Generalized anxiety disorder in type 2 diabetes mellitus: prevalence and clinical characteristics

Objective: This study investigated the prevalence of generalized anxiety disorder (GAD) in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective observational study was conducted with a random sample of patients from the entire population of National Health Insurance enrollees during 2000-2010 and used ICD-9-CM diagnostic codes to identify T2DM patients and GAD. The prevalence of GAD was compared between T2DM patients and the general population. Results: Between 2000 and 2010, the prevalence of GAD was significantly greater in the T2DM patients than the general population, while the increase of GAD was higher in the general population (from 0.25 to 0.63%) than among T2DM patients (from 0.81 to 1.03%). In T2DM patients, GAD was associated with female gender, a Charlson Comorbidity Index ≥ 1, diabetes mellitus duration > 9 years, and the following comorbidities: congestive heart failure, peripheral vascular disease, and depressive disorder. The prevalence of GAD among T2DM patients was negatively associated with rapid-acting insulin injection therapy and with the use of metformin and sulfonylureas. Conclusion: Since the prevalence of GAD was greater among T2DM patients than the general population, public health initiatives are needed to prevent and treat GAD in T2DM patients, specifically those with the above mentioned risk factors.

How Educational Inequalities in Cardiovascular Mortality Evolve While Healthcare Insurance Coverage Grows: Colombia, 1998 to 2015.

OBJECTIVES: We aim to explore how the current increase in Healthcare Insurance Coverage in Colombia potentially affected educational inequalities in cardiovascular disease (CVD) mortality from 1998 to 2015. METHODS: The official death database for the period 1998 to 2015, codified by cause of death for CVD (International Classification of Diseases, Tenth Revision: I00-I99) was analyzed (men = 279 537, women = 292 122). We compared Healthcare Insurance Coverage (HIC) fluctuations with the trends and annual percentage changes (APCs) in CVD age-standardized mortality rates (ASMRs), the rate ratios of the ASMR to educational level, and the Relative Index of Inequality (RII), which was used to measure the educational inequalities. RESULTS: Mortality from CVD is higher in men than in women (ASMR/men = 148.2; 95% CI: 147.6-148.7 vs ASMR/women = 139.4; 95% CI: 138.9-139.9). People with a lower educational level have an increased risk of dying prematurely owing to CVD, the higher inequalities being those for young women (RII = 2.62; 95% CI: 2.60-2.64). Inequalities by educational level (APC of the RII) grew at a rate of 2.5% per year in men and 1.7% in women, despite the steady increase of HIC throughout the period. From 1998 to 2011, there was a significant decrease in mortality rates owing to CVD (APC = -2.4% and APC = -2.1% for men and women, respectively). As of 2011, there was an increase only for men (APC = +3.9%). CONCLUSIONS: In Colombia, educational inequalities could be a cause of the worrying increase in mortality caused by CVD, which affects women more than men, whereas the HIC seem to be ineffective at reducing educational inequalities, and therefore mortality by CVD.

Health system strengthening: Integration of breast cancer care for improved outcomes.

The adoption of the goal of universal health coverage and the growing burden of cancer in low- and middle-income countries makes it important to consider how to provide cancer care. Specific interventions can strengthen health systems while providing cancer care within a resource-stratified perspective (similar to the World Health Organization-tiered approach). Four specific topics are discussed: essential medicines/essential diagnostics lists; national cancer plans; provision of affordable essential public services (either at no cost to users or through national health insurance); and finally, how a nascent breast cancer program can build on existing programs. A case study of Zambia (a country with a core level of resources for cancer care, using the Breast Health Global Initiative typology) shows how a breast cancer program was built on a cervical cancer program, which in turn had evolved from the HIV/AIDS program. A case study of Brazil (which has enhanced resources for cancer care) describes how access to breast cancer care evolved as universal health coverage expanded. A case study of Uruguay shows how breast cancer outcomes improved as the country shifted from a largely private system to a single-payer national health insurance system in the transition to becoming a country with maximal resources for cancer care. The final case study describes an exciting initiative, the City Cancer Challenge, and how that may lead to improved cancer services.

Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study.

OBJECTIVE: To delineate the relationship between traumatic brain injury (TBI) and mood disorders from population-based data in Taiwan. STUDY DESIGN: This prospectively followed cohort study involved a subset of the National Health Insurance Research Database containing complete inpatient and outpatient data of 1 million randomly drawn beneficiaries. We included 10- to 24-year-old patients (n = 15,203) receiving the diagnosis of TBI in ambulatory visits or hospitalization from 2000-2004 and their age- and sex-matched comparison insureds using health service in the same year (n = 76,015). Diagnosis of mood disorders was recorded within 5 years after the traumatic event or index use of health service. Baseline demographics, clinical characteristics, and premorbid psychiatric conditions were compared using χ(2) analysis. Increased risk during the 5-year follow-up period was represented by crude and adjusted hazard ratios with 95% CI using a Cox proportional hazard regression. RESULTS: A total of 451/15,203 patients with TBI (2.97%) received a diagnosis of mood disorders in the 5-year follow-up period compared with 1153/97,445 individuals (1.52%) without antecedent TBI. After adjusting for select premorbid comorbidities, TBI remained a significant predisposing factor with a 1.96-fold (95% CI 1.74-2.22) increase in risk of mood disorders. CONCLUSIONS: Our findings show a higher likelihood of manifesting mood disorders in adolescents and young adults who sustained a prior TBI. Health professionals should carefully monitor both the physical and psychological impacts of head trauma.

Perspectativa mundial de los sistemas de seguridad social / Global perspective of the social security systems

En este trabajo se hace un somero recuento de los principales hitos en la historia de la seguridad social desde sus inicios a fines del siglo XVIII y principios del XIX, con la creación de "seguros de enfermedad", hasta las tendencias que en esta materia pueden observarse en todo el momento actual