Sandra J. Gonzalez

Clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care

AIMS Type 2 diabetes mellitus (T2DM) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. Not much is known about the impact of Clostridium difficile infection (CDI) on health outcomes in hospitalized patients with T2DM. We estimated the prevalence and temporal trends of CDI; evaluated the associations between CDI and in-hospital mortality, length of stay (LOS), and the costs of inpatient care; and compared the impact of CDI with that of other infections commonly seen in patients with T2DM. METHODS We conducted a cross-sectional analysis using data from the Nationwide Inpatient Sample among patients ⩾18years with T2DM and generalized linear regression was used to analyze associations and jointpoint regression for trends. RESULTS The prevalence of CDI was 6.8 per 1000 hospital discharges. Patients with T2DM and CDI had increased odds of in-hospital mortality (OR, 3.63; 95% CI 3.16, 4.17). The adjusted mean LOS was higher in patients with CDI than without CDI (11.9 vs. 4.7days). That translated to average hospital costs of

Substance Use Issues Among the Underserved: United States and International Perspectives

23,000 and

Multimorbidity is associated with increased rates of depression in patients hospitalized with diabetes mellitus in the United States

9100 for patients with and without CDI, respectively. The adjusted risk of mortality in patients who had CDI alone (OR 3.75; 95% CI 3.18, 4.41) was similar to patients who had CDI in addition to other common infections (OR 3.25; 95% CI 2.58, 4.10). CONCLUSION CDI is independently associated with poorer health outcomes in patients with T2DM. We recommend close surveillance for CDI in hospitalized patients and further studies to determine the cost effectiveness of screening for CDI among patients with T2DM.

Primary and secondary prevention of colorectal cancer: An evidence-based review

Substance use affects people of all ages, cultures, and socioeconomic levels. Most underserved populations have lower rates of substance use than the general population in a given society, excluding tobacco use. The impact of substance use is more severe, however, in the underserved, with higher rates of incarceration, job loss, morbidity, and mortality. Innovative solutions are being developed to address these differences. Working together, underserved patients with substance use problems can be helped on their journeys toward health and wholeness.

SBI and EHR: understanding, adoption, and implementation in family medicine clinics

AIMS Information on the burden and risk factors for diabetes-depression comorbidity in the US is sparse. We used data from the largest all-payer, nationally-representative inpatient database in the US to estimate the prevalence, temporal trends, and risk factors for comorbid depression among adult diabetic inpatients. METHODS We conducted a retrospective analysis using the 2002-2014 Nationwide Inpatient Sample databases. Depression and other comorbidities were identified using ICD-9-CM codes. Logistic regression was used to investigate the association between patient characteristics and depression. RESULTS The rate of depression among patients with type 2 diabetes increased from 7.6% in 2002 to 15.4% in 2014, while for type 1 diabetes the rate increased from 8.7% in 2002 to 19.6% in 2014. The highest rates of depression were observed among females, non-Hispanic whites, younger patients, and patients with five or more chronic comorbidities. CONCLUSIONS The prevalence of comorbid depression among diabetic inpatients in the US is increasing rapidly. Although some portion of this increase could be explained by the rising prevalence of multimorbidity, increased awareness and likelihood of diagnosis of comorbid depression by physicians and better documentation as a result of the increased adoption of electronic health records likely contributed to this trend.

Temporal trends in colorectal cancer incidence among Asian American populations in the United States, 1994–2013

Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

Background Alcohol screening and brief intervention (SBI) programs have been shown to be effective in reducing risky alcohol consumption among primary care patients [1-3]. Although various implementation protocols exist, it can be difficult to launch and sustain SBI programs. A number of barriers exist, including those related to clinical workflow, the intake process, and the incorporation of protocols into electronic health records (EHR)[4-6]. This study aims to present challenges and potential solutions to incorporating SBI as a standard of care into an existing EHR of a family medicine system. Material and methods An SBI program was piloted in two underserved family medicine clinical teaching practices. Physicians, residents, nurses, medical assistants and patient service representatives (PSR’s) were trained on the protocol for adopting this practice into daily clinic work. Through this implementation, an EHR template was created to complement the workflow.

Parenting style and perceptions of children’s weight among US Hispanics: a qualitative analysis

Objective To investigate the incidence and trends in colorectal cancer (CRC) among Asian American populations in the United States. Methods CRC incidence data from 1994 through 2013 were obtained from 13 Surveillance, Epidemiology, and End Results registries. SEER*Stat and IBM SPSS Statistics were used. Results The age-adjusted incidence of CRC among Asian Americans decreased from 45.6 per 100,000 in 1994 to 33.0 per 100,000 in 2013, with the annual percent change being −1.8% (P<0.05). The incidences were higher for men, the elderly (aged 60 years or older), and several geographic areas. For those younger than 70 years, the rectal site was more affected compared with those aged 70 years or older, in whom the proximal site were more affected. Most patients presented with localized and regional stages. Men, 80 years or older, in situ stage, and some geographic areas such as Connecticut and California experienced significant incidence decreases in the 20-year observation period. Conclusion Although CRC incidence has declined among Asian American populations in the United States in the past 2 decades, there are persistent differences by age and geographic areas. Further research is needed to guide the design and implementation of tailored strategies to reduce CRC outcome differences across Asian American populations.

Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice

The reciprocal relationship between mental and physical health is well established. Undiagnosed, untreated, and poorly managed mental health conditions are associated with numerous physical health complications, poor treatment adherence, and decreased quality of life. Despite growing evidence regarding the importance of effectively addressing these conditions in primary care, the rates of identification remain low and follow-up and management by primary care providers has been criticized. The objective of this review was to demonstrate the role of Patient-Centered Medical Home (PCMH) and mental health integration in addressing comprehensive health care needs in primary care patients, and to describe common barriers and facilitators to the implementation of these types of programs.