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Hotez E, Pan M, Jackson N, Rava J, Wisk LE, Lei Y, Schickedanz A, Kuo AA. Health and Well-Being at the Transition to Adulthood Among Individuals With Disabilities: An Analysis of the Panel Study of Income Dynamics. J Adolesc Health 2024; 74:964-970. [PMID: 38340121 DOI: 10.1016/j.jadohealth.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To describe positive mental health, or "flourishing," and self-reported health trajectories among transition-aged young adults (TAYA) with developmental/learning and physical disabilities over a 12-year period, utilizing a population-based sample. METHODS This study features a secondary analysis of national data from the Panel Study of Income Dynamics Transition to Adulthood Supplement. The analytic sample included all TAYA with (n = 487) and without (n = 810) disabilities, including developmental/learning disabilities (DD/LD), attention deficit hyperactivity disorder (ADHD), and speech, hearing, and vision impairments who participated in 2017 Transition to Adulthood Supplement data collection (n = 1,297; M age = 24.5, standard deviation = 2.40). We utilized linear mixed modeling to retrospectively describe flourishing and self-reported health trajectories across 12 years among TAYA with and without disabilities between ages 18 to 28, adjusting for demographic and developmental characteristics. RESULTS Relative to TAYA without disabilities, TAYA with speech [0.10, 0.85] and vision impairments [0.10, 0.92], DD/LD [0.38, 1.11], and ADHD [0.27, 0.97] demonstrated lower flourishing. TAYA with speech [0.07, 0.36] and vision impairments [0.08, 0.38], DD/LD [0.15, 0.411], and ADHD [0.14, 0.93] reported lower health. Relative to TAYA with other disabilities, TAYA with ADHD [0.14, 0.93] and DD/LD [0.01, 0.29] reported lower flourishing and health, respectively. Interaction effects and descriptive analyses revealed distinct patterns of change for TAYA with ADHD. DISCUSSION TAYA with disabilities report lower flourishing and health, relative to TAYA without disabilities. TAYA with specific disabilities differ in their flourishing and health trajectories. Findings can inform the development of interventions for TAYA with disabilities.
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Affiliation(s)
- Emily Hotez
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California.
| | - Mengtong Pan
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Nicholas Jackson
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Julianna Rava
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Lauren E Wisk
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Yvonne Lei
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Adam Schickedanz
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Alice A Kuo
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
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Hotez E, Rava JA, Shea L, Kuo A. Developing "Adulting for Health": Investigating the Health Needs of Neurodivergent Emerging Adults. Cureus 2023; 15:e41102. [PMID: 37519609 PMCID: PMC10375927 DOI: 10.7759/cureus.41102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Neurodivergent emerging adults - defined as individuals between the ages of 18 and 30 with intellectual and/or developmental disabilities (e.g., attention-deficit hyperactivity disorder (ADHD), autism, cerebral palsy, learning disabilities, seizures, developmental delays, with or without intellectual impairment) and physical and/or sensory disabilities (e.g., blindness or hearing impairment) - experience poor mental and physical health outcomes. Existing interventions are insufficient because they are not based on the self-reported and developmental needs of this population. METHODS The current study is an exploratory pilot study that features a multidimensional health-based needs assessment of self-identified neurodivergent emerging adults with ADHD, learning disabilities, autism, and other conditions, mean (M) age = 22.8; standard deviation (SD) = 3.4; n = 26). This research used validated measures. The assessment - administered via Qualtrics to the participants in two sites - included the Mental Health Continuum-Short Form, Kessler-6 Psychological Distress Scale, Project EAT (Eating and Activity over Time)-IV (with the intuitive eating, weight-related control, emotional eating, and physical activity subscales), and an original health-focused needs assessment developed by interdisciplinary healthcare professionals and neurodivergent individuals. RESULTS The sample reported low positive mental health, with only 3% reportedly "flourishing." The sample also reported high psychological distress according to clinical and psychometric cut-off scores; varied intuitive eating and weight-control behaviors and attitudes; and distinct needs related to integrating the principles of health promotion into daily life, navigating the healthcare system, and learning from healthcare professionals. Based on these findings, we present an initial conceptualization of "Adulting for Health," a potential virtual education program to promote health-related knowledge and capacities for this population. CONCLUSIONS The results from this exploratory pilot study can be incorporated into existing programs and spur efforts to develop and test new interventions that can ameliorate health disparities for neurodivergent emerging adults.
