The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017.

INTRODUCTION: Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). METHODOLOGY: This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. RESULTS: Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). DISCUSSION: These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

Regional Utilization of Preventive Services in the 55-Plus Age Group: Protocol for a Mixed Methods Study.

BACKGROUND: In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. OBJECTIVE: The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. METHODS: In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). RESULTS: (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. CONCLUSIONS: This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33512.

Online health information seeking, medical care beliefs and timeliness of medical check-ups among African Americans.

OBJECTIVE: This study aims to investigate the relationship among different types of internet sources for health, medical check-up beliefs and the timeliness of annual medical check-ups among African Americans, accounting for both health TV usage and health service use. METHODS: Hierarchical linear regression analysis was conducted on data from 1734 African Americans surveyed in the 2013 Consumer Health Multimedia Audience Research Systems national pharmaceutical study of 19,420 U.S. adults. RESULTS: The results indicate a positive association between seeking health information on medical websites (ß = 0.052, p = 0.04) and consumer-driven health sites (ß = 0.066, p < 0.01), and the timeliness of check-ups among African Americans, an association not found in relation to mainstream or news-related sites. Health TV program use was not associated with timeliness of medical check-ups. Medical check-up belief is positively associated with seeking health info on consumer-driven health sites (ß = 0.072, p < 0.01) but not on medical sites or on TV. CONCLUSION: Seeking information on health-specific websites was associated with more timely check-ups in African Americans and more positive preventative medical care belief, even after controlling for traditional barriers, such as poor provider relationship. PRACTICE IMPLICATIONS: Health specific websites may provide an avenue for intervention to improve preventative care use in African Americans.

Ethnic Differences in Participation in Medical Check-ups Among the Elderly: Evidence from Malaysia.

BACKGROUND: There were ethnic differences in the prevalence of non-communicable diseases among the elderly in Malaysia. OBJECTIVE: To examine ethnic differences in participation in medical check-ups among the elderly. DESIGN: A nationally representative data set was employed. Multiple logistic regressions were utilised to examine the relationship between ethnicity and the likelihood of undergoing medical check-ups. The regressions were stratified by age, income, marital status, gender, household location, insurance access and health status. These variables were also controlled for in the regressions (including stratified regressions). PARTICIPANTS: The respondents were required to be residents of Malaysia and not be institutionalised. Overall, 30,806 individuals were selected to be interviewed, but only 28,650 were actually interviewed, equivalent to a 93% response rate. Of those, only 2248 were used in the analyses, because 26,402 were others or below aged 60. MAIN MEASURES: The dependent variable was participation in a medical check-up. The main independent variables were the three major ethnic groups in Malaysia (Malay, Chinese, Indian). KEY RESULTS: Among the elderly aged 70-79 years, Chinese (aOR 1.89; 95% CI 1.28, 2.81) and Indians (aOR 2.39; 95% CI 1.20, 4.74) were more likely to undergo medical check-ups than Malays. Among the elderly with monthly incomes of ≤ RM999, Chinese (aOR 1.44; 95% CI 1.12, 1.85) and Indians (aOR 1.50; 95% CI 0.99, 2.28) were more likely to undergo medical check-ups than Malays. Indian males were more likely to undergo medical check-ups than Malay males (aOR 2.32; 95% CI 1.15, 4.67). Chinese with hypercholesterolaemia (aOR 1.45; 95% CI 1.07, 1.98) and hypertension (aOR 1.32; 95% CI 1.02, 1.72) were more likely to undergo medical check-ups than Malays. CONCLUSIONS: There were ethnic differences in participation in medical check-ups among the elderly. These ethnic differences varied across age, income, marital status, gender, household location, insurance access and health status.

[Health criteria and scope of workers' periodic health check-ups for selected types of work and exposure factors - Nofer Institute of Occupational Medicine guidelines]. / Kryteria zdrowotne i zakres badan profilaktycznych dla wybranych rodzajów prac i czynników narazenia ­ wytyczne Instytutu Medycyny Pracy w Lodzi.

Workers' medical prophylactic examinations referred to in the Labor Code are one of the tasks of the occupational medicine services. They are regulated by law which has been in force for more than 20 years in unchanged form. During this period, new harmful, burdensome or dangerous to health factors appeared in the workplaces, for which no preventive health check-up standard was defined. In the meantime, the health criteria for drivers and persons applying for driving licenses have also been significantly liberalized. The above changes, the authors' own experience, comments and problems reported by physicians who provide workers' prophylactic health care and employers as well as analysis of literature related to workers' health care in other countries have created the need to harmonize and update guidelines on health requirements for selected types of work. In addition the scope and frequency of prophylactic examinations for exposures, which are not included in applicable legal acts, has been developed. Med Pr. 2019;70(1):125-37.

