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Quebec, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Quebec, Canada
| | - Romy Gaillard
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eram Haider
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Alice Hughes
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Jennifer M Ikle
- Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jarno L T Kettunen
- Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Raymond J Kreienkamp
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Asia Diabetes Foundation, Hong Kong SAR, China
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jonna M E Männistö
- Departments of Pediatrics and Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Robert Massey
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Niamh-Maire Mclennan
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Jasper Most
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Rochelle N Naylor
- Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA
| | - Bige Ozkan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kashyap Amratlal Patel
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katsiaryna Prystupa
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sridharan Raghavan
- Section of Academic Primary Care, US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary R Rooney
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin Schön
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zhila Semnani-Azad
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Magdalena Sevilla-Gonzalez
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Pernille Svalastoga
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Wubet Worku Takele
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claudia Ha-Ting Tam
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Cathrine B Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mustafa Tosur
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Amelia S Wallace
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caroline C Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessie J Wong
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Katherine Young
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Chloé Amouyal
- Department of Diabetology, APHP, Paris, France
- Sorbonne Université, INSERM, NutriOmic team, Paris, France
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sian C Chivers
- Department of Women and Children's Health, King's College London, London, UK
| | - Christoffer Clemmensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adem Y Dawed
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Aaron J Deutsch
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura T Dickens
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Carmella Evans-Molina
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - María Mercè Fernández-Balsells
- Biomedical Research Institute Girona, IdIBGi, Girona, Spain
- Diabetes, Endocrinology and Nutrition Unit Girona, University Hospital Dr Josep Trueta, Girona, Spain
| | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Stephanie L Fitzpatrick
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Stephen E Gitelman
- University of California at San Francisco, Department of Pediatrics, Diabetes Center, San Francisco, CA, USA
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jessica A Grieger
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nahal Habibi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Chuiguo Huang
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Arianna Harris-Kawano
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Heba M Ismail
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin Hoag
- Division of Endocrinology and Diabetes, Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA
- University of South Dakota School of Medicine, E Clark St, Vermillion, SD, USA
| | - Randi K Johnson
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Angus G Jones
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Robert W Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Aaron Leong
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | | | - Kai Liu
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Alice Long
- Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert W Morton
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maleesa Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sofia Pazmino
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
| | - Dianna Perez
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John R Petrie
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Camille E Powe
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alejandra Quinteros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rashmi Jain
- Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Debashree Ray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute for Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Zeb Saeed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vanessa Santhakumar
- Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Kanbour
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- AMAN Hospital, Doha, Qatar
| | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela S F Monaco
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
- Divsion of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA, USA
| | - Maggie A Stanislawski
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nele Steenackers
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
| | - Andrea K Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Norbert Stefan
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- University Hospital of Tübingen, Tübingen, Germany
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sok Cin Tye
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marzhan Urazbayeva
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - Bart Van der Schueren
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Camille Vatier
- Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - John M Wentworth
- Royal Melbourne Hospital Department of Diabetes and Endocrinology, Parkville, Victoria, Australia
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- University of Melbourne Department of Medicine, Parkville, Victoria, Australia
| | - Wesley Hannah
- Deakin University, Melbourne, Victoria, Australia
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Gechang Yu
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shao J Zhou
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Jacques Beltrand
- Institut Cochin, Inserm U 10116, Paris, France
- Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France
| | - Michel Polak
- Institut Cochin, Inserm U 10116, Paris, France
- Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France
| | - Ingvild Aukrust
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Elisa de Franco
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Sarah E Flanagan
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Kristin A Maloney
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew McGovern
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Janne Molnes
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Mariam Nakabuye
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pål Rasmus Njølstad
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Hugo Pomares-Millan
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cécile Saint-Martin
- Department of Medical Genetics, AP-HP Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Cuilin Zhang
- Global Center for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Russell de Souza
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea J Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | | | - Eskedar Getie Mekonnen
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emily Mixter
- Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Diana Sherifali
- Population Health Research Institute, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, Diabetes, University of Colorado, Aurora, CO, USA
| | - John J Nolan
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Endocrinology, Wexford General Hospital, Wexford, Ireland
| | - Louis H Philipson
- Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Rebecca J Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Liana K Billings
- Division of Endocrinology, NorthShore University HealthSystem, Skokie, IL, USA
- Department of Medicine, Prtizker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Kristen Boyle
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - John M Dennis
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Jose C Florez
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Anna L Gloyn
- Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter A Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Siri Atma W Greeley
- Departments of Pediatrics and Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Kurt Griffin
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
- Sanford Research, Sioux Falls, SD, USA
| | - Andrew T Hattersley
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | - Marie-France Hivert
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jami L Josefson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Siew S Lim
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald C W Ma
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rinki Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland Diabetes Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand
- Medical Bariatric Service, Te Whatu Ora Counties, Health New Zealand, Auckland, New Zealand
| | - Richard Oram
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Katharine R Owen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Susan E Ozanne
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Toni I Pollin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Maria J Redondo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert K Semple
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Emily K Sims
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tiinamaija Tuomi
- Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Miriam S Udler
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kimberly K Vesco
- Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Tina Vilsbøll
- Clinial Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Wagner
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark.
| |
Collapse
|
5
|
Addala A, Wong JJ, Penaranda RM, Hanes SJ, Abujaradeh H, Adams RN, Barley RC, Iturralde E, Lanning MS, Tanenbaum ML, Naranjo D, Hood KK. Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations. J Diabetes Complications 2023; 37:108514. [PMID: 37263033 DOI: 10.1016/j.jdiacomp.2023.108514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
AIM Youth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES. METHODS We analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status. RESULTS For youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = -0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = -0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027). CONCLUSION PGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.
Collapse
Affiliation(s)
- Ananta Addala
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States; Stanford Diabetes Research Center, United States.