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Affiliation(s)
- Emily Hotez
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Julianna A Rava
- Public Health, University of California Los Angeles Fielding School of Public Health, Los Angeles, USA
| | - Lindsay Shea
- Health Policy, Drexel University AJ Drexel Autism Institute, Philadelphia, USA
| | - Alice Kuo
- Division of Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Gallardo-Rincón H, Montoya A, Saucedo-Martínez R, Mújica-Rosales R, Suárez-Idueta L, Martínez-Juárez LA, Razo C, Lozano R, Tapia-Conyer R. Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico. BMJ Open 2021; 11:e049836. [PMID: 34475175 PMCID: PMC8413929 DOI: 10.1136/bmjopen-2021-049836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. DESIGN Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. SETTING Public primary health centres in 27/32 Mexican states. PARTICIPANTS Individuals aged ≥20 years lacking healthcare access. RESULTS From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). CONCLUSION Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.
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Affiliation(s)
- Héctor Gallardo-Rincón
- Health Sciences University Center (CUCS-UdeG), University of Guadalajara, Guadalajara, Jalisco, México
| | | | | | | | | | | | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Roberto Tapia-Conyer
- Carlos Slim Foundation, México City, Mexico
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Flores YN, Toth S, Crespi CM, Ramírez-Palacios P, McCarthy WJ, Briseño-Pérez A, Granados-García V, Salmerón J. Risk of developing pre-diabetes or diabetes over time in a cohort of Mexican health workers. PLoS One 2020; 15:e0229403. [PMID: 32210432 PMCID: PMC7094846 DOI: 10.1371/journal.pone.0229403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/05/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers. METHODS Participants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004-2006 (W1) and 2011-2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively. RESULTS Mean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The cross-sectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among individuals who either maintained or acquired MS, elevated ALT, or elevated uric acid (only for diabetes) from W1 to W2. CONCLUSIONS Weight gain and acquiring or maintaining MS, elevated ALT levels, or elevated uric acid were associated with a significant risk of developing pre-diabetes or diabetes. Our findings, especially in the context of the obesity epidemic in Mexico, point towards an urgent need for initiatives to help reduce excess weight in order to avert future cases of pre-diabetes and diabetes.
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Affiliation(s)
- Yvonne N. Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, California, United States of America
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, United States of America
| | - Samantha Toth
- UCLA Department of Biostatistics, Fielding School of Public Health, Los Angeles, California, United States of America
| | - Catherine M. Crespi
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, United States of America
- UCLA Department of Biostatistics, Fielding School of Public Health, Los Angeles, California, United States of America
| | - Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - William J. McCarthy
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, California, United States of America
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, United States of America
| | - Arely Briseño-Pérez
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - Víctor Granados-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud- Área Envejecimiento, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, México
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Rett K, Gottwald-Hostalek U. Understanding prediabetes: definition, prevalence, burden and treatment options for an emerging disease. Curr Med Res Opin 2019; 35:1529-1534. [PMID: 30935247 DOI: 10.1080/03007995.2019.1601455] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Prediabetes is defined as a state of abnormal glucose homeostasis where blood glucose levels are elevated above those considered normal, but not as high as those required for a diagnosis of diabetes. As a condition intermediate between normal glucose homeostasis and the pathological condition of diabetes, the characterization of prediabetes as a distinct pathogenic condition is controversial. Emerging evidence suggests that the condition of prediabetes is associated with pathophysiological changes in several tissues and organs, which would support its recognition as a distinct pathological entity; the recent inclusion of prediabetes and associated billable conditions in the most recent ICD-10 codes provides additional credence to this position. This minireview summarizes our understanding of prediabetes and provides evidence that it should be considered a distinct and important clinical entity.
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Affiliation(s)
- Kristian Rett
- Endokrinologie und Diabetologie, Endokrinologikum, Munich, Germany
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Peterson MD, McGrath R, Zhang P, Markides KS, Al Snih S, Wong R. Muscle Weakness Is Associated With Diabetes in Older Mexicans: The Mexican Health and Aging Study. J Am Med Dir Assoc 2016; 17:933-8. [PMID: 27450948 DOI: 10.1016/j.jamda.2016.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age. DESIGN Cross-sectional. SETTING National sample of households in both urban and rural areas. PARTICIPANTS A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study. MEASUREMENTS Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference. RESULTS NGS was inversely associated with HbA1c (β = -1.56; P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference. CONCLUSIONS NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Ryan McGrath
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Peng Zhang
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kyriakos S Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, Department of Internal Medicine/Division of Geriatrics, University of Texas Medical Branch, Galveston, TX
| | - Rebeca Wong
- Sealy Center on Aging; Preventive Medicine & Community Health; WHO/PAHO Collaborating Center on Aging and Health, University of Texas Medical Branch, Galveston, TX
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