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Cost-related Nonadherence to Medication Treatment Plans: Native Hawaiian and Pacific Islander National Health Interview Survey, 2014. Med Care 2019; 56:341-349. [PMID: 29432260 DOI: 10.1097/mlr.0000000000000887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. OBJECTIVE Examine factors related to CRN to medication treatment plans within an understudied population. RESEARCH DESIGN Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults. Bonferroni-adjusted Wald test and multivariable logistic regression were performed to examine associations among financial burden-related factors, CD status, and CRN. RESULTS Across CD status, NHPI engaged in CRN behaviors had, on an average, increased levels of perceived financial stress, financial insecurity with health care, and food insecurity compared with adults in the total NHPI population. Regression analysis indicated perceived financial stress [adjusted odds ratio (AOR)=1.16; 95% confidence intervals (CI), 1.10-1.22], financial insecurity with health care (AOR=1.96; 95% CI, 1.32-2.90), and food insecurity (AOR=1.30; 95% CI, 1.06-1.61) all increase the odds of CRN among those with CD. We also found significant associations between perceived financial stress (AOR=1.15; 95% CI, 1.09-1.20), financial insecurity with health care (AOR=1.59; 95% CI, 1.19-2.12), and food insecurity (AOR=1.31; 95% CI, 1.04-1.65) and request for lower cost medication. CONCLUSIONS This study demonstrated health-related and non-health-related financial burdens can influence CRN behaviors. It is important for health care providers to collect and use data about the social determinants of health to better inform their conversations about medication adherence and prevent CRN.
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Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Hailu FB, Hjortdahl P, Moen A. Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia. Front Public Health 2018; 6:302. [PMID: 30406070 PMCID: PMC6206899 DOI: 10.3389/fpubh.2018.00302] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Unlike in developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well-studied in the African context. Thus, this study sought to determine effects of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia. Methods: Before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to a nurse-led DSME group and 104 to a treatment-as-usual (comparison) group. A nurse-led DSME with six sessions supported with illustrative pictures handbooks and fliers was customized to local conditions and delivered by trained nurses over 9 months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c ≤ 7%). We used chi-square test and mixed model analysis. Results: Seventy-eight (67%) and 64 (62%) participants assigned to intervention and comparison, respectively completed the study, and included in the final analysis. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, change in the proportion of participants with target HbA1c and end-line mean HbA1c difference between the groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg, respectively. Conclusion: After 9 months of nurse-led DSME, HbA1c was significantly reduced within both groups but there was no significant difference in HbA1c between groups. The intervention also showed some clinically significant effects on blood pressure and FBS. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway.,School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Per Hjortdahl
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
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55
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Cheng LJ, Wu VX, Dawkes S, Lim ST, Wang W. Factors influencing diet barriers among outpatients with poorly-controlled type 2 diabetes: A descriptive correlational study. Nurs Health Sci 2018; 21:102-111. [PMID: 30264523 DOI: 10.1111/nhs.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 01/06/2023]
Abstract
The aim of the present descriptive correlational study was to investigate diet barriers and their influencing factors among outpatients with poorly-controlled type 2 diabetes in Singapore. One hundred and ten patients with poorly-controlled type 2 diabetes were recruited from a tertiary hospital in Singapore. The Personal Diabetes Questionnaire and Appraisal of Diabetes Scale were used to measure the study variables. Our participants reported that the most common diet barriers were eating out, followed by food cravings. Eating problems and negative diabetes appraisal were identified as significant predictors of diet barriers. The findings laid the groundwork with preliminary findings for the development of culturally-tailored and patient-centered education programs to enhance eating behaviors and promote positive appraisal.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Vivien Xi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore
| | - Wenru Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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56
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Food Insecurity and Cardiovascular Disease Risk Factors among Mississippi Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092016. [PMID: 30223555 PMCID: PMC6165024 DOI: 10.3390/ijerph15092016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022]
Abstract
Background: Food insecurity is a public health problem. There is limited data on food insecurity in Mississippi. Methods: We analyzed data from the 2015 Mississippi Behavioral Risk Factor Surveillance System, which included the Social Context Module for 5870 respondents. Respondents who indicated that in the past 12 months they were "always", "usually", or "sometimes" "worried or stressed about having enough money to buy nutritious meals" were considered food insecure. Food insecurity was compared across sociodemographic and health characteristics using chi-square tests, and the association between food insecurity and select cardiovascular disease risk factors was assessed using logistic regression. Results: The prevalence of food insecurity was 42.9%. Compared to the referent group, Mississippi adults with high blood pressure had 51% higher odds, those with diabetes had 30% higher odds, those who were not physically active had 36% higher odds, and those who consumed fewer than five fruits and vegetables daily had 50% higher odds of being food insecure. Conclusion: Among Mississippi adults, food insecurity is associated with high blood pressure, diabetes, obesity, fruit and vegetable consumption, physical inactivity, and smoking.