| | - Jessie J Wong
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Sarah J Hanes
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Rebecca N Adams
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Regan C Barley
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, United States
| | - Monica S Lanning
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Molly L Tanenbaum
- Stanford Diabetes Research Center, United States; Stanford University School of Medicine, Department of Medicine, Division of Endocrinology, Gerontology, and Metabolism, United States
| | - Diana Naranjo
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Korey K Hood
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| |
Collapse
|
6
|
Wong JJ, Addala A, Hanes SJ, Krugman S, Naranjo D, Nelmes S, Rose KJ, Tanenbaum ML, Hood KK. DiabetesWise: An innovative approach to promoting diabetes device awareness. J Diabetes 2023. [PMID: 37139842 DOI: 10.1111/1753-0407.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND DiabetesWise is an unbranded, data-driven online resource that tailors device recommendations based on preferences and priorities of people with insulin-requiring diabetes. The objective of this study is to examine whether DiabetesWise increases uptake of diabetes devices, which are empirically supported to improve glycemic and psychosocial outcomes. METHODS The sample included 458 participants (Mage = 37.1, SD = 9.73; 66% female; 81% type 1 diabetes) with insulin-requiring diabetes and minimal diabetes device use at enrollment. Participants used DiabetesWise and completed online surveys. Chi-square and t tests evaluated requests for a device prescription, receiving a prescription, and starting a new device at 1 and 3 months post use. Baseline predictors of these variables and past use of continuous glucose monitors (CGMs) and changes in diabetes distress post use were also examined. RESULTS Within the first month of interacting with DiabetesWise 19% of participants asked for a prescription for a diabetes device. This rate rose to 31% in the first 3 months. These requests resulted in 16% of the sample starting a new device within the first 3 months. Whereas several factors were associated with prior CGM use, receiving a prescription, and starting a new device, more diabetes distress (t(343) = -3.13, p = .002) was the only factor associated with asking for a prescription. Diabetes distress decreased after interacting with DiabetesWise within 1 month (t(193) = 3.51, p < .001) and 3 months (t(180) = 5.23, p < .001). CONCLUSIONS Within 3 months of interacting with DiabetesWise, one in three participants had requested a prescription for a new diabetes device and average distress levels were reduced, indicating benefit from this low-intensity online platform.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah J Hanes
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | | | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Sierra Nelmes
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Kyle Jacques Rose
- EiR Visiting Faculty, INSEAD Healthcare Management, Fontainebleau, France
| | - Molly L Tanenbaum
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K Hood
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
- Healthmade Design, Oakland, California, USA
| |
Collapse
|
7
|
Wong JJ, Timko C, Heinz AJ, Cronkite R. Sharing the Blues: Longitudinal Influences of Depression within Couples. Contemp Fam Ther 2023. [DOI: 10.1007/s10591-023-09664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
|
8
|
Suttiratana SC, Wong JJ, Lanning MS, Dunlap A, Hanes SJ, Hood KK, Lal RA, Naranjo D. Qualitative Study of User Experiences with Loop, an Open-Source Automated Insulin Delivery System. Diabetes Technol Ther 2022; 24:416-423. [PMID: 35099278 PMCID: PMC9208860 DOI: 10.1089/dia.2021.0485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Loop is an open-source automated insulin delivery (AID) system, used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation. Methods: Focus groups revealed 72 new and existing users' perspectives on Loop uptake, use, and persistence. A subsample of participants from a mixed-methods, observational cohort study shared first-hand accounts of their experiences using Loop. Participants were predominately white (95%), male (50%), privately insured (94%), and reported annual household income ≥$100K (73%) and education exceeding a bachelor's degree (87%) with a mean HbA1c of 6.6% ± 0.8%. Data were analyzed and synthesized by a multidisciplinary team. Results: Participants detailed their experiences with (1) Loop technical support and troubleshooting, (2) decreased mental/behavioral burden, (3) technical issues with parts of the system, (4) glycemic control, (5) personalizing settings, and (6) providers while using Loop. Decreased burden was the most endorsed benefit defined by less worry, stress, and cognitive effort and less time spent on diabetes management tasks. Participants highlighted the benefits of Loop overnight and their introduction to "Loop communities" during use. The most discussed challenges involved technical issues. A range of provider attitudes and knowledge about Loop complicated users' clinical experiences and disclosure. Conclusions: This sample of new and experienced Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components, customizing the system to suit one's lifestyle and habits, and adjusting system settings. Challenges related to system setup and calibrating settings are remediable and, if addressed, may better serve Loop users. Users reported feeling empowered by the customizability of and the educational effects facilitated by the open-source AID system. Loop helped users learn more about their chronic illness and physiology in an acceptable format. Clinical Trial Registration number: NCT03838900.
Collapse
Affiliation(s)
- Sakinah C. Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Address correspondence to: Sakinah C. Suttiratana, PhD, MPH, MBA, Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Jessie J. Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Monica S. Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Adrienne Dunlap
- Division of Agriculture, Food, and Environment, Tufts University, Friedman School of Nutrition Science and Policy, Medford, Massachusetts, USA
| | - Sarah J. Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K. Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| | - Rayhan A. Lal
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
- Division of Endocrinology, Department of Medicine, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, California, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
9
|
Schneider LM, Wong JJ, Adams R, Bates B, Chen S, Ceresnak SR, Danovsky M, Hanisch D, Motonaga KS, Restrepo M, Shaw RJ, Sears SF, Trela A, Dubin AM, Hood KK. Post-Traumatic Stress Disorder in pediatric Implantable Cardioverter Defibrillator patients and their parents. Heart Rhythm 2022; 19:1524-1529. [DOI: 10.1016/j.hrthm.2022.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
|
10
|
Wong JJ, Suttiratana SC, Lal RA, Lum JW, Lanning MS, Dunlap A, Arbiter B, Hanes SJ, Bailey RJ, Hood KK, Naranjo D. Discontinued Use of the Loop Insulin Dosing System: A Mixed-Methods Investigation. Diabetes Technol Ther 2022; 24:241-248. [PMID: 34780283 PMCID: PMC9057870 DOI: 10.1089/dia.2021.0362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Loop is an open-source automated insulin dosing system that allows users unrivaled control over system settings that affect future glucose prediction. Thousands use Loop, but little is known about those who discontinue. Methods: In a large observational study, 874 Loop participants completed surveys and provided glycemic data, 46 (5.3%) of those self-identified as discontinuing Loop use during the observation window, 45 completed a discontinued use survey, 22 provided system settings data, and 19 participated in semistructured interviews about their discontinuation. Qualitative data were transcribed, coded, and analyzed. Results: Older age and not trusting Loop were associated with discontinued use, although no other demographic or clinical characteristics were significant correlates. The most endorsed reasons were "I decided to try something else" (27.8%) followed by "It just didn't help as much as I thought it would" (22.2%). Qualitative analyses revealed prominent themes centered upon mental and emotional burden and adjusting settings. Other reasons for discontinued use included fear of disapproval of Loop use from diabetes provider, barriers to acquiring component devices, a desire to try new/different technologies, concerns that Loop could not accommodate specific exercise or low insulin dose regimens, and worry about Loop use during pregnancy. It was noted that burdens might be alleviated by enhanced technical assistance and expert guidance. Conclusions: Although the majority of individuals in the Loop observational study continued use, those who discontinued reported similar challenges. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users. Clinical Trial Registration: clinicaltrials.gov (NCT03838900).
Collapse
Affiliation(s)
- Jessie J. Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sakinah C. Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rayhan A. Lal
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| | - John W. Lum
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Monica S. Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Adrienne Dunlap
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | | | - Sarah J. Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Korey K. Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
11
|
Affiliation(s)
- Korey K Hood
- Department of Pediatrics and Department of Psychiatry and Behavioral Sciences, Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94304, USA.
| | - Jessie J Wong
- Department of Pediatrics and Department of Psychiatry and Behavioral Sciences, Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94304, USA
| |
Collapse
|
12
|
Addala A, Suttiratana SC, Wong JJ, Lanning MS, Barnard KD, Weissberg-Benchell J, Laffel LM, Hood KK, Naranjo D. Cost considerations for adoption of diabetes technology are pervasive: A qualitative study of persons living with type 1 diabetes and their families. Diabet Med 2021; 38:e14575. [PMID: 33794006 PMCID: PMC9088880 DOI: 10.1111/dme.14575] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cost is a major consideration in the uptake and continued use of diabetes technology. With increasing use of automated insulin delivery systems, it is important to understand the specific cost-related barriers to technology adoption. In this qualitative analysis, we were interested in understanding and examining the decision-making process around cost and diabetes technology use. MATERIALS AND METHODS Four raters coded transcripts of four stakeholder groups using inductive coding for each stakeholder group to establish relevant themes/nodes. We applied the Social Ecological Model in the interpretation of five thematic levels of cost. RESULTS We identified five thematic levels of cost: policy, organizational, insurance, interpersonal and individual. Equitable diabetes technology access was an important policy-level theme. The insurance-level theme had multiple subthemes which predominantly carried a negative valence. Participants also emphasized the psychosocial burden of cost specifically identifying diabetes costs to their families, the guilt of diabetes related costs, and frustration in the time and involvement required to ensure insurance coverage. CONCLUSION We found broad consensus in how cost is experienced by stakeholder groups. Cost considerations for diabetes technology uptake extended beyond finances to include time, cost to society, morality and interpersonal relationships. Cost also reflected an important moral principle tied to the shared desire for equitable access to diabetes technology. Knowledge of these considerations can help clinicians and researchers promote equitable device uptake while anticipating barriers for all persons living with type 1 diabetes and their families.
Collapse
Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA, USA
| | - Sakinah C. Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Jessie J. Wong
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA, USA
| | - Monica S. Lanning
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA, USA
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lori M Laffel
- Harvard Medical School, Boston, MA, USA
- Joslin Diabetes Center, Boston, MA, USA
| | - Korey K. Hood
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA, USA
| | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA, USA
| |
Collapse
|
13
|
Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Yabut K, Roque X, Wong JJ, Baer L, Figg L, Bernier A, Westen S, Lewit E, Sheehan E, Basina M, Lal R, Maizel J, Maahs DM. Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ Open Diabetes Res Care 2021; 9:9/1/e002262. [PMID: 34244218 PMCID: PMC8268922 DOI: 10.1136/bmjdrc-2021-002262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D. RESEARCH DESIGN AND METHODS Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. RESULTS In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). CONCLUSIONS The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.
