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Understanding the Policy Context for Migrant Return and Reintegration

In advance of the December 2018 adoption of the Global Compact for Safe, Orderly, and Regular Migration and its commitment to facilitate the return, readmission, and reintegration of migrants, this webinar examines the policies, practices, and contextual factors that make compulsory returns such a difficult issue for international cooperation, and the programs that are being implemented to make reintegration of returnees sustainable.




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A Once-Smooth Path for the Global Compact on Migration Becomes Rocky

The world’s first international agreement on migration was approved by 164 countries in December 2018, but not without turbulence. U.S. withdrawal from the nonbinding Global Compact on Safe, Orderly, and Regular Migration, on grounds it could impinge on sovereignty, triggered similar actions by others, particularly in Eastern Europe. Amid ongoing political ripple effects, attention now turns to implementation of the deal's goals.




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Democratic Republic of the Congo: A Migration History Marked by Crises and Restrictions

One of the least developed countries in sub-Saharan Africa, the Democratic Republic of the Congo has experienced significant migration outflows and inflows tied to political and economic crises in recent decades. While most Congolese migrants head to neighboring countries, destinations have diversified, with an uptick in those leaving for opportunities in Europe and beyond. This country profile explores historical and contemporary patterns of migration to and from DR Congo.




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The New Reality: Germany Adapts to Its Role as a Major Migrant Magnet

Although long one of the world's top migrant destinations, only in the recent past has Germany come to acknowledge and adjust to its role as a country of immigration. Its welcoming approach—a relatively new development—has been put to the test amid massive humanitarian inflows beginning in 2015. This country profile examines Germany's history on immigration and highlights current and emerging debates.




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South Korea Carefully Tests the Waters on Immigration, With a Focus on Temporary Workers

Faced with labor shortages in key sectors of the economy, South Korea has moved carefully in recent decades toward accepting greater numbers of workers—albeit in temporary fashion. Its Employment Permit System, launched in 2003, earned international accolades for bringing order and legality to immigration in the country, although several challenges remain to be addressed as this Country Profile explores.




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As Its Population Ages, Japan Quietly Turns to Immigration

One of the most rapidly aging societies in the world, Japan is looking to immigration to address increased labor shortages—albeit slowly and largely without public debate. This country profile offers a brief overview of Japan’s migration history and examines the current immigration system, in particular policies and programs to bring in foreign workers, particularly on a temporary basis.




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Russia: A Migration System with Soviet Roots

The history of dynamic migration flows throughout the Soviet Union pre- and post-collapse has significantly shaped the current migration reality in Russia. Even as borders have shifted and policies changed, inflows and outflows still occur mostly within the former Soviet space. As this article explores, Russia has worked in recent decades to strengthen its migration management system and update its residence and citizenship policies.




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The Philippines: Beyond Labor Migration, Toward Development and (Possibly) Return

In the Philippines, a pervasive culture of migration has led millions to seek opportunities abroad, particularly since an economic downturn in the 1970s. The government has long embraced exporting labor as official economic policy, but over time, the focus has shifted: first to protecting workers overseas and much more recently to linking migration and development. This article explores the evolution of Filipino migration policy and trends.




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Afghanistan: Displacement Challenges in a Country on the Move

Nearly 6 million Afghans fled after violence erupted in the late 1970s, primarily to Iran and Pakistan. While millions returned after the collapse of the Taliban in 2001, the security situation has since deteriorated and the government struggles to meet the needs of vulnerable populations, particularly the internally displaced. This country profile explores Afghanistan’s complex migration and displacement history as well as ongoing challenges.




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Migration in Brazil: The Making of a Multicultural Society

In Brazil, where the majority of colonial-era residents were African slaves and their children, millions of immigrants have joined a conversation about race and identity that continues today. Brazil is home to the largest Japanese population outside of Japan, as well as significant European, Latin American, and Middle Eastern populations. This country profile explores historical and contemporary migration patterns in Brazil.




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Egypt: Migration and Diaspora Politics in an Emerging Transit Country

From being a source of labor emigration to the Gulf region to a destination for refugees from Syria, sub-Saharan Africa, and elsewhere, Egypt has long experienced different forms of mobility. This article, which profiles the trends and policies that have shaped Egypt's migration history, focuses on its long-standing use of migration as a soft-power tool to achieve its foreign policy aims and as a safety valve for political discontent.




