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OBJECTIVE: Mitochondrial dysfunction, linked to sepsis-related organ failure, is unknown in febrile illness. METHODS: Prospective study of children in an Emergency Department (ED) with febrile illness or without infection (ED controls); secondary analysis of ICU patients with sepsis or without infection (ICU controls). Mitochondrial oxygen consumption measured in peripheral blood mononuclear cells using respirometry, with primary outcome of spare respiratory capacity (SRC). Mitochondrial content measured as citrate synthase (CS: febrile illness and ED controls) and mitochondrial to nuclear DNA ratio (mtDNA:nDNA: all groups). RESULTS: SRC was lower in febrile illness (6.7 ± 3.0 pmol/sec/106 cells) and sepsis (5.7 ± 4.7) than ED/PICU controls (8.5 ± 3.7; both p < 0.05), but not different between febrile illness and sepsis (p = 0.26). Low SRC was driven by increased basal respiration in febrile illness and decreased maximal uncoupled respiration in sepsis. Differences were no longer significant after adjustment for patient demographics. Febrile illness demonstrated lower CS activity than ED controls (p = 0.07) and lower mtDNA:nDNA than both ED/PICU controls and sepsis (both p < 0.05). CONCLUSION: Mitochondrial SRC was reduced in both febrile illness and sepsis, but due to distinct mitochondrial profiles and impacted by demographics. Further work is needed to determine if mitochondrial profiles could differentiate febrile illness from early sepsis. IMPACT STATEMENT: Mitochondrial dysfunction has been linked to organ failure in sepsis, but whether mitochondrial alterations are evident in febrile illness without sepsis is unknown. In our study, while mitochondrial spare respiratory capacity (SRC), an index of cellular bioenergetic reserve under stress, was reduced in children with both febrile illness and sepsis compared to children without infections, low SRC was driven by increased basal respiration in febrile illness compared with decreased maximal uncoupled respiration in sepsis. Additional research is needed to understand if distinct mitochondrial profiles could be used to differentiate febrile illness from early sepsis in children.
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BACKGROUND: Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension medication adherence remains uncertain. METHODS: Data from the 2016 to 2021 Merative MarketScan Commercial Claims and Encounters Database were used to construct the study cohort, which included nonpregnant individuals aged 25 to 64 years with hypertension. We coded telehealth parity laws related to hypertension management in all 50 US states and the District of Columbia, distinguishing between payment and coverage parity laws. The primary outcomes were measures of antihypertension medication adherence: the average medication possession ratio; medication adherence (medication possession ratio ≥80%); and average number of days of drug supply. We used a generalized difference-in-differences design to examine the impact of these laws. RESULTS: Among 353 220 individuals (mean [SD] age, 49.5 (7.1) years; female, 45.55%), states with payment parity laws were significantly linked to increased average medication possession ratio by 0.43 percentage point (95% CI, 0.07-0.79), and an increase of 0.46 percentage point (95% CI, 0.06-0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI, 0.11-4.17) in prescription supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, gross domestic product per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI, 0.19-4.07) in days of prescription supply but did not significantly increase the average medication possession ratio or probability of medication adherence. CONCLUSIONS: State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.
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BACKGROUND: Recent studies suggest that children and adolescents are at an increased risk of experiencing violence during the COVID-19 pandemic. However, there is limited knowledge about the prevalence of violence against children and adolescents across different regions in the world. OBJECTIVE: To estimate the pooled prevalence of violence against children and adolescents during the COVID-19 pandemic and explore how geographical and methodological factors explain the variation across studies. METHODS: We conducted a systematic search of MEDLINE, Embase, and PsycInfo databases for articles published from January 1, 2020 to October 1, 2022. The study protocol was pre-registered with PROSPERO (CRD42022338181). We included published and unpublished studies available in English that reported the prevalence of violence (e.g., physical, emotional, or sexual violence, neglect, bullying) against children and adolescents (age <18 years) during the pandemic. Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A total of 2740 nonduplicate titles and abstracts were screened, and 217 full-text articles were reviewed for eligibility. RESULTS: Twenty-five studies with 66,637 participants met inclusion criteria. Based on random-effects meta-analysis, the pooled prevalence of violence against children and adolescents was 24 % (95%CI 18 %-30 %). The reported prevalence was higher in studies conducted in low- and middle-income countries compared to high-income countries. CONCLUSIONS: Over one in five children and adolescents globally reported ever experiencing violence during the COVID-19 pandemic. Our findings highlight the urgent need for effective child protection policies and interventions, as well as multisectoral collaboration, to reduce violence against children and adolescents.