Collapse
Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Nicolas Cuttriss
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Korey K Hood
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | | | - Katarina Yabut
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jessie J Wong
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Linda Baer
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Lauren Figg
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Eugene Lewit
- Department of Health Research and Policy, Stanford, Palo Alto, California, USA
| | - Eleni Sheehan
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Marina Basina
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Rayhan Lal
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Jennifer Maizel
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| |
Collapse
|
14
|
Wong JJ, Hanes S, Iturralde E, Lanning MS, Naranjo D, Tanenbaum M, Hood KK. Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability. J Pediatr Psychol 2021; 46:332-340. [PMID: 33316061 DOI: 10.1093/jpepsy/jsaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes. METHODS A sample of 124 adolescents (57.7% female) ages 12-21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates. RESULTS Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not. CONCLUSIONS Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.
Collapse
Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California
| | - Monica S Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Molly Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| |
Collapse
|
15
|
Abstract
The purpose of this study was to determine clinician attitudes about the distinct barriers to uptake of continuous glucose monitoring (CGM) among people with diabetes. Survey data were collected measuring individual barriers, prerequisites to CGM, confidence in addressing barriers, and clinic staff resources. Results show that clinicians commonly report barriers to using CGM among people with diabetes in their clinic. Furthermore, clinicians who report a high number of barriers do not feel confident in overcoming the barriers to CGM. Interventions that attempt to empower clinicians to address concerns about CGM among people with diabetes may be warranted because low uptake does not appear to be directly related to available resources or prerequisites to starting CGM.
Collapse
Affiliation(s)
- Monica S Lanning
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
16
|
Messer LH, Tanenbaum ML, Cook PF, Wong JJ, Hanes SJ, Driscoll KA, Hood KK. Cost, Hassle, and On-Body Experience: Barriers to Diabetes Device Use in Adolescents and Potential Intervention Targets. Diabetes Technol Ther 2020; 22:760-767. [PMID: 32163719 DOI: 10.1089/dia.2019.0509] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Adolescents with diabetes have the highest A1cs of all age groups. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and although the uptake of devices has increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention. Methods: We surveyed 411 adolescents with type 1 diabetes (mean age 16.30 ± 2.25 years) on barriers to diabetes device use, technology use attitudes (general and diabetes specific), benefits and burdens of CGM, self-efficacy for diabetes care, diabetes distress, family conflict, and depression. We characterize barriers to device uptake; assess demographic and psychosocial differences in device users, discontinuers, and nonusers; and determine differences in device use by gender and age. Results: The majority of adolescents used an insulin pump (n = 307, 75%) and more than half used CGM (n = 225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%), which include the hassle of wearing the device (38%) and dislike of device on the body (33%). Adolescents who endorsed more barriers also reported more diabetes distress (P = 0.003), family conflict (P = 0.003), and depressive symptoms (P = 0.014). Pump and CGM discontinuers both endorsed more barriers and more negative perceptions of technology than current users, but reported no difference from device users in diabetes distress, family conflict, or depression. Gender was not related to the perceptions of devices. Conclusions: Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.
Collapse
Affiliation(s)
- Laurel H Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado
| | - Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| |
Collapse
|
17
|
Wong JJ, Barley RC, Hanes S, Tanenbaum ML, Lanning M, Naranjo D, Hood KK. Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use. Diabetes Technol Ther 2020; 22:674-680. [PMID: 31971451 DOI: 10.1089/dia.2019.0492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles of parents of youth with type 1 diabetes based on their attitudes toward diabetes-specific technology and barriers to diabetes technology uptake. Methods: Online survey data were collected from 471 parents in the T1D Exchange Clinic Network (child's age = 12.0 ± 3.2 years; diabetes duration = 7.0 ± 2.9 years; A1c = 8.4% ± 1.3; 75% using insulin pump; 27% using CGM). Results: K-means cluster analyses revealed five parent profiles: Embracers (50.7%), Burdened (15.7%), Hopeful but Hassled (14.2%), Distrusting (12.7%), and Data Minimalists (6.6%). ANOVAs and chi-square tests identified differences between groups based on diabetes distress, worry over hypoglycemia, device use, and demographic characteristics. Conclusions: Providers encouraging device uptake may benefit from tailoring their approaches based on these distinct groups and their corresponding concerns and needs.
Collapse
Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Regan C Barley
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Monica Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
18
|
Tanenbaum ML, Adams RN, Wong JJ, Hood KK. Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes. J Pediatr Psychol 2020; 45:488-497. [PMID: 32196093 PMCID: PMC7233956 DOI: 10.1093/jpepsy/jsaa011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. METHODS We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c. RESULTS A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28). CONCLUSIONS Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.
Collapse
Affiliation(s)
| | | | - Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine
| |
Collapse
|
19
|
Wong JJ, Addala A, Naranjo D, Hood KK, Cengiz E, Ginley MK, Feinn RS, Wagner JA. Monetary reinforcement for self-monitoring of blood glucose among young people with type 1 diabetes: evaluating effects on psychosocial functioning. Diabet Med 2020; 37:665-673. [PMID: 31701566 PMCID: PMC7332232 DOI: 10.1111/dme.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
AIMS To explore the auxiliary psychosocial effects of a monetary reinforcement intervention targeting self-monitoring of blood glucose among young people with Type 1 diabetes. METHODS Sixty young people with Type 1 diabetes, HbA1c concentrations between 58 and 119 mmol/mol (7.5-13.0%), and average self-monitoring of blood glucose <4 times per day were randomized to either enhanced usual care or a 24-week intervention of monetary rewards for self-monitoring of blood glucose and associated behaviours (e.g. uploading glucose meters). Data were collected from the young people and their parents at baseline, during the intervention (6, 12 and 24 weeks) and after the intervention (36 weeks). RESULTS Linear mixed models were used to evaluate the intervention effects on psychosocial outcomes, adjusting for corresponding baseline levels and potential moderation by baseline level. The intervention reduced diabetes distress at week 6 among young people who had average and high baseline distress. It also reduced diabetes distress at weeks 12 and 24 among those with low baseline distress. The intervention also reduced young person-reported diabetes-related family conflict and diabetes-related interference among those with high baseline scores in these areas; however, the intervention worsened young person-reported diabetes interference among those with low baseline interference. Effects were medium-sized and time-limited. CONCLUSIONS Findings indicate predominantly positive impacts of monetary reinforcement interventions on psychosocial outcomes, although effects varied by outcome and time point. Whereas early improvements in diabetes distress were observed for all who received the intervention, improvements in other areas varied according to the level of psychosocial challenge at baseline. Incorporating psychosocial interventions may bolster and maintain effects over time.
Collapse
Affiliation(s)
- J J Wong
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - A Addala
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - D Naranjo
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - K K Hood
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - E Cengiz
- Yale University School of Medicine, New Haven, CT, USA
| | - M K Ginley
- East Tennessee State University, Johnson City, TN, USA
| | - R S Feinn
- Quinnipiac University, Hamden, CT, USA
| | - J A Wagner
- School of Dental Medicine and School of Medicine, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
20
|
Abstract
INTRODUCTION People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service. MATERIALS AND METHODS Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board. RESULTS Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34). CONCLUSIONS This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.