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Migration in the Netherlands: Rhetoric and Perceived Reality Challenge Dutch Tolerance

The Netherlands has witnessed a rise in far-right populism, challenging its reputation as a humanitarian haven. Yet, public fears equating immigration with a rise in religious extremism do not necessarily reflect the facts. This profile explores historical and contemporary migration in a country where population growth relies largely on immigration, and analyzes to what extent policymaking has been shaped by rising populism.




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Using Fear of the “Other,” Orbán Reshapes Migration Policy in a Hungary Built on Cultural Diversity

The recent rise in xenophobia in Hungary stands in marked contrast with the country's rich migration history. After 390,000 migrants and asylum seekers arrived in 2015, the government of Viktor Orbán issued policies to significantly limit migration and enacted a law criminalizing humanitarian assistance to migrants. This country profile examines Hungary’s migration past and present, tracing the country’s multicultural heritage to the current wave of anti-immigrant sentiment.




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Years After Crimea’s Annexation, Integration of Ukraine’s Internally Displaced Population Remains Uneven

With nearly 1.4 million internally displaced persons (IDPs), Ukraine is home to one of the largest IDP populations in the world. Five years after Russia's annexation of Crimea, displaced Ukrainians continue to face challenges related to national identity, social cohesion, and political participation. While the Ukrainian government has had some success integrating IDPs, the conflict’s end remains uncertain, and many are unlikely to return to their communities of origin no matter the outcome.




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Changing U.S. Policy and Safe-Third Country “Loophole” Drive Irregular Migration to Canada

Nearly 50,000 asylum seekers have entered Canada irregularly via land crossing from the United States since spring 2017—contributing to a doubling in the overall number of asylum requests seen in 2016. Based on interviews with asylum claimants, this article analyzes their motivations for making the journey and the political implications of rising irregular migration to Canada.




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Climate Change and Migration Dynamics

The impact of climate change as a driver of human migration is expected by many to dwarf all others. Still, certain frequently repeated forecasts of the number of people who stand to be displaced by climate change are not informed by a complete understanding of migration dynamics, as this report explains.




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Redefining Nepal: Internal Migration in a Post-Conflict, Post-Disaster Society

Even as Nepal will lean more heavily on its international diaspora to help recover from devastating earthquakes that killed thousands and decimated parts of the country, the disasters have had effects on internal migration. Class and gender dynamics have long driven significant internal flows. This feature article explores migration trends in Nepal, including movement between ecological zones, growing urbanization, and the feminization of an increasingly mobile workforce.




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With Millions Displaced by Climate Change or Extreme Weather, Is There a Role for Labor Migration Pathways?

Climate-related displacement is not hypothetical: An average of 21.5 million people per year have been displaced since 2008 by natural disasters, and thousands more have fled slow-onset environmental hazards. While migration can serve as a safety valve to adapt to changing conditions, few orderly, legal channels exist for climate migrants (also known as environmental migrants), as this article explores.




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No Retreat: Climate Change and Voluntary Immobility in the Pacific Islands

While media and academic discussions of "climate refugees" paint a picture of mass displacement of millions, in reality many communities vulnerable to climate change may choose to stay as a result of strong cultural, historical, and spiritual attachments to place. This article explores this "voluntary immobility" and its implications in the Pacific Islands.




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Indonesia: A Country Grappling with Migrant Protection at Home and Abroad

Indonesia, which has a long history as a major origin for migrant labor in the Asia-Pacific and beyond, more recently has reluctantly found itself a transit and destination country, including for asylum seekers. Still, policymakers remain focused on protection of its nationals abroad rather than on assuring the status of Chinese and other foreigners in the country. This country profile explores Indonesia's rich migration history. 

 




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Many Psychology Experiments Lack Evidence of Validity, Says Report

Source:

An examination of nearly 350 published psychological experiments found that nearly half failed to show that they were based on a valid foundation of empirical evidence, suggesting that a wide swath of psychological science may be based on an "untested foundation."






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Often Overlooked Learning Disorder May Affect Millions of Kids

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New research suggests nonverbal learning disability, a poorly understood and often-overlooked disorder that causes problems with visual-spatial processing, may affect nearly 3 million children in the United States alone.