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57
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Rowland B, Mayes K, Faitak B, Stephens RM, Long CR, McElfish PA. Improving Health while Alleviating Hunger: Best Practices of a Successful Hunger Relief Organization. Curr Dev Nutr 2018; 2:nzy057. [PMID: 30191200 PMCID: PMC6121129 DOI: 10.1093/cdn/nzy057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/29/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Food insecurity affects millions each year in the United States. Hunger relief organizations work to reduce hunger and food insecurity; however, the foods they provide are often unhealthy. OBJECTIVE The objective of this article is to document the policy, systems, and environmental changes that Samaritan Community Center made to their programs in order to better serve Washington County and Benton County, Arkansas. METHODS With the use of a case-study approach, researchers held 17 meetings with key members of the organization and conducted >30 h of observations to document policy, systems, and environmental changes and best practices for implementing those changes. RESULTS Researchers identified emergent themes and grouped best practices in the following categories: 1) removing stigma and empowering clients, 2) incremental steps to increase access to healthy foods, 3) embracing multiculturalism, 4) donation policies and procurement, 5) collaboration is key, 6) organizational culture, and 7) challenges and resolutions. CONCLUSIONS Samaritan Community Center has successfully implemented and adopted new programs and practices in order to improve the health of their clients. To our knowledge, this is the first case study to document best practices for making policy, systems, and environmental changes by a hunger relief organization to improve the nutritional quality of foods provided to their clients.
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Affiliation(s)
- Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | | | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - R Michael Stephens
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
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58
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Weigel MM, Armijos RX. Food Insecurity, Cardiometabolic Health, and Health Care in U.S.-Mexico Border Immigrant Adults: An Exploratory Study. J Immigr Minor Health 2018. [PMID: 30159707 DOI: 10.1007/s10903-018-0817-3+[doi]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Household food insecurity (HFI) has been linked to poorer cardiometabolic health and reduced health care access but few studies have examined these issues in the large Mexican immigrant population living on the U.S.-Mexico border. This exploratory study examined the association of HFI with cardiometabolic conditions and health care in 40-84 year urban border immigrants (n = 75). Data were collected on HFI, self-reported and clinical cardiometabolic conditions, health care sources and use. HFI affected 45% of participants. HFI was associated with self-reported and clinical diabetes but not hypertension, hyperlipidemia, obesity, or metabolic syndrome. It also was associated with increased emergency room visits and hospitalizations but not source of primary health care or preventative health care use. These findings highlight the need for additional research on the relationship of HFI with cardiometabolic health and health care in border immigrants as well as reassessment of current immigrant food security and health laws and policies.
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Affiliation(s)
- M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA.
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.,Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA
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59
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Food Insecurity, Cardiometabolic Health, and Health Care in U.S.-Mexico Border Immigrant Adults: An Exploratory Study. J Immigr Minor Health 2018. [DOI: 10.1007/s10903-018-0817-3 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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60
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Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes. Public Health Nutr 2018; 21:3237-3244. [PMID: 30088467 DOI: 10.1017/s1368980018001908] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.Design/Setting/SubjectsAdults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support. RESULTS The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=-0·54, P<0·001) and lower social support (r=-0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control. CONCLUSIONS Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.