Collapse
Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025
| | - Michele L Patel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr., Durham, NC 27708
| | - Jessie J Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, 616 Serra Mall C100, Stanford, CA 94305-6055
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073.,Department of Epidemiology, UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095-1772
| |
Collapse
|
21
|
Schneider LM, Wong JJ, Trela A, Hanisch D, Shaw RJ, Sears SF, Motonaga KS, Ceresnak SR, Hood KK, Dubin AM. An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant. Pacing Clin Electrophysiol 2020; 43:289-296. [DOI: 10.1111/pace.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lauren M. Schneider
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine Stanford California
| | - Jessie J. Wong
- Division of Pediatric EndocrinologyDepartment of PediatricsStanford University School of Medicine Stanford California
| | - Anthony Trela
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford Palo Alto California
| | - Debra Hanisch
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford Palo Alto California
| | - Richard J. Shaw
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine Stanford California
| | - Samuel F. Sears
- Department of Psychology and Cardiovascular ScienceEast Carolina University Greenville North Carolina
| | - Kara S. Motonaga
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
| | - Scott R. Ceresnak
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
| | - Korey K. Hood
- Division of Pediatric EndocrinologyDepartment of PediatricsStanford University School of Medicine Stanford California
| | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
| |
Collapse
|
22
|
Abstract
BACKGROUND Depression is a debilitating condition that affects the individual and the family. OBJECTIVE This study sought to identify potential reciprocal influences between family arguments and depressive symptoms among clinically depressed patients over a 23-year span. METHODS The present study employed a longitudinal, observational design with 424 depressed patients. Separate cross-lagged path models examined longitudinal associations for women and men over 23 years while adjusting for age, income, and marital and parental status. RESULTS Among depressed men, more severe baseline depressive symptoms predicted more family arguments 10 years later. Among depressed women, more severe baseline depressive symptoms predicted fewer family arguments 1 year later, while more severe depressive symptoms at 10-year follow-up predicted more family arguments at 23-year follow-up. More family arguments predicted more severe depressive symptoms among women and men, with some variation in the time intervals of these associations. CONCLUSION These findings suggest that while depressive symptoms may temporarily diminish family arguments among women, such symptoms were associated with more family arguments over longer time intervals. Moreover, family arguments put depressed men and women at risk for more severe depressive symptoms. These results support the use of screening for family arguments and interventions to help depressed individuals develop skills to manage interpersonal conflict.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Nickolas D Frost
- Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA
| | - Christine Timko
- Center of Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Adrienne J Heinz
- Center of Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Ruth Cronkite
- Center of Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Sociology, Stanford University, Palo Alto, CA, USA.,Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| |
Collapse
|
23
|
Wong JJ, Addala A, Abujaradeh H, Adams RN, Barley RC, Hanes SJ, Iturralde E, Lanning MS, Naranjo D, Tanenbaum ML, Hood KK. Depression in context: Important considerations for youth with type 1 vs type 2 diabetes. Pediatr Diabetes 2020; 21:135-142. [PMID: 31644828 DOI: 10.1111/pedi.12939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type. OBJECTIVE Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes. METHODS A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type. RESULTS Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P < .001) than type 1 (β = -.48, P < .001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = .33, P = .035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = .86, P = .043), but not type 1 diabetes. No gender differences were detected. CONCLUSION These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Ananta Addala
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Hiba Abujaradeh
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Regan C Barley
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Esti Iturralde
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Monica S Lanning
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Diana Naranjo
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Korey K Hood
- Department of Pediatrics, Stanford University, Palo Alto, California
| |
Collapse
|
24
|
Breland JY, Wong JJ, McAndrew LM. Are Common Sense Model constructs and self-efficacy simultaneously correlated with self-management behaviors and health outcomes: A systematic review. Health Psychol Open 2020; 7:2055102919898846. [PMID: 32030192 PMCID: PMC6978827 DOI: 10.1177/2055102919898846] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review answered two questions among adults with chronic conditions: When included in the same statistical model, are Common Sense Model constructs and self-efficacy both associated with (1) self-management behaviors and (2) health outcomes? We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included 29 articles. When included in the same statistical model, Common Sense Model constructs and self-efficacy were both correlated with outcomes. Self-efficacy was more consistently associated with self-management behaviors, and Common Sense Model constructs were more consistently associated with health outcomes. Findings support the continued inclusion and integration of both frameworks to understand and/or improve chronic illness self-management and outcomes.
Collapse
Affiliation(s)
| | - Jessie J Wong
- VA Palo Alto Health Care System, USA.,Stanford University School of Medicine, USA
| | - Lisa M McAndrew
- VA New Jersey Health Care System, USA.,University at Albany, State University of New York, USA
| |
Collapse
|
25
|
Finlay AK, Wong JJ, Ellerbe LS, Rubinsky A, Gupta S, Bowe TR, Schmidt EM, Timko C, Burden JL, Harris AHS. Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs. J Stud Alcohol Drugs 2019. [PMID: 30573022 DOI: 10.15288/jsad.2018.79.909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt. METHOD VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis. RESULTS Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership. CONCLUSIONS Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD.
Collapse
Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.,National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, California
| | - Jessie J Wong
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.,Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Laura S Ellerbe
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Anna Rubinsky
- Kidney Health Research Collaborative, University of California San Francisco and VA San Francisco Health Care System, San Francisco, California
| | - Shalini Gupta
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Thomas R Bowe
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Eric M Schmidt
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.,Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jennifer L Burden
- Department of Veterans Affairs, Veterans Health Administration, Salem, Virginia
| | - Alex H S Harris
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.,Department of Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
26
|
Wong JJ, Cucciare MA, Booth BM, Timko C. Predicting Substance Use Patterns Among Rural Adults: The Roles of Mothers, Fathers, and Parenthood. Fam Process 2019; 58:431-445. [PMID: 29663337 PMCID: PMC6191389 DOI: 10.1111/famp.12362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18-61 living in the rural Midwest and Mid-south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders.
Collapse
Affiliation(s)
- Jessie J. Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System
- Center on Health Policy/Center on Primary Care and Outcomes Research, Stanford University
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System
- Department of Psychiatry, University of Arkansas for Medical Sciences
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System
| | - Brenda M. Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
27
|
Wong JJ, Hood KK, Breland JY. Correlates of health care use among White and minority men and women with diabetes: An NHANES study. Diabetes Res Clin Pract 2019; 150:122-128. [PMID: 30844470 DOI: 10.1016/j.diabres.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/31/2019] [Accepted: 03/01/2019] [Indexed: 01/27/2023]
Abstract
AIMS The current study sought to identify patient-level factors related to health care use among White and minority men and women with diabetes. METHODS A sample of 447 of non-pregnant individuals with diabetes, ages 18-64, was drawn from the 2015-2016 National Health and Nutrition Examination Surveys dataset. Poisson regression models tested associations between health care use and self-rated health, depression, medical comorbidities, body mass index, marital status, number of children, income, insurance coverage, and age, stratified by gender and racial/ethnic minority status. RESULTS Poorer self-rated health was the only significant correlate of increased health care use among White men with diabetes whereas income and insurance were significant correlates of increased use among minority men. Among White and minority women, higher levels of depression and being single were correlated with greater health care use. Comorbid medical conditions and insurance coverage were also related to use among minority women. CONCLUSIONS Among individuals with diabetes, health care use among White men appeared to be driven by subjective health whereas financial factors were critical among minority men. Family structure and mental health were instrumentally associated with health care use among all women. These factors can be targeted to promote equitable access to care.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
| |
Collapse
|
28
|
Lemeunier N, da Silva-Oolup S, Olesen K, Shearer H, Carroll LJ, Brady O, Côté E, Stern P, Tuff T, Suri-Chilana M, Torres P, Wong JJ, Sutton D, Murnaghan K, Côté P. Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration. Eur Spine J 2019; 28:1156-1179. [PMID: 30879185 DOI: 10.1007/s00586-019-05949-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/10/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). METHODS We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. RESULTS We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. CONCLUSION The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- N Lemeunier
- Institut Franco-Européen de Chiropraxie (IFEC), 72 chemin de la Flambère, 31300, Toulouse, France.
