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Background: Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives: This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods: This is a retrospective analysis of 100% of 2010–2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results: Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65–0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63–0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57–0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67–0.99). Discussion: The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions: Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.

Objetivo: Conocer la importancia de las enfermedades reumáticas en la población adulta de Cataluña y su repercusión en la salud autopercibida, la restricción de actividades y el uso de servicios sanitarios. Métodos: Encuesta poblacional a 15.926 adultos. Muestreo estratificado polietápico. Variables recogidas: características sociodemográficas, problemas de salud, salud autopercibida, restricción de actividades y uso de recursos sanitarios. Los problemas musculoesqueléticos se clasificaron en cuatro categorías: artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis. Resultados: El 77,4% declara problemas crónicos de salud. La dorsalgia-lumbalgia, la cervicalgia crónica y el grupo artrosis-artritis o reumatismo, por este orden, son los más frecuentemente declarados. Tras ajustar por la edad, el sexo femenino incrementa el riesgo de declarar artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis (odds ratio [OR]=2,6, 1,5, 2,3 y 5,3, respectivamente). La prevalencia es más alta en los grupos de mayor edad con gradiente social. Tras ajustar por edad, sexo, clase social y obesidad, la percepción de la salud es peor en las personas afectadas (42,7% frente a 11%), que también declaran una mayor restricción de la actividad en el último año y en los últimos 15 días (OR=2,70 y 2,32, respectivamente), y un uso de los servicios sanitarios significativamente superior. Conclusiones: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor en las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.Objective: To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. Methods: A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. Results: Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. Conclusiones: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.

Este trabajo explora la existencia de desigualdades de género, de clase y territoriales en la salud de las personas mayores en España, según los datos de la Encuesta Nacional de Salud de 1997, el CMBD de hospitales de 1999, las estadísticas de mortalidad de 1998 y la Encuesta Nacional de Discapacidades de 1999. Se describen las similitudes y diferencias por género y clase social, en las conductas relacionadas con la salud, la salud percibida, los problemas de salud crónicos, la capacidad funcional y el uso de servicios sanitarios. Se comparan, asimismo, las tasas de mortalidad en personas mayores entre las 52 provincias españolas. Las mujeres y los miembros de las clases sociales más desfavorecidas muestran una peor salud percibida. Consumir tabaco o alcohol es más frecuente en los hombres que en las mujeres. La actividad física a esta edad depende, sobre todo, de la actividad cotidiana; los hombres y los miembros de las clases más favorecidas son los que adoptan, en mayor proporción, hábitos sedentarios. Las mujeres presentan problemas de dependencia funcional en mayor medida que los hombres, y entre ellas se observa un claro patrón de desigualdad. Los datos de mortalidad corroboran los hallazgos de otros estudios que sitúan las tasas más altas en el sur de la península.We explore gender, class and geographical inequalities in health of the population aged over 65 years in Spain. We gathered data from the 1997 National Health Survey, 1999 hospital discharge data, 1998 mortality data from vital statistics, and from the 1999 National Survey on Disabilities. Health related behaviors (tobacco and alcohol consumption, eating disorders and physical activity), self-rated health, chronic health problems, functional capacity, and health service utilization are described by gender and social class. Mortality rates among the elderly are compared between the 52 Spanish provinces. Women and members of the lower social classes present worse levels of self-rated health. Tobacco and alcohol consumption are more frequent among men than among women. Physical activity appears correlated to the every-day activities, men and those in the higher classes adopt sedentary habits in a greater proportion. Functional dependency is more frequent among women than among men, showing a clear pattern of inequality. As in other studies, the highest mortality rates were located in the southern part of Spain.