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Signs Your COVID-19 Anxiety Has Become Unhealthy, and What to Do

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As the coronavirus pandemic drags on, experts fear that some of us may begin to lose our ability to cope with the anxiety and stress. Here are five signs that coronavirus anxiety is becoming unhealthy, and tips on how to reduce it.






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U.N. Chief Says Disabled People Should Be Included in COVID-19 Plans

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Disabled people are among the hardest hit by the coronavirus pandemic, United Nations Secretary-General Antonio Guterres said Wednesday, and the inequalities that they already experience are being further intensified by the crisis. To address the problem, Guterres released a report recommending an integrated approach aimed at ensuring people with disabilities are included in response and recovery plans.






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Nearly 20,000 Teens in Georgia Receive Licenses Without a Road Test

Source:

The sweaty palms on the steering wheel. The repeated exclamations of "Sorry!" The nervous glances from the examiner. They're all part of the dreaded road test, which, for decades, has been a rite of passage for every U.S. teenager to obtain a driver's license. Yet now, due to the coronavirus pandemic, nearly 20,000 teens in Georgia have received licenses without taking an official road test, and Wisconsin will soon follow suit.






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Color Boost: How Vivid Hues in Your Home Can Lift Your Mood

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How do colors make us feel? This question has guided color specialist Leatrice Eiseman since childhood. As the executive director of the Pantone Color Institute, she leads color trends and forecasts as well as the decision-making behind the company's annual "Color of the Year" (the choice for 2020, Classic Blue, is proving to be an apt calming color for an already anxious year).






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The Psychology Behind Why Some People Won't Wear Masks

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Most Americans have never had to wear a mask for their health before, let alone while they shop for groceries or go for a run. So, even as businesses or states increasingly require them, rebellion is natural, experts say. In response, they urge Americans to think of the mask guidance not as forced conformity, but as a necessary act of solidarity.






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Ahmaud Arbery and the Racist History of U.S. Loitering Laws

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Ahmaud Arbery went for a jog in a neighborhood of Brunswick, Georgia, a coastal town south of Savannah, in late February. He paused to look around a construction site of a new house. Then, in the middle of his run, a newly public video reveals, he was confronted by Gregory and Travis McMichael, a father-son duo. The father, Gregory, was a retired police officer who'd seen Arbery and decided he looked like a local burglary suspect.






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"Loss of Pleasure" Found in Teen Sleep Study

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Sleep patterns around the world have been disrupted as screen time increases and sleep routines change with COVID-19 self-isolation requirements. Negative mood is not unusual in adolescence, but lack of sleep can affect mental health, causing anhedonia (or loss of pleasure), anxiety, anger and significantly increasing the risk of depression, a global study of more than 350,000 teens suggests.






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Navajo Nation Reels Under Weight of Coronavirus and History of Neglect

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The Navajo Nation now has the highest per-capita coronavirus infection rate after New York and New Jersey, but it has a fraction of the resources to treat and prevent the pandemic. "This has got to end," said president Jonathan Nez after federal relief funds arrived six weeks after they were promised and a week after the U.S. government missed a congressional deadline for distribution.






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What If You Don't Want to Go Back to the Office?

Source:

For Jeff Anderson, working from home during the pandemic has offered a break from office politics. But as the push to reopen the country's economy intensifies, so do feelings of dread at the idea of returning to the office, said Anderson, a self-described introvert and anthropology professor. And Anderson isn't alone. A Gallup poll found that most U.S. adults working from home would prefer to keep doing so "as much as possible" after the...






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Emigration Trends and Policies in China: Movement of the Wealthy and Highly Skilled

This report analyzes the evolution of Chinese emigration from the 1970s, when market-oriented reforms began reducing barriers to movement beyond the country's borders, to the present day. High-skilled and high-value emigration is rising fast. Despite liberalized exit controls, low-skilled labor migration is stagnant as a result of complicated and expensive recruitment procedures.




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Achieving Skill Mobility in the ASEAN Economic Community: Challenges, Opportunities, and Policy Implications

This report by MPI and the Asian Development Bank lays out a realistic roadmap toward freer movement among skilled professionals within the ASEAN Economic Community (AEC), encouraging cooperation among ASEAN Member States in recognizing foreign qualifications and making government investments in training and educations systems that prepare workers in accordance with common standards.