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
| | - S da Silva-Oolup
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - K Olesen
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - H Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 4075 Research Transition Facility, 8308 - 114 St., Edmonton, AB, T6G 2E1, Canada
| | - O Brady
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, USA
| | - E Côté
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St., Toronto, ON, M5T 3A9, Canada
| | - P Stern
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - T Tuff
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - M Suri-Chilana
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - P Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile
| | - J J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - D Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - K Murnaghan
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - P Côté
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| |
Collapse
|
29
|
Wong JJ, Sceats L, Dehghan M, Wren AA, Sellers ZM, Limketkai BN, Bensen R, Kin C, Park KT. Depression and Health Care Use in Patients With Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:19-26. [PMID: 30256923 DOI: 10.1093/ecco-jcc/jjy145] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depression frequently co-occurs in patients with inflammatory bowel disease [IBD] and is a driver in health care costs and use. AIM This study examined the associations between depression and total health care costs, emergency department [ED] visits, computed tomography [CT] during ED/inpatient visits, and IBD-related surgery among IBD patients. METHODS Our sample included 331772 IBD patients from a national administrative claims database [Truven Health MarketScan® Database]. Gamma and Poisson regression analyses assessed differences related to depression, controlling for key variables. RESULTS Approximately 16% of the IBD cohort was classified as having depression. Depression was associated with a $17,706 (95% confidence interval [CI] [$16,892, 18,521]) increase in mean annual IBD-related health care costs and an increased incidence of ED visits (adjusted incidence rate ratio [aIRR] of 1.5; 95% CI [1.5, 1.6]). Among patients who had one or more ED/inpatient visits, depression was associated with an increased probability of receiving repeated CT [one to four scans, adjusted odds ratio [aOR] of 1.6; 95% CI [1.5, 1.7]; five or more scans, aOR of 4.6; 95% CI [2.9, 7.3]) and increased odds of undergoing an IBD-related surgery (aOR of 1.2; 95% CI [1.1, 1.2]). Secondary analysis with a paediatric subsample revealed that approximately 12% of this cohort was classified as having depression, and depression was associated with increased costs and incidence rates of ED visits and CT, but not of IBD-related surgery. CONCLUSIONS Quantifiable differences in health care costs and patterns of use exist among patients with IBD and depression. Integration of mental health services within IBD care may improve overall health outcomes and costs of care.
Collapse
Affiliation(s)
- Jessie J Wong
- Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Sceats
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Melody Dehghan
- Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anava A Wren
- Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Zachary M Sellers
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Berkeley N Limketkai
- Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rachel Bensen
- Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - K T Park
- Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
30
|
Lemeunier N, Jeoun EB, Suri M, Tuff T, Shearer H, Mior S, Wong JJ, da Silva-Oolup S, Torres P, D'Silva C, Stern P, Yu H, Millan M, Sutton D, Murnaghan K, Cȏté P. Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration. Musculoskelet Sci Pract 2018; 38:128-147. [PMID: 30455032 DOI: 10.1016/j.msksp.2018.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). METHODS We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. RESULTS We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. CONCLUSIONS We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.
Collapse
Affiliation(s)
- N Lemeunier
- Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada.
| | - E B Jeoun
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - M Suri
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - T Tuff
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S da Silva-Oolup
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile
| | - C D'Silva
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
| | - P Stern
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - M Millan
- Cabinet d'expertise médicale, Castres, France
| | - D Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - K Murnaghan
- Librarian, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Cȏté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
| |
Collapse
|
31
|
Finlay AK, Wong JJ, Ellerbe LS, Rubinsky A, Gupta S, Bowe TR, Schmidt EM, Timko C, Burden JL, Harris AHS. Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs. J Stud Alcohol Drugs 2018; 79:909-917. [PMID: 30573022 PMCID: PMC6308173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/23/2018] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt. METHOD VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis. RESULTS Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership. CONCLUSIONS Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD.
Collapse
Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, California
| | - Jessie J. Wong
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
- Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Laura S. Ellerbe
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Anna Rubinsky
- Kidney Health Research Collaborative, University of California San Francisco and VA San Francisco Health Care System, San Francisco, California
| | - Shalini Gupta
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Thomas R. Bowe
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Eric M. Schmidt
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
- Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jennifer L. Burden
- Department of Veterans Affairs, Veterans Health Administration, Salem, Virginia
| | - Alex H. S. Harris
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
32
|
Wren AA, Bensen R, Sceats L, Dehghan M, Yu H, Wong JJ, MacIsaac D, Sellers ZM, Kin C, Park KT. Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015. Inflamm Bowel Dis 2018; 24:2093-2103. [PMID: 29986015 PMCID: PMC6692855 DOI: 10.1093/ibd/izy222] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Indexed: 12/22/2022]
Abstract
Background Opioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects. Objectives This study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States. Method A longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15-29 years old with ≥2 IBD diagnoses (Crohn's: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use. Results In a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years. Conclusion Sustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.
Collapse
Affiliation(s)
- Anava A Wren
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| | - Rachel Bensen
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| | - Lindsay Sceats
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Melody Dehghan
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| | - Helen Yu
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| | - Jessie J Wong
- Center for Primary Care and Outcomes Research, Stanford, California
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Donna MacIsaac
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Zachary M Sellers
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| | - Cindy Kin
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - K T Park
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford, California
| |
Collapse
|
33
|
Park KT, Sceats L, Dehghan M, Trickey AW, Wren A, Wong JJ, Bensen R, Limketkai BN, Keyashian K, Kin C. Risk of post-operative surgical site infections after vedolizumab vs anti-tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:340-346. [PMID: 29876995 PMCID: PMC6043399 DOI: 10.1111/apt.14842] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/27/2018] [Accepted: 05/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Perioperative vedolizumab (VDZ) and anti-tumour necrosis factor (TNFi) therapies are implicated in causing post-operative complications in inflammatory bowel disease (IBD). AIM To compare the risk of surgical site infections (SSIs) between VDZ- and TNFi-treated IBD patients in propensity-matched cohorts. METHODS The Optum Research Database was used to identify IBD patients who received VDZ or TNFi within 30 days prior to abdominal surgery between January 2015 and December 2016. The date of IBD-related abdominal surgery was defined as the index date. SSIs were determined by ICD-9/10 and CPT codes related to superficial wound infections or deep organ space infections after surgery. Propensity score 1:1 matching established comparable cohorts based on VDZ or TNFi exposure before surgery based on evidence-based risk modifiers. RESULTS The propensity-matched sample included 186 patients who received pre-operative biologic therapy (VDZ, n = 94; TNFi, n = 92). VDZ and TNFi cohorts were similar based on age, gender, IBD type, concomitant immunomodulator exposure, chronic opioid or corticosteroid therapy, Charlson Comorbidity Index and malnutrition. VDZ patients were more likely to undergo an open bowel resection with ostomy. After propensity score matching, there was no significant difference in post-operative SSIs (TNFi 12.0% vs VDZ 14.9%, P = 0.56). Multivariable analysis indicated that malnutrition was the sole risk factor for developing SSI (OR 3.1, 95% CI 1.11-8.71) regardless of the type of biologic exposure. CONCLUSION In the largest, risk-adjusted cohort analysis to date, perioperative exposure to VDZ therapy was not associated with a significantly higher risk of developing an SSI compared to TNFi therapy.
