Understanding recent increases in chronic disease treatment rates: More disease or more detection?
ABSTRACT The proportion of the population treated for major medical conditions, including diabetes, cancer and mental illness, increased rapidly during the 1990s. We document the magnitude of these increases and use a model of prevalence to identify three potential causes: increased clinical incidence of disease, longer survival times among persons with chronic illnesses and increased detection. We present a series of analyses to evaluate the contribution of each factor. We find that increases in obesity explain a large proportion of the increase in treatment rates for conditions closely linked to obesity (e.g. diabetes). We provide some evidence that increases in treated prevalence unexplained by changes in the underlying clinical incidence of disease are driven by increased detection and treatment of patients with 'subclinical' illness.
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ABSTRACT: Registered Dietitian (RD) services as part of insurance wellness programs offer a promising venue for improving public health. This study was conducted to evaluate the effectiveness of RD nutrition counseling services provided as part of an insurance benefit on body weight and associated health parameters. Eligible members could enroll to receive 6 RDs visits a year for assistance with weight management. The study RDs were randomized into either Usual Care (UC) or Lifestyle Case Management (LCM) groups. Body weight, waist circumference, and systolic and diastolic blood pressure measurements of program enrollees were evaluated for between group as well as start and end program comparisons. There was a statistically significant difference in the number of RD follow-up visits between the two groups as LCM patients had more RD contact than UC patients. Weight and waist circum-ference changes from baseline to end of study show statistically significant changes with a trend for improvement in systolic blood pressure. Additionally, a clinically significant reduction in weight was achieved in a quarter of program enrollees. In conclusion this study shows that through a coordinated health promotion program RDs' services are of value to an insured population.Food and Nutrition Sciences 01/2011; 02(10). DOI:10.4236/fns.2011.210139
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ABSTRACT: Given a complex smooth projective curve X and a vector bundle E on it; there is a corresponding vector bundle F(E) on the symmetric product Sn(X) for any n. We show that there is a natural parabolic structure on the vector bundle F(E). We prove that F(E) is parabolic semistable (respectively, parabolic polystable) if and only if E is semistable (respectively, polystable). If E is not the trivial line bundle on X, then we prove that F(E) is parabolic stable if and only if E is stable.Journal of Geometry and Physics 04/2011; 61(4):773-780. DOI:10.1016/j.geomphys.2010.12.005 · 0.80 Impact Factor
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ABSTRACT: The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. An emerging science that uses quantitative models has provided key insights into the dynamics of this epidemic, and enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels--from individual to population. Forecasts suggest that high rates of obesity will affect future population health and economics. Energy gap models have quantified the association of changes in energy intake and expenditure with weight change, and have documented the effect of higher intake on obesity prevalence. Empirical evidence that shows interventions are effective is limited but expanding. We identify several cost-effective policies that governments should prioritise for implementation. Systems science provides a framework for organising the complexity of forces driving the obesity epidemic and has important implications for policy makers. Many parties (such as governments, international organisations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. The integration of actions within existing systems into both health and non-health sectors (trade, agriculture, transport, urban planning, and development) can greatly increase the influence and sustainability of policies. We call for a sustained worldwide effort to monitor, prevent, and control obesity.The Lancet 08/2011; 378(9793):838-47. DOI:10.1016/S0140-6736(11)60815-5 · 45.22 Impact Factor