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The Germany-Turkey Migration Corridor: Refitting Policies for a Transnational Age

This Transatlantic Council on Migration report describes how the migration of nationals between Germany and Turkey has developed over recent decades; examines the economic, social, and political factors behind this development; and discusses the policy implications and lessons that can be drawn.




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Firing Up Regional Brain Networks: The Promise of Brain Circulation in the ASEAN Economic Community

Given diverging demographics, rising educational attainment and wide variation in economic opportunities, countries in the Association of Southeast Asian Nations are poised to see an expansion of both the demand for and supply of skilled migrants willing and able to move. The convergence of these megatrends represents unique opportunities for human-capital development and brain circulation, as this report explores.




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Children on the Run: An Analysis of First-Hand Accounts from Children Fleeing Central America

This event with UN High Commissioner for Refugees António Guterres includes a discussion on the state of citizen security in Central America and the resulting humanitarian impact, featuring findings from Children on the Run, a UNHCR report based on interviews with more than 400 unaccompanied children from the region.




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Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing

Amid aging populations and the growth of chronic diseases, the demand for skilled health-care professionals is on the rise in the United States, Canada, and Mexico. This report explores the policy implications, benefits, and challenges of harmonizing nursing qualifications in the region, suggesting that a more collaborative approach could result in greater supply and quality of nurses.




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Exploring Innovative Ideas to Strengthen the Global Protection System

A discussion, including the former United Nations Deputy High Commissioner for Refugees, examining the huge strains on the global protection system and how it can better respond to protracted refugee situations and other long-term displacement, focusing on the conclusions of the Transatlantic Council on Migration's recent meeting, Beyond Asylum: Rethinking Protection Policies to Meet Sharply Escalating Needs.




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La Situación de Cambio Constante entre EE UU y México: Tendencias y Políticas de Migración, Incluyendo Menores No Acompañados

Una llamada en español que analiza las dinámicas cambiantes y las cuestiones políticas relacionadas con la migración a través de México a los Estados Unidos.




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La Situación de Cambio Constante entre EE UU y México: Tendencias y Políticas de Migración, Incluyendo Menores No Acompañados

Durante este seminario, ponentes presentaron hallazgos de un reciente informe que utiliza datos de agencias gubernamentales mexicanas, entrevistas con funcionarios clave y relatos de la sociedad civil para examinar el marco legal para la protección de menores no acompañados y su aplicación, al igual que las brechas entre este marco y su aplicación durante los procesos de detención, interrogación y alojamiento. El presidente de MPI, Andrew Selee, también expuso cómo el cambio en la dinámica política en Estados Unidos puede afectar las cuestiones migratorias con México, así como los efectos en la relación bilateral en medio de tensiones sobre el muro fronterizo, la renegociación del acuerdo del TLCAN y una cifra significativa de repatriaciones de migrantes mexicanos.




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Temporary Protected Status at Risk: Implications for Central America and U.S. Policy

As the Trump administration weighs the future of Temporary Protected Status (TPS) for Salvadorans, this teleconference focuses on the legal framework for TPS (particularly for Hondurans and Salvadorans) and profile of current TPS holders; the capacity of El Salvador and Honduras to receive and meaningfully reintegrate returnees; and the implications of TPS termination for broader U.S. policy goals in Central America.




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Economy

Economy (date: 5/9/2020 - Rank: 3)




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Suicide Risk Assessment in Youth and Young Adults With Type 1 Diabetes

OBJECTIVE

To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments.

RESEARCH DESIGN AND METHODS

The Patient Health Questionnaire–9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10–24 years. Only individuals who endorsed suicidal/death ideations (n = 49) completed a standardized suicide risk assessment protocol and safety planning.

RESULTS

Nine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n = 39) or young adults (n = 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred.

CONCLUSIONS

The findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.




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Randomized Study to Evaluate the Impact of Telemedicine Care in Patients With Type 1 Diabetes With Multiple Doses of Insulin and Suboptimal HbA1c in Andalusia (Spain): PLATEDIAN Study

OBJECTIVE

To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients’ health-related quality of life (HRQoL), and physicians’ satisfaction in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians’ satisfaction.

RESULTS

At month 6, the mean change in HbA1c levels was –0.04 ± 0.5% (–0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05).

