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Tag: Wake Forest University School of Medicine

  • Fear of Public Places Is Common in Adults with Epilepsy

    Fear of Public Places Is Common in Adults with Epilepsy

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    Newswise — About 5.1 million people in the U.S. have a history of epilepsy, which causes repeated seizures. According to the Epilepsy Foundation, epilepsy is the fourth most common neurological disorder. While current research has shown an increase in anxiety and depression among people with epilepsy, little is known about this population and agoraphobia, an anxiety disorder that involves the fear of being in a public place or in a situation that might cause panic or embarrassment.

    However, a recent study from Heidi Munger Clary, M.D., M.P.H., associate professor of neurology at Wake Forest University School of Medicine, shows that phobic and agoraphobic symptoms are common and associated with poor quality of life in people with epilepsy.

    The study appears online in Epilepsy Research.

    “We know that agoraphobia can lead to delays in patient care because of a reluctance to go out in public, which includes appointments with health care providers,” said Munger Clary, the study’s principal investigator. “So, this is an area that needs more attention in clinical practice.”

    In the study, researchers conducted a cross-sectional analysis of baseline clinical data from a neuropsychology registry cohort study. Researchers analyzed a diverse sample of 420 adults, ages 18 to 75, with epilepsy who underwent neuropsychological evaluation over a 14-year period at Columbia University Medical Center in New York.

    “More than one-third of the participants reported significant phobic/agoraphobic symptoms,” Munger Clary said. “We also found that phobic/agoraphobic symptoms, along with depression symptoms, were independently associated with poor quality of life, but generalized anxiety symptoms were not.” 

    According to Munger Clary, because phobic/agoraphobic symptoms are not routinely assessed by clinicians, the findings may suggest a need for future studies to develop more comprehensive screeners for psychiatric comorbidity in epilepsy.

    “Symptoms of agoraphobia do not fully overlap with generalized anxiety or depression symptoms that are often screened in routine practice,” Munger Clary said. “Providers might want to consider more robust symptom screening methods to identify and better assist these patients. This may be important to improve health equity, given other key study findings that show those with lower education and non-white race/ethnicity had increased odds of significant phobic/agoraphobic symptoms.”

    This work was supported in part by the National Institutes of Health under grants R01 NS035140, KM1 CA156709, UL1 TR001420 and 5KL2TR001421-04. 

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    Wake Forest University School of Medicine

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  • Families with Food Insecurity Have Greater Health Care Expenditures

    Families with Food Insecurity Have Greater Health Care Expenditures

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    Newswise — WINSTON-SALEM, N.C. – Jan. 9, 2023 – Food insecurity, which is the limited or uncertain availability of nutritionally adequate and safe food, impacts about 10.2% of U.S. households, according to the U.S. Department of Agriculture Economic Research Service. In families with children in the home, food insecurity is even higher, at 12.5%.

    Previous studies have shown an association between food insecurity and individual health care expenditures, but there is little research on how food insecurity impacts families’ health care use.

    Now, researchers at Wake Forest University School of Medicine are reporting the results of a new study that shows food-insecure families have higher health care expenditures than families that are food secure.

    The study was released today in the January issue of Health Affairs.

    “We know that food insecurity has a negative impact on individual health outcomes,” said Deepak Palakshappa, M.D., associate professor of general internal medicine at Wake Forest University School of Medicine and principal investigator of the study. “But we need a better understanding of the financial implications on families and health care expenditures.”

    In the retrospective study, Palakshappa’s team sought to determine the association between a family’s food insecurity over the course of one year and their health care expenditures throughout the following year. Researchers analyzed data from the 2016 and 2017 Medical Expenditure Panel Survey, a large-scale survey conducted annually by the Agency for Healthcare Research and Quality that is representative of the U.S. population. The survey collects information from U.S. medical providers about health care services, health insurance, expenditures and sociodemographic characteristics.

    The team collected data on 14,666 individuals from 6,621 families and found that food-insecure families had 20% greater total health care expenditures than food-secure families, an annual difference of about $2,456.

    “We found that food insecurity in 2016 was associated with increased care expenditures in 2017 among families regardless of insurance coverage type,” Palakshappa said.

    The results also have significant implications for any potential programs or policies aimed at addressing food insecurity.

    “Interventions that address food insecurity in one or more specific family members may also provide benefits to others in the home,” Palakshappa said. “And there’s a potential financial benefit for insurers to invest in these programs.”

    Palakshappa’s team also found that 1 in 5 families had more than one insurance plan, making it challenging to determine the full financial benefit of food insecurity interventions in households with mixed insurance coverage.

    “More parents are enrolling their children in Medicaid or CHIP instead of their employer-sponsored health insurance because of increased out-of-pocket expenses,” Palakshappa said. “However, the expansion of public subsidies such as the Supplemental Nutrition Assistance Program or child tax credits can alleviate food insecurity.”

    Palakshappa said additional research is needed to evaluate how addressing food insecurity at an individual patient visit may affect the health outcomes and health care utilization of other family members.

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    Wake Forest University School of Medicine

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