Undiagnosed diabetes based on HbA1c by socioeconomic status and healthcare consumption in the Tromsø Study 1994–2016

IntroductionWe aimed to investigate whether the proportion of undiagnosed diabetes varies by socioeconomic status and healthcare consumption, in a Norwegian population screened with glycated hemoglobin (HbA1c).Research design and methodsIn this cohort study, we studied age-standardized diabetes prevalence using data from men and women aged 40–89 years participating in four surveys of the Tromsø Study with available data on HbA1c and self-reported diabetes: 1994–1995 (n=6720), 2001 (n=5831), 2007–2008 (n=11 987), and 2015–2016 (n=20 170). We defined undiagnosed diabetes as HbA1c ≥6.5% (48 mmol/mol) and no self-reported diabetes. We studied the association of education, income and contact with a general practitioner on undiagnosed diabetes and estimated adjusted prevalence ratio (aPR) from multivariable adjusted (age, sex, body mass index) log-binomial regression.ResultsHigher education was associated with lower prevalence of diagnosed and undiagnosed diabetes. Those with secondary and tertiary education had lower prevalence of undiagnosed diabetes (aPR for tertiary vs primary: 0.54, 95% CI: 0.44 to 0.66). Undiagnosed as a proportion of all diabetes was also significantly lower in those with tertiary education (aPR:0.78, 95% CI: 0.65 to 0.93). Household income was also negatively associated with prevalence of undiagnosed diabetes. Across the surveys, approximately 80% of those with undiagnosed diabetes had been in contact with a general practitioner the last year, similar to those without diabetes.ConclusionsUndiagnosed diabetes was lower among participants with higher education. The hypothesis that those with undiagnosed diabetes had been less in contact with a general practitioner was not supported.

The influence of social determinants on healthcare consumption in women

Noncommunicable diseases provide a significant impact on global health. Information about the factors influencing the noncommunicable morbidity and the need for medical care is important for forecasting need and distribution of healthcare resources. The article presents the results of a study dealing with the relationship between social determinants of health and acute conditions requiring medical care in women. Social determinants including the standard hierarchy of values and the level of education (high school) influence on individual self-assessment of health and are associated with lower need for medical care due to acute non-communicable diseases. The graph method was used for the study and can be proposed for further investigation of the influence of social determinants on the need for medical care.

Understanding the Abrupt Effect of Spousal Bereavement on Mortality: an Application of Complex Dynamic Systems Theory

BackgroundThe process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition.MethodsUsing longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators ‘average’, ‘slope’, ‘mean squared error’, and ‘lag-1 autocorrelation’ one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis and the added value for mortality prediction was estimated by the time dependent area under the receiver operating characteristic curve.ResultsThe study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Values of all dynamic indicators were significantly higher with increasing age, in men compared to women, and except lag-1 autocorrelation, higher in the year after bereavement (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The area under the curve of the final model to predict mortality, including all relevant indicators, was 77.7% for males and it was 81.8% for females.ConclusionsIt is concluded that healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women. High values of these dynamic indicators before bereavement indicate loss of resilience as manifested by their predictive value to predict mortality when mourning after spousal loss.

Patients with tinnitus use more primary healthcare compared to people without tinnitus

Tinnitus is a heterogeneous condition not only in terms of nature of the sound, but also in co-morbidities such as mental health issues. Prevalence number range widely between 5 and 43%. Even though the etiologic pathway between tinnitus and its comorbidities remains unclear, in this study we aim to assess whether people with tinnitus use more primary health care than people without tinnitus. To compare primary healthcare consumption between patients with tinnitus and people without tinnitus. In this cross-sectional study, data on number of consultations with the general practitioner or nurse practitioner mental health services were obtained from Nivel (Netherlands Institute for Health Service Research) Primary Care Database in 2018 (n = 963,880 people). People with an open tinnitus episode (n = 8050) were defined as a patient with tinnitus and compared to all other people. Percentages, means, ranges and mean differences were calculated for the total number of consultations and for organ specific diagnoses registered as ICPC-1 code on the day of consultation. Secondary, the total number of referrals to medical specialists and number of drug prescriptions was collected. Logistic regressions were performed to predict having one or more contacts, referrals, and prescriptions,with having tinnitus, this was corrected for age and gender. Patients with tinnitus had a mean of 9.8 (SD 10.9) primary care consultations in 2018, compared to 5.7 (SD 7.9) for people without tinnitus. More patients with tinnitus had more than one referral to medical specialists (47%) compared to people without tinnitus (25%). Patients with tinnitus have 1.2 (mean difference) more drug prescriptions than people without tinnitus. Compared to people without tinnitus, patients with tinnitus were more likely to have one or more of primary healthcare contact, independent of age group and gender. Patients with tinnitus had more consultations in primary health care than people without tinnitus. They are more often referred to medical specialists and receive more drug prescriptions. The causal relationship between tinnitus and the higher healthcare consumption remains to be researched.