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COVID-19 , Maus-Tratos Infantis , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Adolescente , Criança , Prevalência , Maus-Tratos Infantis/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Violência/estatística & dados numéricos , SARS-CoV-2RESUMO
INTRODUCTION: Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS: Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS: About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS: The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
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BACKGROUND: Medicare supplement insurance, or Medigap, covers 21% of Medicare beneficiaries. Despite offsetting some out-of-pocket (OOP) expenses, remaining OOP costs may pose a barrier to medication adherence. This study aims to evaluate how OOP costs and insurance plan types influence medication adherence among beneficiaries covered by Medicare supplement plans. METHODS: We conducted a retrospective analysis of the Merative MarketScan Medicare Supplement Database (2017-2019) in Medigap enrollees (≥65 years) with hypertension. The proportion of days covered (PDC) was a continuous measure of medication adherence and was also dichotomized (PDC ≥0.8) to quantify adequate adherence. Beta-binomial and logistic regression models were used to estimate associations between these outcomes and insurance plan type and log-transformed OOP costs, adjusting for patient characteristics. RESULTS: Among 27,407 patients with hypertension, the average PDC was 0.68â ±â 0.31; 47.5% achieved adequate adherence. A mean $1 higher in 30-day OOP costs were associated with a 0.06 (95% confidence intervals [CIs]: -0.09 to -0.03) lower probability of adequate adherence, or a 5% (95% CI: 4%-7%) decrease in PDC. Compared with comprehensive plan enrollees, the odds of adequate adherence were lower among those with point-of-service plans (odds ratio [OR]: 0.69, 95% CI: 0.62-0.77), but higher among those with preferred provider organization (PPO) plans (OR: 1.08, 95% CI: 1.01-1.15). Moreover, the association between OOP costs and PDC was significantly greater for PPO enrollees. CONCLUSIONS: While Medicare supplement insurance alleviates some OOP costs, different insurance plans and remaining OOP costs influence medication adherence. Reducing patient cost-sharing may improve medication adherence.
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Anti-Hipertensivos , Gastos em Saúde , Hipertensão , Adesão à Medicação , Humanos , Estados Unidos , Adesão à Medicação/estatística & dados numéricos , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/economia , Masculino , Feminino , Estudos Retrospectivos , Idoso , Idoso de 80 Anos ou mais , Seguro de Saúde (Situações Limítrofes)/economia , Medicare/economia , Custos de Medicamentos , Bases de Dados FactuaisRESUMO
INTRODUCTION: Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020. METHODS: This longitudinal analysis of 2,846 counties from 2017-2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure. RESULTS: In our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7`; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents. CONCLUSIONS: Our findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.
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Overdose de Drogas , Racismo , Determinantes Sociais da Saúde , Humanos , Overdose de Drogas/mortalidade , Racismo/estatística & dados numéricos , Masculino , Feminino , Estudos Longitudinais , Adulto , Estados Unidos/epidemiologiaRESUMO
The structural, mechanical, and electronic properties of cubic Cr0.5-xAl0.5TMxN, doped with TM (transition metal) elements (TM = Ti, V, Y, Zr, Hf, and Ta) at low concentrations (x = 0.03 and 0.06), was investigated by first-principles calculations. The results of the structural properties calculations reveal that the addition of Ti, Y, Hf, Zr, and Ta expand the volume, while V has the opposite effect. All doped compounds are thermodynamically stable, and Cr0.5-xAl0.5TMxN with TM = Ti is energetically more favorable than other doped compounds. At the same doping concentration, Cr0.5-xAl0.5VxN possesses the highest stiffness, hardness, and resistance to external forces due to its greatest mechanical properties, and Cr0.5-xAl0.5TaxN possesses the highest elastic anisotropy and the lowest Young's modulus. Substituting Cr atoms with TM atoms in a stepwise manner results in a decrease in the bulk modulus, shear modulus, Young's modulus, and theoretical hardness of Cr0.5-xAl0.5TMxN, while increasing its toughness. Based on the calculation results of the total and partial density of states of Cr0.5Al0.5N and Cr0.47Al0.5TM0.03N, all compounds exhibit metallic behavior as indicated by the finite density of states at the Fermi level. The contribution of Ti-3d, V-3d, and Ta-3d orbitals at Fermi level is significantly higher than that of other TM atoms, resulting in a more pronounced metallic character for Cr0.47Al0.5Ti0.03N, Cr0.47Al0.5V0.03N, and Cr0.47Al0.5Ta0.03N.
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Importance: Economic policies have the potential to impact management and control of hypertension. Objectives: To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. Evidence Review: A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than â140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. Findings: In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. Conclusions and Relevance: The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.