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61
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Mellor DD, Langley-Evans S, Holt RIG. Update of Diabetes UK Evidence-Based Nutritional Guidelines for 2018: a celebration of two leading journals working together to improve nutritional science and dietetic care for people living with diabetes. J Hum Nutr Diet 2018; 31:289-291. [DOI: 10.1111/jhn.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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62
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The Effect of Self-Care on Glycated Hemoglobin and Fasting Blood Sugar Levels on Adolescents with Diabetes. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/compreped.62661] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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63
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Mellor D, Langley-Evans S, Holt RIG. Update of Diabetes UK Evidence-Based Nutritional Guidelines for 2018: a celebration of two leading journals working together to improve nutritional science and dietetic care for people living with diabetes. Diabet Med 2018; 35:539-540. [PMID: 29658193 DOI: 10.1111/dme.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D Mellor
- Journal of Human Nutrition and Dietetics, University of Canberra, ACT, Australia
| | - S Langley-Evans
- Journal of Human Nutrition and Dietetics, University of Nottingham, Nottingham, UK
| | - R I G Holt
- Diabetic Medicine, University of Southampton, Southampton, UK
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Ashe KM, Lapane KL. Food Insecurity and Obesity: Exploring the Role of Social Support. J Womens Health (Larchmt) 2018; 27:651-658. [PMID: 29182494 DOI: 10.1089/jwh.2017.6454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women are disproportionately affected by both obesity and food insecurity. Food insecurity occurs when there is limited ability to acquire adequate foods. It is unknown whether social support can reduce the effect of food insecurity on increased obesity. This study seeks to determine whether social support modifies the relationship between food insecurity and obesity. METHODS We conducted a cross-sectional study in a nationally representative sample of 4672 women aged ≥40 years using National Health and Nutrition Examination Survey (2003-2008). Individual food insecurity was assessed based on the U.S. Department of Agriculture 18-item validated household food security scale. Women were categorized as fully food secure (0 affirmative responses) or food insecure (1-10 affirmative responses). Obesity was defined as body mass index ≥30 kg/m2. Outcomes were analyzed by multivariable logistic regression. RESULTS Fourteen percent were food insecure. Women with food insecurity had 1.4 the odds of obesity as those who were fully food secure, adjusting for race/ethnicity and health status (95% confidence interval [CI] 1.22-1.62). Food-insecure women were 80% less likely to report strong social support than women who were fully food secure (95% CI 0.11-0.36). Social support as measured in this study did not modify the association between food insecurity and obesity. CONCLUSIONS Women reporting food insecurity reported lower levels of social support and were more likely to experience obesity. Interventions to reduce obesity in women who are food insecure must consider the limited resources available to these women.
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Affiliation(s)
- Karen M Ashe
- 1 Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School , Worcester, MA
| | - Kate L Lapane
- 2 Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, MA
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65
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Weaver LJ, Fasel CB. A Systematic Review of the Literature on the Relationships between Chronic Diseases and Food Insecurity. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/fns.2018.95040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mahmoodi MR, Najafipour H, Mohsenpour MA, Amiri M. The relationship between food insecurity with cardiovascular risk markers and metabolic syndrome components in patients with diabetes: A population-based study from Kerman coronary artery disease risk study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:118. [PMID: 29184576 PMCID: PMC5680660 DOI: 10.4103/jrms.jrms_12_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/16/2017] [Accepted: 07/29/2017] [Indexed: 11/17/2022]
Abstract
Background: We sought the prevalence of food insecurity and whether cardiovascular risk markers and metabolic syndrome components are significantly different in categories of food insecurity in patients with type 2 diabetes. Materials and Methods: In this cross-sectional study, 520 patients with type 2 diabetes from the Kerman coronary artery disease risk study aged between 23 and 87 years (60.8 ± 11.4) who selected by one-stage cluster sampling were assigned into four groups of “food secure” and “mild,” “moderate,” and “severe” food insecure. Household food insecurity was assessed by a 9-item household food insecurity access scale questionnaire. Results: The prevalence of food security and mild, moderate, and severe food insecurity in patients with diabetes was 24.4%, 33.1%, 28.9%, and 13.6%, respectively. There was a significant difference among the food-secure/insecure sex groups (P = 0.001). The prevalence of food insecurity and risk factors such as total cholesterol, high low-density lipoprotein cholesterol, and visceral obesity in mild food-insecure females was significantly higher than males (P < 0.001, 0.001, and 0.001, respectively). The fasting blood sugar significantly increased (P = 0.020) in diabetic females with food security than the other female groups. Diastolic blood pressure significantly increased (P = 0.028) in diabetic females with severe food insecurity than the other female groups. The glycosylated hemoglobin significantly increased (P = 0.013) in diabetic males with severe food insecurity than the other male groups. Food insecurity odds ratio in females was 1.74 (95% confidence interval [CI]: 1.10–2.70), 2.39 (95% CI: 1.48–3.88), and 2.73 (95% CI: 1.49–5.01) times higher than in males for mild, moderate, and severe food insecurity, respectively. Conclusion: Food insecurity may deteriorate some cardiometabolic biomarkers in type 2 diabetes. Improving food security in patients with diabetes may help reduce cardiovascular disease.