Swedish healthcare for women subjected to Female Genital Mutilation/Cutting (FGM/C)

Background: FGM/C can lead to a number of health complications, such as pain during intercourse or childbirth, psychological problems, and postpartum complications. This study seeks to describe and assess Swedish healthcare for women subjected to FGM/C.Methods: This aim encompasses three research foci: (1) to inventory Swedish regional healthcare guidelines and policies for care for women who have undergone FGM/C, (2) to map healthcare consumption among women who have undergone FGM/C, and (3) to map the type of care measures and treatment they have been offered in the Swedish healthcare system. A questionnaire was sent to healthcare regional managers and a database study was conducted.Results: The inventory of the healthcare regions' guidelines shows that five of 21 had no guidelines. The number of women who have been subjected to FGM/C and sought care has increased steadily between 2012 and 2018. Women who have been subjected to FGM/C seek care mostly in connection with pregnancy and childbirth.Conclusions: The type of care that should be offered to women who have been subjected to FGM/C vary depending on individual needs. Care may include surgical procedures in the form of defibulation, clitoral reconstruction, or removal of cysts, as well as psychosexual care. Existing treatment options in surgical care, together with psychosexual treatment, are the care measures that seem to be helpful for some women who have undergone FGM/C, but not for all. Communication and treatment are of great importance in order to be able to offer care to women who have undergone FGM/C.

A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption

Background Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment. Method The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication. Results The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs. Conclusions Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration This study has been registered with the ISRCTN: 15885573.

Evaluation of intermediate care for knee and hip osteoarthritis: a mixed-methods study

Background To evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incorporate specialist services into general practice to prevent unnecessary referrals to hospitals. Methods We used a mixed methods approach including semi-structured interviews, patient experience questionnaires and data from medical records from three intermediate care projects. Semi-structured interviews were conducted with patients, general practitioners (GPs), orthopaedists and a healthcare manager in intermediate care. Satisfaction of patients who received intermediate care (n = 100) was collected using questionnaires. Referral data and healthcare consumption from medical records were collected retrospectively from KHOA patients before (n = 96) and after (n = 208) the implementation of intermediate care. Results GPs and orthopaedists in intermediate care experienced more intensive collaboration compared to regular care. This led to a perceived increase in GPs’ knowledge enabling better selection of referrals to orthopaedics and less healthcare consumption. Orthopaedists felt a higher workload and limited access to diagnostic facilities. Patients were satisfied and experienced better access to specialists’ knowledge in a trusted environment compared to regular care. Referrals to physiotherapy increased significantly after the implementation of intermediate care (absolute difference = 15%; 95% CI = 7.19 to 22.8), but not significantly to orthopaedics (absolute difference = 5.9%; 95% CI = -6.18 to 17.9). Conclusions Orthopaedists and GPs perceived the benefits of an intensified collaboration in intermediate care. Intermediate care may contribute to high quality of care through more physiotherapy referrals. Further research with longer follow-up is needed to confirm these findings and give more insight in referrals and healthcare consumption.

Personality Variables as Predictors of Health Services Consumption

Expenditure on healthcare and services can be a serious problem for public health. Personality variables should be included as indicators to be considered when studying the consumption of health resources and their planning. This study aims to identify the psychological and psychosocial variables that identify people who can be considered high consumers of health resources versus those who barely consume such resources. The sample was made up of a total of 1124 subjects; one half were men, and one half were women, all of legal age and residents in Spain. A battery of tests was created that included a questionnaire of sociodemographic variables and of healthcare consumption, as well as several psychological variables (Zimbardo Time Paradox Inventory, Multidimensional Locus of Control Scale, Psychological Reactance Scale, Coping Responses Inventory, self-efficacy scale applied to health, and the Symptom Checklist-90-R). The following variables of the model were significant predictors (p ≤ 0.05): a negative past, a fatalistic present, psychological cognitive reactance, behavioral coping, health self-efficacy, and the level of somatization. Data from the statistical analyses show how to create a psychological profile of people who are high consumers of healthcare resources that will allow for the creation of intervention programs in this regard.