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Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
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Health Care Services Utilization of Persons with Direct, Indirect and without Migration Background in Germany: A Longitudinal Study Based on the German Socio-Economic Panel (SOEP). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111640. [PMID: 34770152 PMCID: PMC8583515 DOI: 10.3390/ijerph182111640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022]
Abstract
There is ambiguous evidence with regard to the inequalities in health care services utilization (HCSU) among migrants and non-migrants in Germany. The aim of this study was to analyze the utilization of doctors and hospitalization of persons with direct and indirect migration background as well as those without in Germany. This study was based on data of the German Socio-Economic Panel using the adult sample of the years 2013 to 2019. HCSU was measured by self-reported utilization of doctors and hospitalization. Associations between HCSU and migration background were examined using multilevel mixed-effects logistic regression and zero-truncated multilevel mixed-effects generalized linear models. The odds ratios of utilization of doctors and hospitalization for persons with direct migration background compared with persons without migration background were 0.73 (p < 0.001) and 0.79 (p = 0.002), respectively. A direct migration background was associated with a 6% lower number of doctoral visits within three months compared with no migration background (p = 0.023). Persons with direct migration background still have a lower HCSU than persons without migration background in Germany. Access to health care needs to be ensured and health policy-makers are called upon to keep focus on the issue of inequalities in HCSU between migrants and non-migrants in Germany.
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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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Nakhla M, Rahme E, Simard M, Larocque I, Legault L, Li P. Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study. CMAJ 2019; 190:E416-E421. [PMID: 29632036 DOI: 10.1503/cmaj.170676] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis is the leading cause of death among children with type 1 diabetes mellitus, and is an avoidable complication at first-time diagnosis of diabetes. Because having a usual provider of primary care is important in improving health outcomes for children, we tested the association between having a usual provider of care and risk of diabetic ketoacidosis at onset of diabetes. METHODS Using linked health administrative data for the province of Quebec, we conducted a population-based retrospective cohort study of children aged 1-17 years in whom diabetes was diagnosed from 2006 to 2015. We estimated adjusted risk ratios (RRs) for an episode of diabetic ketoacidosis at the time of diabetes diagnosis in relation to usual provider of care (family physician, pediatrician or none) using Poisson regression models with robust error variance. RESULTS We identified 3704 new cases of diabetes in Quebec children from 2006 to 2015. Of these, 996 (26.9%) presented with diabetic ketoacidosis. A decreased risk of this complication was associated with having a usual provider of care; the association was stronger with increasing age, reaching statistical significance among those aged 12-17 years. Within this age group, those who had a family physician or a pediatrician were 31% less likely (adjusted RR 0.69, 95% confidence interval [CI] 0.56-0.85) or 38% less likely (adjusted RR 0.62, 95% CI 0.45-0.86), respectively, to present with diabetic ketoacidosis, relative to those without a usual provider of care. INTERPRETATION For children with newly diagnosed diabetes, having a usual provider of care appears to be important in decreasing the risk of diabetic ketoacidosis at the time of diabetes diagnosis. Our results provide further evidence concerning the need for initiatives that promote access to primary care for children.
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Affiliation(s)
- Meranda Nakhla
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.
| | - Elham Rahme
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Marc Simard
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Isabelle Larocque
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Laurent Legault
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Patricia Li
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
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Klein J, von dem Knesebeck O. Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review. Int J Equity Health 2018; 17:160. [PMID: 30382861 PMCID: PMC6211605 DOI: 10.1186/s12939-018-0876-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/18/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Despite the growing number of people with migrant background in Germany, a systematic review about their utilization of health care and differences to the non-migrant population is lacking. By covering various sectors of health care and migrant populations, the review aimed at giving a general overview and identifying special areas of potential intervention. METHODS A systematic review was conducted in PubMed database including records that were published until 1st of June 2017. Further criteria for eligibility were a publication in a peer-reviewed journal written in English or German language. The studies have to report quantitative and original data of a population residing in Germany. The appropriateness of the studies was judged by both authors. Studies were excluded if native controls were not originated from the same sample. Moreover, indicators of health care utilization have to assess individual behaviour like consultation or participation rates. 63 studies met the inclusion criteria for a qualitative synthesis of the findings. RESULTS The overall findings indicate a lower utilization among migrants, although the results vary in terms of health care sector, indicator of health care utilization and migrant population. For specialist care, medication use, therapist consultations and counselling, rehabilitation as well as disease prevention (early cancer detection, prevention programs for children and oral health check-ups) a lower utilization among people with migrant background was found. The lower usage was particularly shown for migrants of the 1st generation, people with two-sided migrant background, children/adolescents and women. Due to the methodological heterogeneity a meta-analysis was not feasible. As most of the studies were cross-sectional, no causal interpretations could be drawn. CONCLUSIONS The inequalities in utilization could not substantially be explained by differences in the socioeconomic status. Other reasons of lower utilization could be due to differences in need, preferences, information, language and formal access barriers (e.g. charges, waiting times, travel distances or lost wages). Different migrant-specific and migrant-sensitive strategies are relevant to address the problem for certain health care sectors and migrant populations. TRIAL REGISTRATION The review protocol was registered on PROSPERO ( CRD42014015162 ).