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Affiliation(s)
- Mohammad Reza Mahmoodi
- Department of Nutrition, Cardiovascular Research Center, Institute of Basic and Clinical Physiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Najafipour
- Physiology Research Center, Institute of Basic and Clinical Physiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Mohsenpour
- Department of Nutrition, Nutrition and Food Security Research Center, International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojgan Amiri
- Department of Nutrition, Nutrition and Food Security Research Center, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes: Findings From the National Health Interview Survey. Med Care 2017; 54:796-803. [PMID: 27219636 DOI: 10.1097/mlr.0000000000000565] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non-health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN. METHODS Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN. RESULTS Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05-1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5-1.67), and food insecurity (PR=1.30; 95% CI, 1.2-1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2-0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. CONCLUSIONS Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
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68
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McBrien KA, Naugler C, Ivers N, Weaver RG, Campbell D, Desveaux L, Hemmelgarn BR, Edwards AL, Saad N, Nicholas D, Manns BJ. Barriers to care in patients with diabetes and poor glycemic control-A cross-sectional survey. PLoS One 2017; 12:e0176135. [PMID: 28459820 PMCID: PMC5411045 DOI: 10.1371/journal.pone.0176135] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/05/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS To determine and quantify the prevalence of patient, provider and system level barriers to achieving diabetes care goals; and to examine whether barriers were different for people with poor glycemic control (HbA1c ≥ 10%; 86 mmol/mol) compared to fair glycemic control (7 to <8%; 53-64 mmol/mol). METHODS We administered a survey by telephone to community-dwelling patients with diabetes, to examine patient-reported barriers and facilitators to care. We compared responses in individuals with HbA1c ≥ 10% (86 mmol/mol) against those with HbA1c between 7-8% (53-64 mmol/mol). We examined associations between HbA1c group and barriers to care, adjusting for sociodemographic factors and diabetes duration. RESULTS The survey included 805 people with HbA1c ≥ 10% (86 mmol/mol), and 405 people with HbA1c 7-8% (53-64 mmol/mol). Participants with HbA1c ≥ 10% (86 mmol/mol) reported good access to care, however 20% of participants with HbA1c ≥ 10% (86 mmol/mol) felt that their care was not well-coordinated and 9.6% reported having an unmet health care need. In adjusted analysis, patients with HbA1c ≥10% (86 mmol/mol) were more likely to report lack of confidence and inadequate social support, compared to patients with HbA1c 7-8% (53-64 mmol/mol). They were also significantly more likely not to have drug insurance nor to have received recommended treatments because of cost. CONCLUSIONS These results reinforce the importance of an individualized, yet multi-faceted approach. Specific attention to financial barriers seems warranted. These findings can inform the development of programs and initiatives to overcome barriers to care, and improve diabetes care and outcomes.
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Affiliation(s)
- Kerry A. McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital, Toronto, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alun L. Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Canada
| | - Nathalie Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Patel MR, Resnicow K, Lang I, Kraus K, Heisler M. Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study. HEALTH EDUCATION & BEHAVIOR 2017; 45:101-111. [PMID: 28443371 DOI: 10.1177/1090198117704683] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. AIMS We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. METHOD We report a pre-post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. RESULTS Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% "learned a lot," 98% "topics relevant" 95% "applicable to their lives," 98% "liked the information"). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p < .05) and pharmacists (13% to 25.5%, p < .01), not skipping doses of medicines due to cost (11% to 4%, p < .03), and financial management (33.83 to 39.62, p < .007). There were no significant changes in perception of financial burden. CONCLUSION A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.
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Affiliation(s)
- Minal R Patel
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ian Lang
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kathleen Kraus
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA.,2 VA Center for Clinical Management Research, Ann Arbor, MI, USA
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Chakkalakal RJ, Venkatraman S, White RO, Kripalani S, Rothman R, Wallston K. Validating Health Literacy and Numeracy Measures in Minority Groups. Health Lit Res Pract 2017; 1:e23-e30. [PMID: 29888342 PMCID: PMC5991606 DOI: 10.3928/24748307-20170329-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited. Objective: This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) by trait (health literacy or numeracy) and by method (subjective or objective) among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic patients with type 2 diabetes mellitus (T2DM). Methods: We conducted a secondary analysis of baseline data from the Partnering to Improve Diabetes Education (PRIDE) study, a clustered randomized controlled trial testing the efficacy of a health communication intervention on T2DM outcomes at state Department of Health clinics in middle Tennessee. PRIDE participants with race/ethnicity data available (n = 398) were included in this study. Most patients identified as NHW (59%), 18% identified as NHB, and 23% identified as Hispanic. Pearson correlations among the 4 measures were compared for each racial/ethnic group by trait and method. The convergent validity of each measure with education was also assessed using Pearson correlation analyses. Key Results: Significant correlations were observed across all 3 subgroups for the numeracy measures (SNS and DNT-5) and the objective measures (DNT-5 and S-TOFHLA). Nonsignificant correlations were observed among Hispanic participants for the health literacy measures (BHLS and S-TOFHLA, correlation coefficient = 0.13) and among NHB and Hispanic participants for the subjective measures (SNS and BHLS, correlations coefficients = 0.15 and 0.09, respectively). A significant positive correlation was noted between education and each measure across all 3 subgroups. Conclusions: Subjective and health literacy measures demonstrate weaker correlations than objective and numeracy measures, respectively, among minority patients in this study. Our findings highlight the need to further evaluate the appropriateness of these tools for use with minority populations, particularly the BHLS for Hispanic patients. [Health Literacy Research and Practice. 2017;1(2):e23–e30.] Plain Language Summary: Few studies have tested the validity of health literacy and numeracy measures in minority groups. This study highlights racial/ethnic differences in the results of validity testing of the Subjective Numeracy Scale, the Diabetes Numeracy Test, the Brief Health Literacy Screen, and the Short Test of Functional Health Literacy in Adults among adults with type 2 diabetes.