Collapse
Affiliation(s)
- KT Park
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine
| | - Lindsay Sceats
- Division of Colorectal Surgery, Department of Surgery & Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine
| | - Melody Dehghan
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine
| | - Amber W. Trickey
- Division of Colorectal Surgery, Department of Surgery & Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine
| | - Anava Wren
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine
| | - Jessie J. Wong
- Health Services Research & Development, VA Palo Alto Health Care System, Palo Alto, CA
| | - Rachel Bensen
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine
| | - Berkeley N. Limketkai
- Division of Gastroenterology, Department of Medicine, Stanford University School of Medicine
| | - Kian Keyashian
- Division of Gastroenterology, Department of Medicine, Stanford University School of Medicine
| | - Cindy Kin
- Division of Colorectal Surgery, Department of Surgery & Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine
| |
Collapse
|
34
|
Sellers ZM, MacIsaac D, Yu H, Dehghan M, Zhang KY, Bensen R, Wong JJ, Kin C, Park KT. Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014. Gastroenterology 2018; 155:469-478.e1. [PMID: 29660323 PMCID: PMC6067969 DOI: 10.1053/j.gastro.2018.04.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/07/2018] [Accepted: 04/06/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Epidemiologic analyses of acute pancreatitis (AP) and chronic pancreatitis (CP) provide insight into causes and strategies for prevention and affect allocation of resources to its study and treatment. We sought to determine current and accurate incidences of AP and CP, along with the prevalence of CP, in children and adults in the United States. METHODS We collected data from the Truven MarketScan Research Databases of commercial inpatient and outpatient insurance claims in the United States from 2007 through 2014 (patients 0-64 years old). We calculated the incidences of AP and CP and prevalence of CP based on International Classification of Diseases, 9th Revision diagnosis codes. Children were defined as 18 years or younger and adults as 19 to 64 years old. RESULTS The incidence of pediatric AP was stable from 2007 through 2014, remaining at 12.3/100,000 persons in 2014. Meanwhile, the incidence for adult AP decreased from 123.7/100,000 persons in 2007 to 111.2/100,000 persons in 2014. The incidence of CP decreased over time in children (2.2/100,000 persons in 2007 to 1.9/100,000 persons in 2014) and adults (31.7/100,000 persons in 2007 to 24.7/100,000 persons in 2014). The prevalences of pediatric and adult CP were 5.8/100,000 persons and 91.9/100,000 persons, respectively, in 2014. Incidences of AP and CP increased with age. We found little change in incidence during the first decade of life but linear increases starting in the second decade. CONCLUSIONS We performed a comprehensive epidemiologic analysis of privately insured, non-elderly adults and children with AP and CP in the United States. Changes in gallstone formation, smoking, and alcohol consumption, along with advances in pancreatitis management, may be responsible for the stabilization and even decrease in the incidences of AP and CP.
Collapse
Affiliation(s)
- Zachary M Sellers
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California.
| | - Donna MacIsaac
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California; Surgery, Stanford University, Palo Alto, California
| | - Helen Yu
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California
| | - Melody Dehghan
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California
| | - Ke-You Zhang
- Pediatrics, Stanford University, Palo Alto, California
| | - Rachel Bensen
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California
| | - Jessie J Wong
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California; Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California
| | - Cindy Kin
- Surgery, Stanford University, Palo Alto, California
| | - K T Park
- Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California
| |
Collapse
|
35
|
Gonzales NA, Jensen M, Tein JY, Wong JJ, Dumka LE, Mauricio AM. Effect of Middle School Interventions on Alcohol Misuse and Abuse in Mexican American High School Adolescents: Five-Year Follow-up of a Randomized Clinical Trial. JAMA Psychiatry 2018; 75:429-437. [PMID: 29562080 PMCID: PMC5875338 DOI: 10.1001/jamapsychiatry.2018.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations. OBJECTIVE To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with a Mexican American sample. DESIGN, SETTING, AND PARTICIPANTS A previous randomized clinical trial was conducted with 516 Mexican American 7th graders and at least 1 parent who identified as having Mexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school. INTERVENTIONS The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish. MAIN OUTCOMES AND MEASURES Primary outcomes were diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey. RESULTS Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11). CONCLUSIONS AND RELEVANCE Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders among Mexican American high school students and implementation of universal middle school interventions to reach Latino communities.
Collapse
Affiliation(s)
- Nancy A. Gonzales
- Department of Psychology and REACH Institute, Arizona State University, Tempe
| | - Michaeline Jensen
- Center for Developmental Science, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jenn Yun Tein
- Department of Psychology and REACH Institute, Arizona State University, Tempe
| | - Jessie J. Wong
- Center on Primary Care and Outcomes Research, Stanford University, Stanford, California,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Larry E. Dumka
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe
| | - Anne Marie Mauricio
- Department of Psychology and REACH Institute, Arizona State University, Tempe
| |
Collapse
|
36
|
Yu H, MacIsaac D, Wong JJ, Sellers ZM, Wren AA, Bensen R, Kin C, Park KT. Market share and costs of biologic therapies for inflammatory bowel disease in the USA. Aliment Pharmacol Ther 2018; 47:364-370. [PMID: 29164650 PMCID: PMC5760274 DOI: 10.1111/apt.14430] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/06/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Real-world data quantifying the costs of increasing use of biologics in inflammatory bowel disease (IBD) are unknown. AIM To determine the outpatient IBD drug utilization trends, relative market share, and costs in the USA during a 9-year period. METHODS The Truven MarketScan® Database was analysed for patients with Crohn's disease (CD) and ulcerative colitis (UC) during 2007-2015. National drug codes were used to identify prescription drugs; Healthcare Common Procedure Coding System J-codes were used to capture biologic out-patient infusions. Proportion of drug usage, relative market share and per-member per-year (PMPY) costs were analysed for biologics, immunomodulators, 5-ASAs and corticosteroids. RESULTS In 415 405 patients (188 842 CD; 195 183 UC; 31 380 indeterminate colitis; 54.67% female), utilization trends show a consistent rise in the market share of biologics during the 9-year study period. The proportion of patients using biologics increased from 21.8% to 43.8% for CD and 5.1%-16.2% for UC. This contrasts a small decrease in immunomodulator and 5-ASA use for CD and relative constancy of other classes including corticosteroids-only use as primary IBD medication from 2007 to 2015. The average biologic-taking patient accounted for $25 275 PMPY in 2007 and $36 051 PMPY in 2015. The average paediatric biologic-taking patient accounted for $23 616 PMPY in 2007 and $41 109 PMPY in 2015. In all patients, the share of costs for biologics increased from 72.9% in 2007 to 85.7% in 2015 (81.7% in 2007 to 94.9% in 2015 in paediatrics). CONCLUSION The vast majority of costs allocated to out-patient IBD medications in the USA is attributed to increasing use of biologic therapies despite the relative minority of biologic-taking patients.
Collapse
Affiliation(s)
- Helen Yu
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Donna MacIsaac
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA,Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessie J. Wong
- Center for Health Policy, Department of Medicine, Palo Alto Veterans Affairs, Stanford University School of Medicine, Stanford, CA, USA
| | - Zachary M. Sellers
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Anava A. Wren
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Bensen
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindy Kin
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - KT Park
- Stanford Children’s Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
37
|
Timko C, Booth BM, Han X, Schultz NR, Blonigen DM, Wong JJ, Cucciare MA. Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. ACTA ACUST UNITED AC 2017; 41:110-122. [PMID: 29051795 DOI: 10.1037/rmh0000065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304 USA
| | - Brenda M Booth
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Xiaotong Han
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205.,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
| | | | - Daniel M Blonigen
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Palo Alto University, Palo Alto, CA 94304, USA
| | - Jessie J Wong
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94025 USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.,VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
| |
Collapse
|
38
|
Lemeunier N, da Silva-Oolup S, Chow N, Southerst D, Carroll L, Wong JJ, Shearer H, Mastragostino P, Cox J, Côté E, Murnaghan K, Sutton D, Côté P. Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1-A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Eur Spine J 2017; 26:2225-2241. [PMID: 28608175 DOI: 10.1007/s00586-017-5153-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/24/2017] [Accepted: 05/20/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. METHODS We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes. RESULTS We screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II-III studies). Preliminary evidence suggests that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling's and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry. CONCLUSIONS Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension-rotation test, neurological examination, Spurling's and the upper limb neurodynamic tests.