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Affiliation(s)
- Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Markkula N, Cabieses B, Lehti V, Uphoff E, Astorga S, Stutzin F. Use of health services among international migrant children - a systematic review. Global Health 2018; 14:52. [PMID: 29769091 PMCID: PMC5956827 DOI: 10.1186/s12992-018-0370-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Migrant children have specific health needs, and may face difficulties in accessing health care, but not enough is known about their health service use. This study aims to describe patterns of use of health services of international migrant children and differences to respective native populations. METHODS Electronic databases PubMed and Web of Science, references of identified publications, and websites of relevant international agencies were searched. We included observational studies published between 2006 and 2016 that reported use of formal health services by migrant children (0-18 years), including first and second generation migrants. Data on study characteristics, study theme, main outcome and study quality were extracted. RESULTS One hundred seven full texts were included in the review. Of the studies that reported comparable outcomes, half (50%) indicated less use of healthcare by migrants compared with non-migrants; 25% reported no difference, 18% reported greater use, and 7% did not report this outcome. There was variation by theme, so that the proportion of conclusions "less use" was most common in the categories "general access to care", "primary care" and "oral health", whereas in the use of emergency rooms or hospitalisations, the most common conclusion was "greater use". CONCLUSIONS Migrant children appear to use different types of healthcare services less than native populations, with the exception of emergency and hospital services. SYSTEMATIC REVIEW REGISTRATION PROSPERO systematic review registration number: CRD42016039876 .
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Affiliation(s)
- Niina Markkula
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
| | - Baltica Cabieses
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
- Department of Health Sciences, University of York, York, England
| | - Venla Lehti
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eleonora Uphoff
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sofia Astorga
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
| | - Francisca Stutzin
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
- Centre for Interdisciplinary and Intercultural Inquiry, Health Humanities, University College London, London, UK
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Nakhla M, Rahme E, Simard M, Guttmann A. Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis. CMAJ Open 2017; 5:E586-E593. [PMID: 28747349 PMCID: PMC5621957 DOI: 10.9778/cmajo.20170022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes. METHODS We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function. RESULTS Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RRafter] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RRafter 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas. INTERPRETATION The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas.
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Affiliation(s)
- Meranda Nakhla
- Affiliations: Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont
| | - Elham Rahme
- Affiliations: Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont
| | - Marc Simard
- Affiliations: Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont
| | - Astrid Guttmann
- Affiliations: Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont
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Blicke M, Körner U, Nixon P, Salgin B, Meissner T, Pollok B. The relation between awareness of personal resources and metabolic control in children and adolescents with type 1 diabetes. Pediatr Diabetes 2015; 16:454-61. [PMID: 25040238 DOI: 10.1111/pedi.12177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The study aims to elucidate whether awareness of personal resources, such as positive attributions and beliefs or social support, affects metabolic control in children and adolescents with type 1 diabetes. In addition, it will be determined to what extent metabolic control is influenced by concordance between children and parents regarding awareness of resources and the parents' ability to adopt their children's perspective. Also, the children's wishes particularly in relation to their illness will be investigated, as well as the kind of advice they would offer to fellow patients. METHODS Seventy-eight children/adolescents with type 1 diabetes completed the Essen Resource Inventory for Children and Adolescents including personal, social, structural, and migration-specific resources. In addition, children/adolescents and their parents completed a systemic-oriented, diabetes-specific resource questionnaire in order to explore the parents' ability to adopt their children's perspective. RESULTS Resources such as body awareness and open-minded attitude to the disease were associated with metabolic control. Particularly, resources associated to a migration background were found to be inversely correlated with hemoglobin A1c (HbA1c) value. Moreover, it was shown that the parents' ability to adopt their children's perspective was associated with improved metabolic control. Children advising fellow patients to accept the disease showed the best HbA1c value. DISCUSSION This data identified specific modifiable factors related to metabolic control that can be addressed during counseling of pediatric patients. Also the parents' ability for adopting their child's perspective was identified as a relevant factor which should be considered during clinical counseling of young type 1 diabetes patients.