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Affiliation(s)
- Rosette J Chakkalakal
- Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University Medical Center
| | | | - Richard O White
- Division of Community Internal Medicine and Family Medicine, Mayo Clinic Florida
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
| | - Russell Rothman
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
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Bermúdez-Millán A, Pérez-Escamilla R, Segura-Pérez S, Damio G, Chhabra J, Osborn CY, Wagner J. Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus. J Nutr 2016; 146:2051-2057. [PMID: 27489004 PMCID: PMC5037870 DOI: 10.3945/jn.116.231365] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus. OBJECTIVES We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus. METHODS Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation. RESULTS Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R2: 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R2: 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R2: 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status. CONCLUSIONS Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096.
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Affiliation(s)
- Angela Bermúdez-Millán
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health, Farmington, CT;
| | | | | | | | - Jyoti Chhabra
- Research Program, Hartford Hospital, Hartford, CT; and
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Julie Wagner
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health, Farmington, CT
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Abstract
Food insecurity is an important issue in public health even in developed societies, particularly for vulnerable populations. Food insecurity refers to the uncertain or limited access to adequate and safe foods. Emerging evidence shows an association between food insecurity, type 2 diabetes risk factors, and management of type 1 and type 2 diabetes. A review of the current literature describing the association between food insecurity and diabetes reveals possible mechanisms and pathophysiologic pathways. There is less evidence for effective interventions, and much of the current literature is limited to cross-sectional studies. Future work should evaluate longitudinal associations and ways to help vulnerable patients with diabetes access adequate food for effective diabetes management.
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Affiliation(s)
- Utibe R Essien
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA
| | - Naysha N Shahid
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seth A Berkowitz
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA.
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA.
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Schmitt A, Reimer A, Hermanns N, Huber J, Ehrmann D, Schall S, Kulzer B. Assessing Diabetes Self-Management with the Diabetes Self-Management Questionnaire (DSMQ) Can Help Analyse Behavioural Problems Related to Reduced Glycaemic Control. PLoS One 2016; 11:e0150774. [PMID: 26938980 PMCID: PMC4777391 DOI: 10.1371/journal.pone.0150774] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/18/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To appraise the Diabetes Self-Management Questionnaire (DSMQ)'s measurement of diabetes self-management as a statistical predictor of glycaemic control relative to the widely used SDSCA. METHODS 248 patients with type 1 diabetes and 182 patients with type 2 diabetes were cross-sectionally assessed using the two self-report measures of diabetes self-management DSMQ and SDSCA; the scales were used as competing predictors of HbA1c. We developed a structural equation model of self-management as measured by the DSMQ and analysed the amount of variation explained in HbA1c; an analogue model was developed for the SDSCA. RESULTS The structural equation models of self-management and glycaemic control showed very good fit to the data. The DSMQ's measurement of self-management showed associations with HbA1c of -0.53 for type 1 and -0.46 for type 2 diabetes (both P < 0.001), explaining 21% and 28% of variation in glycaemic control, respectively. The SDSCA's measurement showed associations with HbA1c of -0.14 (P = 0.030) for type 1 and -0.31 (P = 0.003) for type 2 diabetes, explaining 2% and 10% of glycaemic variation. Predictive power for glycaemic control was significantly higher for the DSMQ (P < 0.001). CONCLUSIONS This study supports the DSMQ as the preferred tool when analysing self-reported behavioural problems related to reduced glycaemic control. The scale may be useful for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting associations between self-management behaviours and glycaemic control.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
| | - Jörg Huber
- Centre for Health Research, University of Brighton, Falmer, BN1 9PH, United Kingdom
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Sabine Schall
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
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