Background: The present study assesses the time intervals from symptom discovery to treatment start and describes the health service use experiences of uninsured patients with cancer of the breast, cervix uteri, testicle, and prostate before their arrival to the cancer hospital., Methods: This cross-sectional study included 1468 patients who were diagnosed between June 2016 and May 2017 and received treatment for the selected cancers in two of the largest public cancer hospitals in Mexico City, financed through Seguro Popular. Data was collected through a survey administered via face-to-face interviews with patients and a review of their medical files., Results: The median time between detection (symptom discovery or first abnormal screening test) and treatment start was 6.6 months. For all types of cancer, the longest interval was the diagnostic interval -between the first use of healthcare services and the confirmation of cancer. Less than 20% cancer patients were diagnosed in the earliest stages that are associated with the best chances of long-term survival. The participants described a high use of private services for their first consultation, the use of several different types of health services and multiple consultations before arrival to the cancer centers, and 35% perceived being misdiagnosed by the first doctor they consulted., Conclusions: Most cancer patients treated in the two largest public institutions available for the uninsured faced long delays to get diagnosed and started treatment at advanced stages. Strengthening quality and access for effective early cancer diagnosis and treatment is key to improve patient outcomes in low and middle-income settings., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Misdiagnosis of COPD is common. The goal of this study was to quantify the health services burden of undiagnosed and overdiagnosed COPD in a real-world, North American population., Methods: A population-based cohort study was conducted. Presence of COPD using spirometry was ascertained in randomly selected adults aged ≥ 40 years from Ontario, Canada, who participated in the Canadian Obstructive Lung Disease study. The presence of physician-diagnosed COPD was ascertained for the same subjects by using linked health administrative data. Participants were then categorized into four groups: correctly diagnosed, undiagnosed, overdiagnosed, and no COPD according to either criteria. Age- and sex-standardized rates of hospitalizations, ED visits, and ambulatory care visits in each group were determined and compared., Results: Of 1,403 participants, 13.7% had undiagnosed COPD, 5.1% were overdiagnosed, and 3.7% had correctly diagnosed COPD. Subjects with overdiagnosed COPD had significantly higher rates of hospitalizations, ED visits, and ambulatory care visits, and subjects with moderate to severe undiagnosed COPD had higher rates of hospitalizations, than subjects in the non-COPD population., Conclusions: Undiagnosed and overdiagnosed COPD contribute to significant health care burden. Given that misdiagnosed COPD was fivefold more common than correctly diagnosed COPD, these findings point to a substantial misdiagnosis-associated burden of disease that might be prevented, at least in part, with a correct diagnosis., (Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objective: The rate of caesarean section continues to increase, and there is evidence that childbirth fear is a contributing factor. Insufficient evidence is available on the impact of reducing childbirth fear on health-related quality of life and health service use. We undertook an economic evaluation of a psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia., Methods: Pregnant women (n = 339) with high childbirth fear were randomised to a midwife-led psycho-education intervention for childbirth fear or to usual care. This paper presents the economic evaluation of the intervention based on health-related quality of life and health service use from recruitment to six weeks postpartum (n = 184)., Results: The changes in health-related quality of life after birth (EQ-5D-3L: 0.016 vs. 0.010, p = 0.833, for usual care and intervention) and total health care use cost (AUS$10,110 vs. AUS$9980, p = 0.819) were similar between groups. The intervention did not increase costs; however, in a post hoc analysis, the interventions might be cost-effective for those women with very high childbirth fear., Conclusion: This brief psycho-education intervention by midwives did not improve the health-related quality of life of women, and had no impact on overall cost., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To explore factors that might lead to delays in appropriate cervical cancer screening and diagnosis among Black women in Massachusetts., Design: Qualitative using focus groups., Setting: Hospitals, health centers, and community-based organizations in Boston, Massachusetts., Participants: Sixty-four participants including Black, non-Hispanic women from the general population and cervical cancer survivors, community leaders in women's health, and health care providers., Methods: Six focus groups. Data were analyzed using methods based on grounded theory., Results: Findings from interviews revealed that inadequate information and education of providers and patients create barriers to appropriate screening and treatment practices for Black women. Fear, cultural beliefs, and compounding factors related to poverty, gender roles, and health system barriers create delays to screening and follow-up care. Also, unconscious bias, therapeutic delays, and miscommunication are important factors affecting continuity of care., Conclusion: These results suggest a need for comprehensive, culturally specific cervical cancer prevention education initiatives and interventions for Black women and strategies to improve patient-provider relationships., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)