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Affiliation(s)
- Maren Blicke
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Ulrike Körner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Patricia Nixon
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Burak Salgin
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Duesseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Duesseldorf, Germany
| | - Bettina Pollok
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Scheuing N, Wiegand S, Bächle C, Fröhlich-Reiterer E, Hahn E, Icks A, Ludwig KH, Mönkemöller K, Razum O, Rosenbauer J, Holl RW. Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry. PLoS One 2015; 10:e0135178. [PMID: 26295472 PMCID: PMC4546611 DOI: 10.1371/journal.pone.0135178] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/18/2015] [Indexed: 12/13/2022] Open
Abstract
Objective To study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome. Study Design and Methods 27,643 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother’s origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05. Results 83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant. Conclusion The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
- * E-mail:
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin, Berlin, Germany
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
| | | | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany
| | - Andrea Icks
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
- Department of Public Health, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Karl-Heinz Ludwig
- Clinic for Children and Adolescent Medicine, Mutterhaus der Borromäerinnen, Trier, Germany
| | | | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
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Icks A, Razum O, Rosenbauer J, Bächle C, Hungele A, Mönkemöller K, Müller-Godeffroy E, Heidtmann B, Kapellen T, Scheuing N, Holl RW. Lower frequency of insulin pump treatment in children and adolescents of Turkish background with type 1 diabetes: analysis of 21,497 patients in Germany. Diabetes Technol Ther 2012; 14:1105-9. [PMID: 23216338 PMCID: PMC3521139 DOI: 10.1089/dia.2012.0138] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. SUBJECTS AND METHODS Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients < 20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions. RESULTS In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 ± 4.1 and 12.6 ± 4.2 years; mean diabetes duration, 4.7 ± 3.9 and 5.3 ± 4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially. CONCLUSIONS The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed.
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Affiliation(s)
- Andrea Icks
- Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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Impact of Socio-economic Status on Utilization of Diabetes Educators and Diabetes Control: A Canadian Experience. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ommen O, Thuem S, Pfaff H, Janssen C. The relationship between social support, shared decision-making and patient's trust in doctors: a cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire. Int J Public Health 2010; 56:319-27. [PMID: 21076932 DOI: 10.1007/s00038-010-0212-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 10/15/2010] [Accepted: 10/20/2010] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Empirical studies have confirmed that a trusting physician-patient interaction promotes patient satisfaction, adherence to treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social support, shared decision-making and inpatient's trust in physicians in a hospital setting. METHODS A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six hospitals in Germany. Logistic regression was performed with a dichotomized index for patient's trust in physicians. RESULTS The logistic regression model identified significant relationships (p < 0.05) in terms of emotional support (standardized effect coefficient [sc], 3.65), informational support (sc, 1.70), shared decision-making (sc, 1.40), age (sc, 1.14), socioeconomic status (sc, 1.15) and gender (sc, 1.15). We found no significant relationship between 'tendency to excuse' and trust. The last regression model accounted for 49.1% of Nagelkerke's R-square. CONCLUSIONS Insufficient physician communication skills can lead to extensive negative effects on the trust of patients in their physicians. Thus, it becomes clear that medical support requires not only biomedical, but also psychosocial skills.
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Affiliation(s)
- Oliver Ommen
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, Cologne, Germany.
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Nakhla M, Daneman D, To T, Paradis G, Guttmann A. Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics 2009; 124:e1134-41. [PMID: 19933731 DOI: 10.1542/peds.2009-0041] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The goals were (1) to describe rates of diabetes mellitus (DM)-related hospitalizations and retinopathy screening before and after transition to adult care and (2) to test whether different methods of transfer of care were associated with improved outcomes. METHODS In a retrospective cohort study, we included 1507 young adults with DM of >or=5-year duration and tracked these patients until 20 years of age. RESULTS DM-related hospitalization rates increased from 7.6 to 9.5 cases per 100 patient-years in the 2 years after transition to adult care (P = .03). Previous DM-related hospitalizations, lower income, female gender, and living in areas with low physician supply were associated with higher admission rates. With controlling for all other factors, individuals who were transferred to a new allied health care team with no change in physician were 23% less likely (relative risk: 0.23 [95% confidence interval: 0.05-0.79]) to be hospitalized after the transition than were those transferred to a new physician with either a new or no allied health care team. The rates of eye examinations were stable across the transition to adult care (72% vs 70%; P = .06). Female patients, patients with higher income, and patients with previous eye care were more likely to have an eye care visit after transfer. CONCLUSIONS During the transition to adult health care, there is increased risk of DM-related hospitalizations, although this may be attenuated in youths for whom there is physician continuity. Eye care visits were not related to transition; however, rates were below evidence-based guideline recommendations.
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Affiliation(s)
- Meranda Nakhla
- Division of Endocrinology and Metabolism, Hospital for Sick Children, Toronto, Ontario, Canada.
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Estrada CL, Danielson KK, Drum ML, Lipton RB. Hospitalization subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics 2009; 124:926-34. [PMID: 19706582 PMCID: PMC2888679 DOI: 10.1542/peds.2008-3826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes. PATIENTS AND METHODS We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (> or = once per 2 years' duration) versus infrequent rehospitalization rates. RESULTS Mean (range) duration was 5.1 years (0.1-19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non-type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non-type 1 diabetes versus type 1; OR: 2.74; P = .04), head of household not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01). CONCLUSIONS Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.
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Affiliation(s)
- Carmela L. Estrada
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Kirstie K. Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Melinda L. Drum
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Rebecca B. Lipton
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, Department of Health Studies, University of Chicago, Chicago, Illinois
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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