Showing posts with label more. Show all posts
Showing posts with label more. Show all posts
More On The Diabetes Depression Link
Wednesday, May 21, 2014
People with diabetes experience depression more often than people without diabetes.Does having diabetes raise your risk of developing depression? Or is it the other way around ... Does experiencing depression raise your risk of developing diabetes?
No definitive answer to that question exists. In fact, the two may be inextricably intertwined. That did not deter a group of Johns Hopkins researchers from seeking to tease the two conditions apart. Their findings were reported in the June 18 issue of JAMA:
Examining A Bidirectional Association Between Depressive Symptoms And Diabetes
The study had two parts. The cohort used was the Multi-Ethnic Study of Atherosclerosis (MESA study), a group of US adults followed for about 3 years.
The first part involved 5201 participants without diabetes. Their findings:
"The crude incidence of type 2 diabetes over 3.2 years was 22.0 per 1000-person years for those with elevated depressive symptoms and 16.6 per 1000 person-years for those without elevated depressive symptoms."So, there was a small increase in risk for diabetes in individuals experiencing depression. This difference, however, was partially lessened when lifestyle factors (smoking history, caloric intake, alcohol use, physical activity level) were considered. It is possible that the same lifestyle factors that put someone at risk for depression (physical inactivity, higher caloric intake with weight gain), also increase their risk for diabetes.
The second part involved 4847 participants without depressive symptoms. Their findings:
"Individuals with untreated type 2 diabetes were not at increased risk of developing elevated depressive symptoms, those with treated type 2 diabetes were at increased risk of developing elevated depressive symptoms. ... Treated type 2 diabetes was associated with a 52% higher odds of developing elevated depressive symptoms."That last finding, where untreated patients did not experience depression but treated patients did, led the authors to conclude:
"Clinicians should be aware of increased risk of elevated depressive symptoms in individuals with treated type 2 diabetes and consider routine screening for depressive symptoms among these patients."What is it about treatment for diabetes that raises risk for depression?
The authors speculate that psychological stress associated with diabetes management may contribute. Also, if youre being treated, youre likely to have a number of complications which by themselves could increase the risk for depression.
More On Why No One Believes the Numbers and the Uncertainty of Measuring Return on Investment in Disease Management
Saturday, May 10, 2014
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| Measuring ROI |
The search for simple answers explains much of the appeal of this book.
According to author, one important solution is the "dummy year analysis" (DYA). This relies on repeated year-over-year measurements of utilization that use multiple comparison pairings of all patients with the condition of interest. When thats combined with a "plausibility" check list, Mr. Lewis says purchasers of the Patient Centered Medical Home (PCMH), disease management or wellness programs should be able to get a better fix on whether they saved any money. You can a sense of that perspective here.
The DMCB isnt too sure about that because a) other factors that have nothing to do with population health management can also impact utilization during and after the dummy years, making it difficult to assign an attributable ROI and b) entire health plan populations can likewise regress toward a regional or national mean.
The DMCB also sees three additional reasons why there may be less to this books methodology than meets the eye:
1. When employers, health plans, accountable care organizations or other buyers have a list of names that have been through a care program, they typically want to understand the outcomes for the individuals on that list. If thats the case, the challenge is to find an adequate comparator that portrays what would have happened in the absence of the care program. Multiple options for identifying a parallel comparator have been used in published science for decades. Thats difficult, imperfect, but not broken. It remains an option.
2. While the book is replete with examples of "actuaries behaving badly," it is impossible to underestimate the influence of actuarial science and trending on premium rate setting, statutory accounting, and the regulation of insurance. As a result, if the actuaries say money is - or is not - being saved, health system leaders ignore their insights at their peril.
3. Isolating the impact of PCMH, disease management or wellness program out of all the other "noise" of a changing economy, evolving consumerism, benefit changes, electronic health record databases, medical advances, inflation and the news media is a function of an increasingly sophisticated and changing statistical sciences and computational technology. Its ironic, but one outcome has been a better description and measurement of the uncertainty surrounding a result.
To the authors credit, Why No One Believes the Numbers is not being promoted as the single best methodology that will lead PCMH, disease management and wellness programs to outcomes certainty. Rather, it is one option among many in asking whether a program had any financial impact.
Ultimately, theore, thats why the DMCB advises that measuring outcomes in PHM - absent an ironclad methodology - comes down to using multiple approaches to triangulate on the truth. After reading Why No One Believes the Numbers, some readers may choose it as one of those approaches.
Quick Weight Loss Results in More Pounds Lost
Friday, May 9, 2014
(Article first published as Engage the Mind for Quick Weight Loss Results on Technorati.)
The study cautioned against resorting to crash diets, pills, drugs or weight loss surgery, but noted that weight which was lost at a faster pace resulted in more pounds lost overall. Specifically, researchers found that participants who lost 1.5 pounds per week reached a final weight 15% lower than those who lost at a pace of a half pound each week.
The study leaders believe the results are due to the psychological factor, increasing motivation from losing weight at a faster rate. Further monitoring will be required to determine if the weight loss is sustainable. Any weight loss plan which provides positive results is significant, as the burgeoning obesity epidemic threatens the quality and length of life for millions.
This report underscores the importance of having the right mindset before restructuring a new dietary plan. The following guidelines provide the critical first steps to begin a quick weight loss program which is safe, healthy and delivers results.
Guideline 1: Get Your Mind in the Game
Guideline 2: Set a Realistic Goal
Many people attempting to lose weight will set a target which is virtually impossible to attain. It’s not necessary to be at the same weight as when you were 20. Your body is different, and has evolved to store fat and build muscle differently as you age. For most people, a reasonable weight is 10 to 15% higher than your lowest weight in early adulthood. Following a sensible reduced calorie diet and regular exercise schedule, combined with the correct target weight, will enable you to meet your goal without added stress.
Guideline 3: Plan Meals in Advance
Healthy weight loss requires three key components to be successful. Reduced calories from nutritious sources and physical activity fuel the process and burn fat, yet neither are sustainable without engaging the mind. Only begin a weight loss program when you are fully committed and prepared to maintain your new lifestyle for the long term. When your mind is conditioned to improve and regain your health, weight loss will proceed at a naturally accelerated pace.
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