Clinical characteristics of individuals with serious mental illness and type 2 diabetes.

Objective: Data from 157 individuals with serious mental illness and comorbid diabetes enrolled in an ongoing treatment study were used to examine clinical correlates of diabetes control.

Methods: Factors assessed included depressive symptoms (Montgomery-Åsberg Depression Rating Scale), global psychopathology severity (Brief Psychiatric Rating Scale), and glycosylated hemoglobin (HbA1c), a biomarker of diabetes control.

Results: Seventy-seven participants had depression, 40 had schizophrenia, and 40 had bipolar disorder.

Are trends in the proportions of non-medically indicated inductions different by Medicaid status?

Objective: To determine whether Medicaid status influenced the effect of a quality improvement effort.

Study Design: Using a data set consisting of the 2006 to 2010 vital statistics data linked with Medicaid status data, we identified non-medically indicated inductions between 36 0/7 and 38 6/7 weeks gestational age and compared rates of non-medically indicated inductions between women with Medicaid and all other payers. We also compared these rates in hospitals that did and did not participate in the Ohio Perinatal Quality Collaborative (OPQC).

Stroke recovery and prevention barriers among young african-american men: potential avenues to reduce health disparities.

Background: African Americans (AAs) who experience a first time stroke are younger and have double the stroke rate and more poststroke complications than other Americans.

Objective: To assess perceived poststroke care barriers among younger AA men and their care partners (CPs) in order to inform the development of acceptable and effective improvements in poststroke care for this high-risk group.

Methods: Ten community-dwelling AA stroke survivors and 7 of their CPs participated in focus groups and advisory board meetings.

Disentangling Multiple Sclerosis and depression: an adjusted depression screening score for patient-centered care.

Screening for depression can be challenging in Multiple Sclerosis (MS) patients due to the overlap of depressive symptoms with other symptoms, such as fatigue, cognitive impairment and functional impairment, for MS patients. The aim of this study was to understand these overlapping symptoms and subsequently develop an adjusted depression screening tool for better clinical assessment of depressive symptoms in MS patients. We evaluated 3,507 MS patients with a self-reported depression screening (PHQ-9) score using a multiple indicator multiple cause modeling approach.

Effectiveness and safety of patient activation interventions for adults with type 2 diabetes: systematic review, meta-analysis, and meta-regression.

Background: Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control.

Methods: Electronic databases were searched from inception through November 2011.

Training peer educators to promote self-management skills in people with serious mental illness (SMI) and diabetes (DM) in a primary health care setting.

Aim: To describe the training and participant experience of patients with both severe mental illness (SMI) and diabetes (DM) who were enrolled in a Peer Educator Training Program adapted to a primary health care setting.

Background: The mortality of patients with both SMI and DM is high. Illness self-management includes medications, psychosocial treatments, and healthy behaviors, yet treatment engagement is often sub-optimal with adherence rates of 52% for diabetic medications and 62% for antipsychotic medications among the SMI.

Risk factors for contact lens-induced papillary conjunctivitis associated with silicone hydrogel contact lens wear.

Background: Contact lens-induced papillary conjunctivitis (CLPC) continues to be a major cause of dropout during extended wear of contact lenses. This retrospective study explores risk factors for the development of CLPC during extended wear of silicone hydrogel lenses.

Methods: Data from 205 subjects enrolled in the Longitudinal Analysis of Silicone Hydrogel Contact Lens study wearing lotrafilcon A silicone hydrogel lenses for up to 30 days of continuous wear were used to determine risk factors for CLPC in this secondary analysis of the main cohort.

Neighborhood racial residential segregation and changes in health or death among older adults.

We assessed relationships between neighborhood racial residential segregation (RRS), individual-level health declines and mortality using Health and Retirement Study data. We calculated the census-tract level Location Quotient for Racial Residential Segregation (LQRRS), and estimated adjusted relative risks (ARR) of LQRRS for declines in self-reported health or death 1992-2000, controlling for individual-level characteristics. Of 6653 adults, 3333 lived in minimal, 2242 in low, 562 in moderate, and 516 in high LQRRS tracts in 1992.

Abnormal Left Ventricular Filling and Postoperative Atrial Fibrillation After Cardiac Surgery.

Diastolic dysfunction has been associated with the development of atrial fibrillation (AF) in the community and recently in the postoperative setting. We hypothesized that abnormal left ventricular filling predicts AF after cardiac surgery, a common marker of poor outcomes. Cohort study of 233 consecutive patients, who underwent coronary artery bypass grafting (CABG) and/or valve surgery.

Impact of non-clinical factors on primary cesarean deliveries.

The patient characteristics that influence cesarean rates are well known. However, there are many non clinical factors that also influence cesarean rates. Understanding these non clinical factors and how they can be changed to improve care is an important part of obstetrics.

Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results.

In this article we describe how patients assign meanings to medical test results and use these meanings to justify their actions. Evidence is presented from lay interpretations of medical tests for monitoring hepatitis C viral infection (HCV) to show how numeracy becomes embodied in the absence of physical symptoms. Illness narratives from 307 individuals infected with HCV were collected from the internet and analysed qualitatively.

Changes in the indications for scheduled births to reduce nonmedically indicated deliveries occurring before 39 weeks of gestation.

Objective: To estimate the change in indications for scheduled deliveries during the Ohio Perinatal Quality Collaborative's initiative to decrease scheduled deliveries for nonmedical indications before 39 weeks of gestation.

Methods: Documented indications for scheduled deliveries between 36 0/7 and 38 6/7 weeks were categorized as: strong medically accepted reasons for delivery; intermediate acceptability; and unnecessary before 39 weeks. We describe each of these indication categories as a proportion of all deliveries in the participating hospitals between October 2008 and December 2009.

Clinical outcomes after bariatric surgery: a five-year matched cohort analysis in seven US states.

Background: Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery.

Methods: Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery.

Psychosocial correlates of alcohol use and reduction for individuals with hepatitis C.

Objective: Patients with hepatitis C virus (HCV) are advised to refrain from alcohol consumption. A questionnaire was developed to measure concepts associated with alcohol use for individuals with HCV.

Method: Subjects with HCV (N = 527) completed a telephone survey.

Measuring disparities: bias in the Short Form-36v2 among Spanish-speaking medical patients.

Background: Many national surveys have found substantial differences in self-reported overall health between Spanish-speaking Hispanics and other racial/ethnic groups. However, because cultural and language differences may create measurement bias, it is unclear whether observed differences in self-reported overall health reflect true differences in health.

Objectives: This study uses a cross-sectional survey to investigate psychometric properties of the Short Form-36v2 for subjects across 4 racial/ethnic and language groups.

Rates of labor induction without medical indication are overestimated when derived from birth certificate data.

Objective: The purpose of this study was to determine the rates of late preterm inductions without a medical indication from birth certificate data and to compare them with rates that were obtained from medical charts.

Study Design: The Ohio Perinatal Quality Collaborative, which comprises 20 hospitals in Ohio that came together in 2008 for the purpose of decreasing nonmedically indicated scheduled deliveries, abstracted data on all scheduled births between 36 weeks and 38 weeks 6 days of gestation. We compared labor inductions with "elective" documented or no indication documented in charts to birth certificate data for inductions with no maternal or fetal complications recorded.

Trends in and patterns of obesity reduction medication use in an insured cohort.

Several prescription medications are approved to treat obesity, yet little is known about their use in the United States. Our objective was to describe recent trends and patterns of obesity reduction medication use in an insured US population. From among ~4.

Trends in the rehabilitation therapist workforce in underserved areas: 1980-2000.

Context: There is little information about how increases in the rehabilitation therapist workforce have been distributed over the nation. There is evidence that rural areas continue to face a shortage of trained rehabilitation providers. There has also been little attention to therapist distribution in non-rural settings where health professionals are in short supply.

Communicating about alcohol consumption to nonharmful drinkers with Hepatitis C: patient and provider perspectives.

Background: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C(HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not bea problem in the absence of their HCV diagnosis.

Electronic medical record-assisted design of a cluster-randomized trial to improve diabetes care and outcomes.

Background: Electronic medical records (EMRs) have the potential to facilitate the design of large cluster-randomized trials (CRTs).

Objective: To describe the design of a CRT of clinical decision support to improve diabetes care and outcomes.

Methods: In the Diabetes Improvement Group-Intervention Trial (DIG-IT), we identified and balanced preassignment characteristics of 12,675 diabetic patients cared for by 147 physicians in 24 practices of 2 systems using the same vendor's EMR.

Communicating about alcohol consumption to nonharmful drinkers with hepatitis C: patient and provider perspectives.

Background: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis.

Repeated hematocrit measurements in low-risk pregnant women.

Objective: To determine the incidence of anemia in the third trimester among women with normal hematocrits early in pregnancy.

Study Design: Low-risk women seeking prenatal care were identified. Patients with a hematocrit >33% in the first or second trimester and a hematocrit drawn in the third trimester were included.

Efficacy studies of malaria treatments in Africa: efficient estimation with missing indicators of failure.

The effect of missing data in causal inference problems is widely recognized. In malaria drug efficacy studies, it is often difficult to distinguish between new and old infections after treatment, resulting in indeterminate outcomes. Methods that adjust for possible bias from missing data include a variety of imputation procedures (extreme case analysis, hot-deck, single and multiple imputation), weighting methods, and likelihood based methods (data augmentation, EM procedures and their extensions).