Norman Turk

Psychological distress in long‐term survivors of solid tumors diagnosed in childhood: A report from the childhood cancer survivor study

To evaluate and compare psychological distress in long‐term survivors of solid tumors diagnosed in childhood and their siblings, and to identify significant correlates of psychological distress.

Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes.

OBJECTIVE To compare drug costs and adherence among Medicare beneficiaries with the standard Part D coverage gap versus supplemental gap coverage in 2006. DATA SOURCES Pharmacy data from Medicare Advantage Prescription Drug (MAPD) plans. STUDY DESIGN Parallel analyses comparing beneficiaries aged 65+ with diabetes in an integrated MAPD with a gap versus no gap (n=28,780); and in a network-model MAPD with a gap versus generic-only coverage during the gap (n=14,984). PRINCIPAL FINDINGS Drug spending was 3 percent (95 percent confidence interval [CI]: 1-4 percent) and 4 percent (CI: 1-6 percent) lower among beneficiaries with a gap versus full or generic-only gap coverage, respectively. Out-of-pocket expenditures were 189 percent higher (CI: 185-193 percent) and adherence to three chronic drug classes was lower among those with a gap versus no gap (e.g., odds ratio=0.83, CI: 0.79-0.88, for oral diabetes drugs). Annual out-of-pocket spending was 14 percent higher (CI: 10-17 percent) for beneficiaries with a gap versus generic-only gap coverage, but levels of adherence were similar. CONCLUSIONS Among Medicare beneficiaries with diabetes, having the Part D coverage gap resulted in lower total drug costs, but higher out-of-pocket spending and worse adherence compared with having no gap. Having generic-only coverage during the gap appeared to confer limited benefits compared with having no gap coverage.

Heart rate mediation of sex differences in pain tolerance in children

&NA; Despite evidence supporting the existence of important sex‐related differences in pain, the mechanisms underpinning such differences are not well understood. The aim of this study is to examine the relationship between sex and pubertal differences in autonomic arousal and pain tolerance to laboratory pain stimuli in healthy children. We tested the following specific hypotheses: (1) females would have greater autonomic arousal and less pain tolerance than males, and (2) this sex difference in pain tolerance would be mediated by autonomic arousal. Participants were 244 healthy children (50.8% female, mean age 12.73±2.98 years, range 8–18 years). Separate 4‐trial blocks of cutaneous pressure and thermal pain stimuli were presented in counterbalanced order. Heart rate (HR) was recorded during 2–3 min periods preceding each block and a 1‐min period between trials. Results indicated lower tolerance in females for cutaneous pressure, but not thermal pain, compared to males. In addition, pre‐trial HR was greater for females than males. Mediation analyses suggested that sex differences in pressure pain tolerance were accounted for by sex differences in pre‐trial HR. There were also significant effects for puberty, but these did not vary by sex. Overall, early pubertal children had greater pre‐trial HR and less pain tolerance than those in late puberty for both cutaneous pressure and thermal pain across sex. These results suggest that autonomic arousal may be a mediator of sex‐related differences in pain responses in children.

Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self‐care?

BACKGROUND Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. OBJECTIVE To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. DATA Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. METHODS Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. RESULTS Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. DISCUSSION Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

Generic-only drug coverage in the medicare part D gap and effect on medication cost-cutting behaviors for patients with diabetes mellitus: The translating research into action for diabetes study

OBJECTIVES: To examine the association between drug coverage during the Medicare Part D coverage gap and medication cost‐cutting behaviors of beneficiaries with diabetes mellitus who use and do not use insulin.

Patterns of prescription drug expenditures and medication adherence among medicare part D beneficiaries with and without the low-income supplement

BackgroundThe association between the Medicare Part D low-income subsidy (LIS), gap coverage, and outcomes such as medical expenditures, prescription fills, and medication adherence is not well understood. The purpose of this study was to examine the relationship between the LIS and these measures for patients within a large, national Part D plan in the United States.MethodsIn this cross-sectional, retrospective analysis, we compared total and plan expenditures, out-of-pocket costs, and medication fills and adherence for three categories of Medicare beneficiaries: non-LIS beneficiaries without gap coverage (non-LIS/non-GC), non-LIS beneficiaries with gap coverage (non-LIS/GC), and LIS beneficiaries (LIS).ResultsLIS beneficiaries, relative to non-LIS/non-GC and non-LIS/GC beneficiaries, had higher total expenditures (

Evaluation of the diabetes health plan to improve diabetes care and prevention.

1,887 vs.

Association of Medicare Part D Low‐Income Cost Subsidy Program Enrollment with Increased Fill Adherence to Clopidogrel After Coronary Stent Placement

1,360 vs.

The association of a diabetes-specific health plan with ER and inpatient hospital utilization: a natural experiment for translation in diabetes (NEXT-D)

1,341); lower out-of-pocket costs (

Drug benefit changes under Medicare Advantage Part D: heterogeneous effects on pharmaceutical use and expenditures.

148 vs.