Factors Related to Physical Health Monitoring in Community-Dwelling Patients with Schizophrenia Spectrum Disorder / 대한정신분열병학회지

OBJECTIVES: To identify factors related to physical health monitoring of patients with schizophrenia spectrum disorder. METHODS: A total of 172 patients with schizophrenia spectrum disorder registered in mental health welfare centers and rehabilitation facilities in Gwangju were recruited. Physical health monitoring was defined by two health behaviors; fasting blood tests within recent 2 years in all participants and routine medical check-ups covered by national insurance within recent 5 years in participants aged 40 years or older. Demographic and clinical characteristics including overweight, metabolic syndrome and knowledge about physical illness were compared according to physical health monitoring. RESULTS: Prevalence of overweight and metabolic syndrome were 62.8% and 40.1%, respectively. The rates of fasting blood tests and routine medical check-ups were 34.9% and 67.9%, respectively. The rates of fasting blood tests were significantly higher in general hospital and university hospital compared to mental hospital or private clinic. Rates of routine medical check-ups were significantly lower in individuals using daily rehabilitation service and smokers. Knowledge about cancer and chronic illness were significantly better in individuals receiving routine medical check-ups compared with those not receiving it. CONCLUSION: Education about physical health should be integrated to mental health service in community mental health center.

The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-ups.

BACKGROUND: Patients with primary spontaneous pneumothorax (PSP) usually complain of sudden-onset dyspnea and pleuritic chest pain. However, asymptomatic PSP has been incidentally detected on chest X-rays. In this study, we analyzed the incidence, characteristics, risk factors, and prognosis of asymptomatic PSP detected during regular medical check-ups in university students. METHODS: In this study, 101,709 chest X-rays were performed during medical check-ups for students at the University of Tokyo between April 2011 and March 2016. Among them, 43 cases of asymptomatic PSP (0.042%) were detected. We calculated the lung collapse rate of pneumothorax using Kircher's method. We also analyzed risk factors associated with asymptomatic PSP using characteristics inspected in medical check-ups. RESULTS: The incidence of asymptomatic PSP was significantly higher in men than in women (0.050% vs 0.018%). Multivariate analysis revealed an association of younger age, greater height, lower body mass index, and greater height growth per year with an increased risk of asymptomatic PSP in male students. Mild lung collapse (<10%) was present in 22 of 43 students with asymptomatic PSP; among these, eight students eventually underwent an invasive therapy. CONCLUSIONS: The prevalence of asymptomatic PSP among university students was as high as 0.042%. In addition to known risk factors for conventional PSP, greater height growth was a risk factor for asymptomatic PSP. Careful follow-up is very important because a considerable number of patients with mild lung collapse eventually require an invasive medical procedure.

[Challenges to occupational medicine in view of the problem of work-related diseases and the aging of workforce. Directions for further development and intentional changes in preventive care of employees in Poland]. / Wyzwania medycyny pracy wobec problemu chorób zwiazanych z praca oraz starzenia sie populacji osób pracujacych. Dalszy kierunek rozwoju i celowe zmiany w opiece profilaktycznej nad pracujacymi w Polsce.

The system of occupational health care in Poland, based on occupational medicine service, takes care of almost 12.5 million employees subjected to over 4.5 million obligatory periodic medical check ups. This form of providing prophylactic care comes down to examinations dictated by legal regulations, whose scope is not oriented towards a comprehensive workers' health assessment, but to the examination of the systems and organs critical to work-related dangers. Simultaneously, epidemiological data indicate a large number of chronic diseases, which may influence the professional activity, like hypertension or diabetes and a high percentage of patients not aware of their illness. Since patients participating in obligatory examinations usually feel healthy and do not use health care services on a daily basis, an occupational medicine physician has a unique opportunity to detect health disorders at an early stage, which can prevent the development of health complications affecting the condition of the patient, limiting their professional activity, but also causing additional costs of the health care system. The authors have proven the need to involve occupational medicine services in the prevention of chronic diseases and the need to introduce additional sources of financing for procedures enabling early detection of diseases the patient may not be aware of or control of the effectiveness of already diagnosed illnesses. They addressed the need to change the current legal form of establishing and announcing the range of examinations and directives for certifying the lack or presence of health contraindications to work to the specified and updated standards prepared by scientific research institutes and occupational medicine societies. Med Pr 2016;67(5):691-700.

[Realities of the prophylactic health care of workers in Poland]. / Realia profilaktycznej opieki zdrowotnej nad pracownikami w Polsce.

BACKGROUND: The Polish occupational health system (OHS), existing over the past 17 years, has recently been contested as never before. Critical voices pertain to both legislative and executive aspects of the system, in which key roles are played by employers and occupational medicine service. There are some reasons for making a hypothesis that relevant norms are not always respected by the main actors. MATERIAL AND METHODS: The data on the observance of norms by entities responsible for providing workers with prophylactic health care were analyzed. They were obtained from the existing external resources and materials collected during the implementation of tasks assigned by the Ministry of Health. RESULTS: Legal norms, which constitute OHS in Poland are generally neither respected by the employers, nor by the representatives of occupational medicine service. Nearly half (45-47%) of employers infringe provisions relating to medical examinations of workers. Such a degree of non-observance of respective laws would have not been the case if it was not for the attitudes and "silent approval" of many (but not all) occupational physicians. Laws defining the responsibilities of occupational medicine service units on one hand, and of employers on the other, are for many reasons infringed by both groups. CONCLUSIONS: The data analyses indicate that the Polish OHS is, to a large extent, not acceptable and should be replaced with another one founded on other assumptions and responsive to contemporary occupational health challenges. New provisions should be formulated on the basis of merit and guided by socially accepted norms.