Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Motivational Interviewing: Preparing People for Change

The AUDIT Alcohol Consumption Questions (AUDIT-C) An Effective Brief Screening Test for Problem Drinking

Rationale: Idiopathic pulmonary fibrosis is a chronic interstitial lung disease of unknown etiology; its epidemiology in the United States has not been well characterized.Objective: To estimate the annual incidence and prevalence of idiopathic pulmonary fibrosis in the United States.Methods: Retrospective cohort design utilizing a large health care claims database spanning the period January 1996 through December 2000.Measurements and Main Results: Persons with idiopathic pulmonary fibrosis were identified based on diagnosis and procedure codes. Using broad case-finding criteria, prevalence was estimated to range from 4.0 per 100,000 persons aged 18 to 34 yr to 227.2 per 100,000 among those 75 yr or older; annual incidence was estimated to range from 1.2 to 76.4 per 100,000. Using narrow case-finding criteria, prevalence ranged from 0.8 to 64.7 per 100,000 persons; comparable figures for incidence were 0.4 to 27.1 per 100,000 persons. Extrapolating these rates to the overall United States' population, pre...

https://www.atsjournals.org/doi/pdf/10.1164/rccm.200602-163OC

Incidence and Prevalence of Idiopathic Pulmonary Fibrosis

More than 25% of the U.S. population aged ≥65 years has diabetes (1), and the aging of the overall population is a significant driver of the diabetes epidemic. Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization (2). Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease.

Despite having the highest prevalence of diabetes of any age-group, older persons and/or those with multiple comorbidities have often been excluded from randomized controlled trials of treatments—and treatment targets—for diabetes and its associated conditions. Heterogeneity of health status of older adults (even within an age range) and the dearth of evidence from clinical trials present challenges to determining standard intervention strategies that fit all older adults. To address these issues, the American Diabetes Association (ADA) convened a Consensus Development Conference on Diabetes and Older Adults (defined as those aged ≥65 years) in February 2012. Following a series of scientific presentations by experts in the field, the writing group independently developed this consensus report to address the following questions:

1. What is the epidemiology and pathogenesis of diabetes in older adults?

2. What is the evidence for preventing and treating diabetes and its common comorbidities in older adults?

3. What current guidelines exist for treating diabetes in older adults?

4. What issues need to be considered in individualizing treatment recommendations for older adults?

5. What are consensus recommendations for treating older adults with or at risk for diabetes?

6. How can gaps in the evidence best be filled?

According to the most recent surveillance data, the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria …

/pdf/diabetes-in-older-adults-1jwxiauo81.pdf

Diabetes in Older Adults

Massachusetts was the first state to introduce a statewide specialty mental health managed care plan for its Medicaid program. This study assesses the impact of this program on expenditur...

Mental Health/Substance Abuse Treatment in Managed Care: the Massachusetts Medicaid Experience

Purpose. Quality of life (QOL) has become an important endpoint in clinical trials and studies of medical interventions for many chronic diseases, but has not been widely studied in the substance a...

Quality of Life Assessments by Adult Substance Abusers Receiving Publicly Funded Treatment in Massachusetts

Aims To test the hypothesis that persistent pain is associated with an increased odds of substance use after detoxification.



Design  Analysis of data from a prospective cohort enrolled in a randomized controlled trial (RCT) to improve linkage with primary medical care.



Setting  An urban residential detoxification program.



Participants  Adults (n = 397) enrolled in the RCT with heroin, alcohol or cocaine as a substance of choice and at least one follow-up interview.



Measurements  The key independent variable was pain status: persistent pain (moderate to very severe pain at all available interviews), no pain (mild pain or less at all available interviews) and intermittent pain (all others). There were four outcomes of interest: self-reported use of any substance; heroin/opioid use; heavy alcohol use; and cocaine use 24 months after detoxification. Multivariable logistic regression controlled for several covariates including demographics, physical/sexual abuse, depressive symptoms, duration of follow-up and addiction severity at study entry.



Findings  Pain in detoxification patients was common; 16% had persistent pain and 54% had intermittent pain. Persistent pain was associated with an increased odds for use of any substance [adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI) 1.9–9.3], heroin/opioid use (AOR 5.4, 95% CI 2.1–13.8) and heavy alcohol use (AOR 2.2, 95% CI 1.0–4.5) at the 24-month follow-up. A statistically non-significant increase in the odds of cocaine use (AOR 2.0, 95% CI 0.9–4.6) was also observed.



Conclusions  Among individuals leaving residential detoxification, chronic pain is a common problem and is associated independently with long-term substance use after detoxification. Addressing pain as a treatable chronic condition among adults receiving detoxification presents a potential opportunity to improve long-term clinical outcomes and warrants further intervention research.

Persistent pain is associated with substance use after detoxification: a prospective cohort analysis.

OBJECTIVE—To compare the odds of major depression among Medicare claimants with and without diabetes and to test whether annual medical payments are greater for those with both diabetes and major depression than for those with diabetes alone. RESEARCH DESIGN AND METHODS—This retrospective analysis relies on claims data from the 1997 Medicare 5% Standard Analytic Files. Using these data, we statistically determined whether the odds of major depression are greater among elderly claimants with diabetes after controlling for age, race/ethnicity, and sex. We then used regression analysis on a sample of over 220,000 elderly claimants with diabetes to test whether payments for non-mental health-related services are greater for those with both diabetes and major depression (n = 4,203) than for those with diabetes alone. RESULTS—Our findings indicate that the odds of major depression are significantly greater among elderly Medicare claimants with diabetes than among those without diabetes (OR 1.58 ± 0.05). We also found that elderly claimants with both diabetes and major depression seek treatment for more services and spend more time in inpatient facilities, and as a result incur higher medical costs than claimants with diabetes but without major depression. These results hold even after excluding services related to mental health treatment. CONCLUSIONS—This analysis suggests that treatment for major depression among claimants with diabetes may reduce total medical costs if treatment results in a decrease in utilization for general medical services in the future.

/pdf/prevalence-and-costs-of-major-depression-among-elderly-bvz13khhu9.pdf

Prevalence and costs of major depression among elderly claimants with diabetes.

Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.

/pdf/the-case-for-chronic-disease-management-for-addiction-5rovc16qjq.pdf

Mary Jo Larson

Papers

Mental Health/Substance Abuse Treatment in Managed Care: the Massachusetts Medicaid Experience

Quality of Life Assessments by Adult Substance Abusers Receiving Publicly Funded Treatment in Massachusetts

Persistent pain is associated with substance use after detoxification: a prospective cohort analysis.

Prevalence and costs of major depression among elderly claimants with diabetes.

The Case for Chronic Disease Management for Addiction