Collapse
Affiliation(s)
- Nadège Lemeunier
- Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France. .,UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.
| | - S da Silva-Oolup
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - N Chow
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - D Southerst
- Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 63 Downing Street, New York, NY, 10014, USA
| | - L Carroll
- School of Public Health, University of Alberta, 116 St and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| | - H Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.,Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - P Mastragostino
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - J Cox
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - E Côté
- Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
| | - K Murnaghan
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - D Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| | - P Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, Canada
| |
Collapse
|
39
|
Finlay AK, Ellerbe LS, Wong JJ, Timko C, Rubinsky AD, Gupta S, Bowe TR, Burden JL, Harris AHS. Barriers to and facilitators of pharmacotherapy for alcohol use disorder in VA residential treatment programs. J Subst Abuse Treat 2017; 77:38-43. [PMID: 28476269 PMCID: PMC5467688 DOI: 10.1016/j.jsat.2017.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022]
Abstract
Among US military veterans, alcohol use disorder (AUD) is prevalent and in severe cases patients need intensive AUD treatment beyond outpatient care. The Department of Veterans Affairs (VA) delivers intensive, highly structured addiction and psychosocial treatment through residential programs. Despite the evidence supporting pharmacotherapy among the effective treatments for AUD, receipt of these medications (e.g., naltrexone, acamprosate) among patients in residential treatment programs varies widely. In order to better understand this variation, the current study examined barriers and facilitators to use of pharmacotherapy for AUD among patients in VA residential treatment programs. Semi-structured qualitative interviews with residential program management and staff were conducted and the Consolidated Framework for Implementation Research was used to guide coding and analysis of interview transcripts. Barriers to use of pharmacotherapy for AUD included cultural norms or philosophy against prescribing, lack of access to willing prescribers, lack of interest from leadership, and perceived lack of patient interest or need. Facilitators included cultural norms of openness or active promotion of pharmacotherapy; education for patients, program staff and prescribers; having prescribers on staff, and care coordination within residential treatment and with other clinic settings in and outside VA. Developing and testing improvement strategies to increase care coordination and consistent support from leadership may also yield increases in the use of pharmacotherapy for AUD among residential patients.
Collapse
Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; National Center on Homelessness Among Veterans, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Laura S Ellerbe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Jessie J Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Anna D Rubinsky
- Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center; 500 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Shalini Gupta
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Thomas R Bowe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Jennifer L Burden
- Department of Veterans Affairs, Veterans Health Administration, 1970 Roanoke Blvd. (116A), Salem, VA 24153, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, Stanford, CA 94305, USA.
| |
Collapse
|
40
|
Chong LA, Khalid F, Khoo TB, Teh SH, Kuan GL, Aina Mariana AM, Alias E, Chieng CH, Razali H, Ong GB, Zainah SH, Shukor INC, Wong JJ. Clinical spectrum of children receiving palliative care in Malaysian Hospitals. Med J Malaysia 2017; 72:32-36. [PMID: 28255137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services. METHODS An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out. RESULTS There were 315 patients analysed, 90 (28.6%) and 46 (14.6%) were neonates and adolescents respectively. The main ICD-10 diagnostic categories for all patients were identified to be 'Congenital malformations, deformations and chromosomal abnormalities' 117 (37.1%), 'Diseases of nervous system' 76 (24.1%) and 'Neoplasms' 60 (19.0%). At referral 156 (50%) patients had holistic needs assessments. Patients with 'Diseases of nervous system' were assessed to have significantly more physical needs than the other two diagnostic categories. Majority of patients who knew of their diagnosis and prognosis were those with malignancy. Over a fifth of referrals were at their terminal admission. Of 144 who died, 111 (77.1%) had advanced care plans. There was bereavement follow-up in 98 (68.1%) patients. CONCLUSION Patients referred for palliative care have varied diagnoses and needs. To ensure all paediatricians are competent to deliver quality care to all children, further education and training initiatives is imperative.
Collapse
Affiliation(s)
- L A Chong
- Hospis Malaysia, Cheras, Kuala Lumpur, Malaysia.
| | - F Khalid
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Selangor, Malaysia
| | - T B Khoo
- Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - S H Teh
- Hospital Miri, Miri, Sarawak, Malaysia
| | - G L Kuan
- Malacca Hospital, Malacca, Malaysia
| | | | - E Alias
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | | | - H Razali
- Hospital Sultan Ismail, Johor Bahru, Johor, Malaysia
| | - G B Ong
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - S H Zainah
- Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia
| | | | - J J Wong
- Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
| |
Collapse
|
41
|
Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, Goldgrub R, Nordin M, Gross DP, Shearer HM, Carroll LJ, Stern PJ, Ameis A, Southerst D, Mior S, Stupar M, Varatharajan T, Taylor-Vaisey A. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2016; 21:201-216. [PMID: 27712027 DOI: 10.1002/ejp.931] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 12/13/2022]
Abstract
We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited. SIGNIFICANCE Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.
Collapse
Affiliation(s)
- J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - P Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - D A Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - K Randhawa
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - H Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - S Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - R Goldgrub
- Masters Program, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - M Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, USA
| | - D P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada
| | - H M Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - L J Carroll
- Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - P J Stern
- Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - A Ameis
- Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, QC, Canada
| | - D Southerst
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada
| | - S Mior
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - M Stupar
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada
| | - T Varatharajan
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.,Masters Program, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada
| |
Collapse
|
42
|
Disterer P, Kryczka A, Liu Y, Badi YE, Wong JJ, Owen JS, Khoo B. Development of therapeutic splice-switching oligonucleotides. Hum Gene Ther 2014; 25:587-98. [PMID: 24826963 DOI: 10.1089/hum.2013.234] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Synthetic splice-switching oligonucleotides (SSOs) target nuclear pre-mRNA molecules to change exon splicing and generate an alternative protein isoform. Clinical trials with two competitive SSO drugs are underway to treat Duchenne muscular dystrophy (DMD). Beyond DMD, many additional therapeutic applications are possible, with some in phase 1 clinical trials or advanced preclinical evaluation. Here, we present an overview of the central factors involved in developing therapeutic SSOs for the treatment of diseases. The selection of susceptible pre-mRNA target sequences, as well as the design and chemical modification of SSOs to increase SSO stability and effectiveness, are key initial considerations. Identification of effective SSO target sequences is still largely empirical and published guidelines are not a universal guarantee for success. Specifically, exon-targeted SSOs, which are successful in modifying dystrophin splicing, can be ineffective for splice-switching in other contexts. Chemical modifications, importantly, are associated with certain characteristic toxicities, which need to be addressed as target diseases require chronic treatment with SSOs. Moreover, SSO delivery in adequate quantities to the nucleus of target cells without toxicity can prove difficult. Last, the means by which these SSOs are administered needs to be acceptable to the patient. Engineering an efficient therapeutic SSO, therefore, necessarily entails a compromise between desirable qualities and effectiveness. Here, we describe how the application of optimal solutions may differ from case to case.
Collapse
Affiliation(s)
- Petra Disterer
- 1 Institute for Liver and Digestive Health, Division of Medicine, University College London , London, NW3 2PF, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
43
|
Wong JJ, Gonzales NA, Montaño Z, Dumka L, Millsap RE. Parenting intervention effects on parental depressive symptoms: examining the role of parenting and child behavior. J Fam Psychol 2014; 28:267-277. [PMID: 24798817 DOI: 10.1037/a0036622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Parental depression is a major risk factor in child development. Growing research suggests parenting programs can positively impact parental depressive symptoms, although the specific mechanisms that explain these effects are unknown. The current study examined parenting mediated effects of a parenting program on mothers' and fathers' depressive symptoms, as well as the role of child behavior in linking parenting to reductions in depressive symptoms. The study samples included 494 mothers and 288 fathers of Mexican origin adolescents who participated in a randomized trial of the Bridges to High School Program/Proyecto Puentes a la Secundaria, a universal prevention and promotion intervention that included parent training but did not directly target parental depressive symptoms. Parenting mediator models tested program effects on parental depressive symptoms through changes in harsh and supportive parenting. Results showed a significant indirect intervention effect on maternal depressive symptoms through changes in mothers' harsh parenting. Next, child behavior models revealed a partial mediation effect of harsh parenting and a full mediation effect of supportive parenting on maternal depressive symptoms through mothers' reports of child externalizing symptoms. Indirect effects of fathers' harsh and supportive parenting on paternal depressive symptoms were also found through fathers' reports of child behavior.