CONCLUSIONS

The use of telemedicine in patients with type 1 diabetes with HbA1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.




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Diabetes INSIDE: Improving Population HbA1c Testing and Targets in Primary Care With a Quality Initiative

OBJECTIVE

To improve outcomes of patients with adult type 2 diabetes by decreasing HbA1c undertesting, reducing the proportion of patients with poor glycemic control, and lowering mean HbA1c levels using a quality improvement (QI) program.

RESEARCH DESIGN AND METHODS

Six years of outpatient electronic health record (EHR) data were analyzed for care gaps before and 2 years after implementing a QI initiative in an urban academic medical center. QI strategies included 1) individual provider and departmental outcome reports, 2) patient outreach programs to address timely follow-up care, 3) a patient awareness campaign to improve understanding of achieving clinical goals, 4) improving EHR data capture to improve population monitoring, and 5) professional education.

RESULTS

Analysis (January 2010 to May 2018) of 7,798 patients from Tulane Medical Center (mean age 61 years, 57% female, 62% black, 97% insured) with 136,004 visits showed target improvements. A Cox proportional hazards model controlling for age, sex, race, and HbA1c level showed a statistically significant reduction in HbA1c undertesting >6 months (hazard ratio 1.20 ± 0.07). Statistical process control charts showed 15.5% relative improvement in the patient proportion with HbA1c >9% (75 mmol/mol) from 13% to 11% (P < 10–6) following QI interventions and a 2.1% improvement of population mean HbA1c from 7.4% (57 mmol/mol) to 7.2% (55 mmol/mol) (P < 10–6).

CONCLUSIONS

Multidisciplinary QI teams using EHR data to design interventions for providers and patients produced statistically significant improvements in both care process and clinical outcome goals.




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Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort

OBJECTIVE

In patients with type 1 diabetes and end-stage renal disease, it is controversial whether a simultaneous pancreas-kidney (SPK) transplantation improves survival compared with kidney transplantation alone. We compared long-term survival in SPK and living- or deceased-donor kidney transplant recipients.

RESEARCH DESIGN AND METHODS

We included all 2,796 patients with type 1 diabetes in the Netherlands who started renal replacement therapy between 1986 and 2016. We used multivariable Cox regression analyses adjusted for recipient age and sex, dialysis modality and vintage, transplantation era, and donor age to compare all-cause mortality between deceased- or living-donor kidney and SPK transplant recipients. Separately, we analyzed mortality between regions where SPK transplant was the preferred intervention (80% SPK) versus regions where a kidney transplant alone was favored (30% SPK).

RESULTS

Of 996 transplanted patients, 42%, 16%, and 42% received a deceased- or living-donor kidney or SPK transplant, respectively. Mean (SD) age at transplantation was 50 (11), 48 (11), and 42 (8) years, respectively. Median (95% CI) survival time was 7.3 (6.2; 8.3), 10.5 (7.2; 13.7), and 16.5 (15.1; 17.9) years, respectively. SPK recipients with a functioning pancreas graft at 1 year (91%) had the highest survival (median 17.4 years). Compared with deceased-donor kidney transplant recipients, adjusted hazard ratios (95% CI) for 10- and 20-year all-cause mortality were 0.79 (0.49; 1.29) and 0.98 (0.69; 1.39) for living-donor kidney and 0.67 (0.46; 0.98) and 0.79 (0.60; 1.05) for SPK recipients, respectively. A treatment strategy favoring SPK over kidney transplantation alone showed 10- and 20-year mortality hazard ratios of 0.56 (0.40; 0.78) and 0.69 (0.52; 0.90), respectively.

CONCLUSIONS

Compared with living- or deceased-donor kidney transplantation, SPK transplant was associated with improved patient survival, especially in recipients with a long-term functioning pancreatic graft, and resulted in an almost twofold lower 10-year mortality rate.




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Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial

OBJECTIVE

To evaluate and compare the efficacy of long-term use of low-dose aspirin for the prevention of dementia in men and women.

RESEARCH DESIGN AND METHODS

This study is a follow-up cohort study of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial, which was a randomized, open-label, standard care–controlled trial examining the effects of low-dose aspirin on cardiovascular events. We followed up 2,536 Japanese patients with type 2 diabetes (T2D) enrolled in the JPAD trial from 2002 to 2017. The primary outcome of this post hoc analysis was the incidence of dementia, which was defined by the prescription of antidementia drugs or admission due to dementia.

