Our results demonstrated that early conservative intervention for breast cancer patients high risk for BCRL who were prospectively monitored by utilizing BIS significantly lowers rates of BCRL. These findings support early prospective screening and intervention for BCRL. Early detection with patient-directed interventions improves patient outcomes and decreases the risk of persistent BCRL.
Background
Hearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health.
Methods
A self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged > 18 years (
n
= 6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes.
Results
Approximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from “a little trouble hearing” to being “deaf.” Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR = 0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (β = 2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant.
Conclusions
Self-reported hearing difficulty was associated with report of increased confusion and memory loss and poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.
There are currently 2 versions of the Brief Addiction Monitor (BAM) being widely used within Department of Veterans Affairs (VA) medical centers and other treatment settings: the BAM, which entails use of discrete response options for all items, and the revised version, the BAM-R, which consists of the same items but uses continuous response options for several of the items. There is also conflicting evidence about the factor structure of the original BAM, with a 4-factor structure proposed by 1 study that refutes a 3-factor structure proposed from the original study of the measure. The BAM-R is widely administered in substance use treatment settings across the country and is overtaking the discrete BAM as the preferred instrument, although little research has examined the factor structure or longitudinal performance of this version of the measure. The purpose of this study is to examine the factor structure and temporal stability of the BAM-R among a large national sample of veterans across multiple treatment settings (i.e., all VA veterans with at least 2 complete BAM-R administrations reflected in the medical record; N ϭ 22,453). Findings suggest that the 4-factor structure is superior to the commonly used 3-factor structure for both model fit and stability over two occasions of measurement and should be the factor structure used for clinical and research purposes pending further measure revisions.
Public Significance StatementA widely used assessment in substance use disorder treatment settings, the Brief Addiction Monitor (BAM), has 2 versions: the BAM and the BAM-R. In this study, we demonstrate that the original 3-factor structure of the BAM does not fit the data from the BAM-R as well as does an alternative 4-factor structure, and we discuss implications for future research and clinical use of the BAM-R.
Objective: Type 2 diabetes mellitus is a growing epidemic in the United States. In 2015 alone, it affected 30.2 million people. Additionally, the cost of managing type 2 diabetes continues to rise. This condition requires long-term management, and the out-of-pocket costs for type 2 diabetes are not well-characterized. The objective of this study was to understand the magnitude of out-of-pocket costs for type 2 diabetes.
Methods: We identified studies in the PubMed databank that were published between 2000 and 2017. From these studies, we examined the amount spent on out-of-pocket costs by type 2 diabetes patients.
Results: Across the ten studies examined, we found a cost range of $143 per year to $2210 per year, a mean cost of $2063 per year, and a median cost of $435 per year. There is a wide range in cost of out-of-pocket costs for people with diabetes.
Conclusion: Clearly, there is not a consistent cost measurement through all of the studies. Some of the variation is accounted for by different definitions of out-of-pocket cost across the studies. To help better inform patients and healthcare policy decision-makers accurately assessing out-of-pocket cost per year in patients with diabetes, there needs to be a consistent definition of out-of-pocket costs, as well as a consistent way to measure out-of-pocket costs.
Disclosure
C. Davis: None. E. Burgen: None. G.J. Chen: None.
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