Collapse
Affiliation(s)
| | | | | | - Larry Dumka
- School of Social and Family Dynamics, Arizona State University
| | | |
Collapse
|
44
|
Jensen MR, Wong JJ, Gonzales NA, Dumka LE, Millsap R, Coxe S. Long-term effects of a universal family intervention: mediation through parent-adolescent conflict. J Clin Child Adolesc Psychol 2014; 43:415-27. [PMID: 24730357 PMCID: PMC4008685 DOI: 10.1080/15374416.2014.891228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This randomized trial of a family-focused preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence, 5 years after completing the intervention. Parent-adolescent conflict was tested as a mediator of these effects. The role of parent and adolescent acculturation in these pathways was also examined. There were 494 seventh-grade adolescents and their primary female caregivers randomized to receive either a 9-week multicomponent intervention or a brief workshop control group. Assessments were conducted at pretest, 2-year follow-up (9th grade), and 5-year follow-up (when most participants were in the 12th grade). The Bridges program significantly reduced mother-adolescent conflict measured in the 9th grade, with conflict mediating program effects on internalizing and externalizing symptoms, adolescent substance use, and diagnosed internalizing disorder in late adolescence. Mother and child acculturation were both significantly predictive of late adolescence outcomes. Contrary to hypotheses, neither mother nor child acculturation emerged as a significant predictor of mother-adolescent conflict, and the interaction of mother and adolescent acculturation was similarly not related to mother-adolescent conflict. Intervention effects were largely consistent across different levels of acculturation. These findings provide support for the efficacy of family-focused intervention during early adolescence, both in reducing mental health problems and substance use in the long term and in impacting parent-adolescent conflict processes that appear to play an important role in the development of later adjustment problems.
Collapse
|
45
|
Wong JJ, Roubinov DS, Gonzales NA, Dumka LE, Millsap RE. Father enrollment and participation in a parenting intervention: personal and contextual predictors. Fam Process 2013; 52:440-454. [PMID: 24033241 PMCID: PMC5889082 DOI: 10.1111/famp.12024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Fathers are an important, though often underrepresented, population in family interventions. Notably, the inclusion of ethnic minority fathers is particularly scarce. An understanding of factors that promote and hinder father participation may suggest strategies by which to increase fathers' presence in studies designed to engage the family unit. The current research examined Mexican origin (MO) fathers' involvement in a family-focused intervention study. Participants included 495 fathers from eligible two-parent MO families with an adolescent child. Individual, familial, and culturally relevant predictors based on father, mother, and/or child report data were collected through pretest interviews and included in two separate logistic regression analyses that predicted the following: (1) father enrollment in the study and (2) father participation in the intervention. Results indicated that higher levels of maternal education and lower levels of economic stress and interparental conflict were associated with increased father enrollment in the study. Rates of father participation in the intervention were higher among families characterized by lower levels of interparental conflict, economic stress, and Spanish language use. Results highlight the relevancy of the familial and environmental context to MO fathers' research participation decisions. These findings as well as their implications for future research and practice are discussed.
Collapse
Affiliation(s)
- Jessie J Wong
- Department of Psychology, Arizona State University, Tempe, AZ
| | | | | | | | | |
Collapse
|
46
|
Deardorff J, Cham H, Gonzales NA, White RMB, Tein JY, Wong JJ, Roosa MW. Pubertal timing and Mexican-origin girls' internalizing and externalizing symptoms: the influence of harsh parenting. Dev Psychol 2012; 49:1790-804. [PMID: 23231686 DOI: 10.1037/a0031016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early-maturing girls are at risk for internalizing and externalizing problems. Research concerning pubertal timing and mental health among Mexican Americans or the influence of parenting behaviors on these relations has been scarce. This study addressed these gaps. This was a prospective examination of 362 Mexican-origin girls and their mothers in 3 waves of data. Measures included girls' self-report of pubertal development and girls' and mothers' report of maternal harsh parenting and daughters' mental health. Using structural equation modeling, we examined whether pubertal timing in 5th grade predicted girls' internalizing and externalizing outcomes in 10th grade. We also examined the mediating and moderating effects of harsh parenting on the relations between pubertal timing and internalizing and externalizing behaviors, as well as the influence of mothers' and daughters' nativity on these relations. Results differed depending on reporter and maternal nativity. Using daughters' report, we found that Mexican American mothers' harsh parenting acted as a moderator. At high levels of harsh parenting, early pubertal timing predicted higher externalizing scores, while at low levels of harsh parenting, early timing predicted lower externalizing scores. For Mexican immigrant mothers, harsh parenting mediated the effects of pubertal timing on girls' internalizing and externalizing problems. There were no significant pubertal effects for mothers' report. Findings suggest that maternal harsh parenting plays a key role in the relations between early pubertal timing and behavioral and emotional outcomes among Mexican-origin girls.
Collapse
Affiliation(s)
- Julianna Deardorff
- Community Health and Human Development, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
Umaña-Taylor AJ, Wong JJ, Gonzales NA, Dumka LE. Ethnic identity and gender as moderators of the association between discrimination and academic adjustment among Mexican-origin adolescents. J Adolesc 2011; 35:773-86. [PMID: 22152761 DOI: 10.1016/j.adolescence.2011.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 11/11/2011] [Accepted: 11/12/2011] [Indexed: 12/28/2022]
Abstract
Existing work has identified perceived discrimination as a risk factor that may contribute to the relatively poorer academic outcomes exhibited by Mexican-origin adolescents in the U.S. The current study examined the longitudinal associations among perceived discrimination and three indices of adolescent adjustment in the school setting (i.e., grade point average, teacher reports of externalizing, adolescents' deviant peer associations) among 178 Mexican-origin adolescents (53% female). Ethnic identity affirmation was examined as a protective factor expected to reduce the negative effects of discrimination on adolescents' adjustment, and gender was examined as a potential moderator of the associations of interest. Findings indicated that the deleterious effects of discrimination on adolescents' adjustment in school were particularly salient for Mexican-origin male adolescents. Importantly, ethnic identity affirmation emerged as a protective factor for Mexican-origin male adolescents by buffering the negative effects of discrimination on their externalizing behaviors in school.
Collapse
Affiliation(s)
- Adriana J Umaña-Taylor
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287-3701, USA.
| | | | | | | |
Collapse
|
48
|
Gonzales NA, Dumka LE, Millsap RE, Gottschall A, McClain DB, Wong JJ, Germán M, Mauricio AM, Wheeler L, Carpentier FD, Kim SY. Randomized trial of a broad preventive intervention for Mexican American adolescents. J Consult Clin Psychol 2011; 80:1-16. [PMID: 22103956 DOI: 10.1037/a0026063] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This randomized trial of a family-focused preventive intervention for Mexican American (MA) adolescents evaluated intervention effects on adolescent substance use, internalizing and externalizing symptoms, and school discipline and grade records in 8th grade, 1 year after completion of the intervention. The study also examined hypothesized mediators and moderators of intervention effects. METHOD Stratified by language of program delivery (English vs. Spanish), the trial included a sample of 516 MA adolescents (50.8% female; M = 12.3 years, SD = 0.54) and at least one caregiver that were randomized to receive a low-dosage control group workshop or the 9-week group intervention that included parenting, adolescent coping, and conjoint family sessions. RESULTS Positive program effects were found on all 5 outcomes at 1-year posttest but varied depending on whether adolescents, parents, or teachers reported on the outcome. Intervention effects were mediated by posttest changes in effective parenting, adolescent coping efficacy, adolescent school engagement, and family cohesion. The majority of intervention effects were moderated by language, with a larger number of significant effects for families who participated in Spanish. Intervention effects also were moderated by baseline levels of mediators and outcomes, with the majority showing stronger effects for families with poorer functioning at baseline. CONCLUSION Findings not only support the efficacy of the intervention to decrease multiple problem outcomes for MA adolescents but also demonstrate differential effects for parents and adolescents receiving the intervention in Spanish vs. English, and depending on their baseline levels of functioning.
Collapse
Affiliation(s)
- Nancy A Gonzales
- Department of Psychology and Prevention Research Center,Arizona State University, Tempe, AZ 85287-1104, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Wong JJ, Wong CYC. Non-contact infrared thermal imagers for mass fever screening--state of the art or myth? Hong Kong Med J 2006; 12:242-4. [PMID: 16760559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
|
50
|
Wong JJ. Advent of recombinant human growth hormone to increase final adult height of the normal child. Hong Kong Med J 2003; 9:468-70. [PMID: 14660817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- J J Wong
- Chelsea and Westminster Hospital, London, United Kingdom
| |
Collapse
|