RESULTS

Among the originally enrolled patients, 2,121 (84%) retained their original allocation. During a median follow-up of 11.4 years, 128 patients developed dementia. The overall effect of low-dose aspirin on the prevention of dementia adjusted for age, sex, and other established risk factors was not significant (hazard ratio [HR] 0.82, 95% CI 0.58–1.16). However, a significant reduction was seen in the risk of dementia in women (HR 0.58, 95% CI 0.36–0.95), but not in men (HR 1.27, 95% CI 0.75–2.13) (Pinteraction = 0.03).

CONCLUSIONS

Long-term use of low-dose aspirin may reduce the risk for dementia in women with T2D.




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Late Relapse of Diabetes After Bariatric Surgery: Not Rare, but Not a Failure

OBJECTIVE

To characterize the status of cardiometabolic risk factors after late relapse of type 2 diabetes mellitus (T2DM) and to identify factors predicting relapse after initial diabetes remission following bariatric surgery to construct prediction models for clinical practice.

RESEARCH DESIGN AND METHODS

Outcomes of 736 patients with T2DM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at an academic center (2004–2012) and had ≥5 years’ glycemic follow-up were assessed. Of 736 patients, 425 (58%) experienced diabetes remission (HbA1c <6.5% [48 mmol/mol] with patients off medications) in the 1st year after surgery. These 425 patients were followed for a median of 8 years (range 5–14) to characterize late relapse of diabetes.

RESULTS

In 136 (32%) patients who experienced late relapse, a statistically significant improvement in glycemic control, number of diabetes medications including insulin use, blood pressure, and lipid profile was still observed at long-term. Independent baseline predictors of late relapse were preoperative number of diabetes medications, duration of T2DM before surgery, and SG versus RYGB. Furthermore, patients who relapsed lost less weight during the 1st year after surgery and regained more weight afterward. Prediction models were constructed and externally validated.

CONCLUSIONS

While late relapse of T2DM is a real phenomenon (one-third of our cohort), it should not be considered a failure, as the trajectory of the disease and its related cardiometabolic risk factors is changed favorably after bariatric surgery. Earlier surgical intervention, RYGB (compared with SG) and more weight loss (less late weight regain) are associated with less diabetes relapse in the long-term.




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Intellectual Disability in KATP Channel Neonatal Diabetes

OBJECTIVE

Neonatal diabetes has been shown to be associated with high neuropsychiatric morbidity in a genotype-phenotype–dependent manner. However, the specific impact of different mutations on intellectual functioning is still insufficiently characterized. Specifically, only a small number of subjects with developmental delay have been comprehensively assessed, creating a knowledge gap about patients carrying the heaviest burden.

RESEARCH DESIGN AND METHODS

We assessed the intellectual functioning and mental health of the complete Norwegian population with KATP channel neonatal diabetes. Eight sulfonylurea-treated children (five with the p.V59M genotype [KCNJ11]) were assessed using age-matched control subjects with type 1 diabetes. The investigations included a physical and motor developmental examination, cerebral MRI, psychometrical examination, and questionnaires assessing intellectual capabilities and psychiatric morbidity.

RESULTS

A strong genotype-phenotype correlation was found, revealing the p.V59M genotype as highly associated with substantial intellectual disability, with no significant correlation with the time of sulfonylurea initiation. Consistent with previous studies, other genotypes were associated with minor cognitive impairment. Cerebral MRI verified normal brain anatomy in all but one child.

CONCLUSIONS

We here presented a comprehensive assessment of intellectual functioning in the largest cohort of p.V59M subjects to date. The level of intellectual disability revealed not only changes the interpretation of other psychological measures but downplays a strong protective effect of sulfonylurea. Within the scope of this study, we could not find evidence supporting an early treatment start to be beneficial, although a weaker effect cannot be ruled out.




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Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease--A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

OBJECTIVE

Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects.

RESEARCH DESIGN AND METHODS

The European Society of Cardiology’s European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016–2017) included 8,261 CAD patients, aged 18–80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated.

RESULTS

A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium–glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small.

CONCLUSIONS

Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.