Purpose Underestimating one’s weight is often seen as a barrier to weight loss. However, recent research has shown that weight under-perception may be beneficial, with lower future weight gain and fewer depressive symptoms. Here, we examine the relationship between adolescent weight under-perception and future blood pressure. Methods Using data from the National Longitudinal Study of Adolescent to Adult Health, we obtained a nationally representative sample of 2463 adolescents with overweight and obesity (students in grades 8–12 in 1996). We used multivariable linear regression to prospectively examine the relationship between weight self-perception in adolescence and blood pressure in adulthood (year 2008; follow-up rate 80.3%), controlling for age, gender, race/ethnicity, smoking, alcohol consumption, education level, household income, and BMI. Additional analyses were stratified by gender and race/ethnicity. Results Youth with overweight/obesity who under-perceived their weight had lower blood pressure in adulthood than those who perceived themselves to be overweight. The decrease in systolic blood pressure was −2.5 mmHg (95% CI:−4.3,−0.7; p=0.006). Although the interaction by gender was statistically insignificant (p=0.289), important differences appeared upon stratification by gender. Young men showed no significant difference in adult blood pressure related to weight self-perception. Conversely, in young women, weight under-perception was associated with an average decrease in systolic blood pressure of −4.3 mmHg (95% CI:−7.0,−1.7; p=0.002). Conclusions Contrary to conventional wisdom, weight under-perception is associated with improved health markers in young women. The observed differences in blood pressure are clinically relevant in magnitude, and interventions to correct weight under-perception should be re-examined for unintended consequences.
IMPORTANCE More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. OBJECTIVE To investigate the association between Medicaid home care services and family caregivers' health. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate withinperson changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age Ն21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020. EXPOSURES New onset of regular (Ն1 time per month) Medicaid home care in the household.MAIN OUTCOMES AND MEASURES Self-rated mental and physical health (planned prior to beginning the study). RESULTSThe study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, −0.06 to 0.06; P = .99). CONCLUSIONS AND RELEVANCEIn this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.
A quarter of patients with type 2 diabetes (T2D) use insulin, yet most remain under treated. The shortcoming of the therapy stems from its dynamic nature which necessitate frequent dosage titration. In reality, current overburdened health-care systems fall short of time to delivering sufficient insulin titrations. The d-Nav® Insulin Guidance Service overcomes this barrier. d-Nav is a handheld device that automatically titrates insulin dosage at least weekly, based on glucose readings that the patient is already scheduled to take with the d-Nav. Additionally, the service includes dedicated support of care specialists. We enrolled 181 sub-optimally controlled T2D patients to a multicenter, 1:1 randomized control trial to assess the effectiveness and safety of the d-Nav service compared to close follow-up of diabetes specialists. Both groups received 7 interactions in the 6-month study. d-Nav group: automatic titrations occurred 1±0.2 times per week (see Figure.); A1c reduction 8.7±0.8% to 7.7±1.0%; 94.6% retention; high-level of satisfaction and comfort; minor hypoglycemia (<55mg/dl) 0.3±0.6/month. Control: A1c reduction 8.5±0.8% to 8.2±0.9% (p<0.0001 between groups). Severe hypoglycemia: statistically similar and low. Expansion of supervised automated insulin titrations is feasible as long as it is simple to use by the patient and it does not increase providers’ burden. It may lead to a sizable reduction in complications and costs. Disclosure I. Hodish: Stock/Shareholder; Self; Hygieia. R.M. Bergenstal: Research Support; Self; Johnson & Johnson Services, Inc.. Consultant; Self; Johnson & Johnson Services, Inc.. Research Support; Self; Abbott. Advisory Panel; Self; Abbott. Research Support; Self; Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Takeda Pharmaceuticals U.S.A., Inc., Dexcom, Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Research Support; Self; Eli Lilly and Company, Sanofi. Advisory Panel; Self; Sanofi, Roche Pharma. Research Support; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Medtronic. Consultant; Self; Medtronic. Research Support; Self; Hygieia. Advisory Panel; Self; Hygieia, Glooko, Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. M.L. Johnson: Research Support; Self; Calibra Medical, Medtronic, Sanofi, Novo Nordisk Inc., Abbott, POPS! Diabetes Care, National Institute of Diabetes and Digestive and Kidney Diseases, Dexcom, Inc., Hygieia, JDRF. R.A. Passi: Research Support; Self; Novo Nordisk Inc., Bristol-Myers Squibb Company, Hygieia, Amylin Pharmaceuticals, Medtronic, Calibra Medical, JAEB Center For Health Research, Boehringer Ingelheim Pharmaceuticals, Inc., National Institutes of Health, JDRF, Abbott, POPS Diabetes Care, Dexcom, Inc.. A. Bhargava: None. N. Young: None. D.F. Kruger: Research Support; Self; Dexcom, Inc.. Speaker's Bureau; Self; Dexcom, Inc.. Stock/Shareholder; Self; Dexcom, Inc.. Consultant; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Intarcia Therapeutics, Inc., Abbott. Research Support; Self; Sanofi. Consultant; Self; Sanofi. Research Support; Self; JAEB Center For Health Research. Consultant; Self; Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Research Support; Self; Hygieia, Lexicon Pharmaceuticals, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Valeritas, Inc., Insulet Corporation. Consultant; Self; Insulet Corporation. Research Support; Self; Insulet Corporation. Consultant; Self; Merck & Co., Inc.. A. Hailey: None. E. Unger: Employee; Self; Hygieia. E. Bashan: Employee; Self; Hygieia.
Objective: To ascertain the impact of Affordable Care Act (ACA) state Medicaid expansion on human papillomavirus (HPV) vaccination among both adolescent and young adult US women. Data Sources:We used state-level data on ACA Medicaid expansion and individuallevel data on US women aged 15-25 years living at or below 138% of the Federal
Improved glycemic control in patients with type 2 diabetes (T2D) is associated with avoidance of complications and reduced healthcare costs. Yet for decades, most patients have not achieved treatment goals and a third have A1>9%. The d-Nav® Insulin Guidance Service facilitates scalable attainment and maintenance of therapy goals without increasing provider burden. d-Nav is a handheld device that automatically titrates insulin dosage based on the patient’s glucose readings obtained using the d-Nav device. Additionally, the service includes dedicated support of care specialists and pharmacological optimization if A1c improves. This 9-month study assessed the financial impact of the d-Nav service on diabetes related costs in sub-optimally control patients with T2D. We enrolled 218 insulin-treated patients, 193 of whom completed the 3-month follow-up. Thus far, 156 have completed the study. See Figure for A1c changes and patient satisfaction. Furthermore, 88% have chosen to enroll in a 12-month extension. Direct savings was estimated at $6,172 per patient per year (PPPY) for patients using branded medications and $1,736 PPPY across the entire cohort (p<0.001). Given the simplicity of use for the patient and no added provider burden, expansion of such a service may lead to a sizable reduction in cost. Disclosure I. Hodish: Stock/Shareholder; Self; Hygieia. S.G. Bisgaier: Employee; Self; Hygieia. E. Unger: Employee; Self; Hygieia. M.M. Austin: None.
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