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Hipertensão , Medicare Part D , Idoso , Adulto , Humanos , Estados Unidos/epidemiologia , Anti-Hipertensivos/uso terapêutico , Reembolso de Incentivo , Hipertensão/tratamento farmacológico , Atenção à SaúdeRESUMO
BACKGROUND: Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties young adult cancer survivors in the United States experience in the post-Patient Protection and Affordable Care Act period. METHOD: We identified 1009 cancer survivors aged 18 to 39 years from the National Health Interview Survey (2015-2022) and matched 963 (95%) cancer survivors to 2733 control individuals using nearest-neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and to assess whether this association varied by age, sex, race and ethnicity, and region of residence. RESULTS: Compared with those who did not have a history of cancer, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio = 1.65, 95% confidence interval = 1.50 to 1.81) and behavior-related financial hardship (34.3% vs 24.4%; odds ratio = 1.62, 95% confidence interval = 1.49 to 1.76) but not psychological financial hardship (52.6% vs 50.9%; odds ratio = 1.07, 95% confidence interval = 0.99 to 1.16). Young adult cancer survivors who were Hispanic or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. CONCLUSIONS: We found that young adult cancer survivors were more likely to experience material and behavior-related financial hardship than young adults without a history of cancer. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.
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Sobreviventes de Câncer , Estresse Financeiro , Neoplasias , Humanos , Adulto Jovem , Etnicidade , Neoplasias/epidemiologia , Neoplasias/terapia , Patient Protection and Affordable Care Act , Estados Unidos/epidemiologia , Adolescente , AdultoRESUMO
BACKGROUND: Previous studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the United States (US). METHODS: Serial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999-2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed. RESULTS: A total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) (P-trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) (P-trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) (P-interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full (P-trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) (P-trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) (P-trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low (P-trend = 0.35) (P-interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others. CONCLUSIONS AND RELEVANCE: Prevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.
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Diabetes Mellitus , Hipertensão , Adulto , Humanos , Feminino , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Masculino , Inquéritos Nutricionais , Prevalência , Estudos Transversais , Hipertensão/epidemiologia , Diabetes Mellitus/epidemiologia , Segurança AlimentarRESUMO
OBJECTIVE: Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system. METHODS: Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis. RESULTS: State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement. CONCLUSIONS AND IMPLICATIONS: Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.
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Atenção Plena , Telemedicina , Humanos , Educação em Saúde , Dieta , Estado NutricionalRESUMO
OBJECTIVE: To compare hospitalization rates between African American (AA) and European American (EA) deceased-donor (DD) kidney transplant (KT) recipients during over a10-year period. METHOD: Data from the Scientific Registry of Transplant Recipients and social determinants of health (SDoH), measured by the Social Deprivation Index, were used. Hospitalization rates were estimated for kidney recipients from AA and EA DDs who had one kidney transplanted into an AA and one into an EA, leading to four donor/recipient pairs (DRPs): AA/AA, AA/EA, EA/AA, and EA/EA. Poisson-Gamma models were fitted to assess post-transplant hospitalizations. RESULT: Unadjusted hospitalization rates (95% confidence interval) were higher among all DRP involving AA, 131.1 (122.5, 140.3), 134.8 (126.3, 143.8), and 102.4 (98.9, 106.0) for AA/AA, AA/EA, and EA/AA, respectively, compared to 97.1 (93.7, 100.6) per 1000 post-transplant person-years for EA/EA pairs. Multivariable analysis showed u-shaped relationships across SDoH levels within each DRP, but findings varied depending on recipients' race, i.e., AA recipients in areas with the worst SDoH had higher hospitalization rates. However, EA recipients in areas with the best SDoH had higher hospitalization rates than their counterparts. CONCLUSIONS: Relationship between healthcare utilization and SDoH depends on DRP, with higher hospitalization rates among AA recipients living in areas with the worst SDoH and among EA recipients in areas with the best SDoH profiles. SDoH plays an important role in driving disparities in hospitalizations after kidney transplantation.
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With over 350,000 cases occurring each year, out-of-hospital cardiac arrest (OHCA) remains a severe public health concern in the United States. The correct and timely use of automated external defibrillators (AEDs) has been widely acknowledged as an effective measure to improve the survival rate of OHCA. While general guidelines have been provided by the American Heart Association (AHA) for AED deployment, the lack of detailed instructions hindered the adoption of such guidelines under dynamic scenarios with various time and space distributions. Formulating the AED deployment as a location optimization problem under budget and resource constraints, we proposed an overlayed spatio-temporal optimization (OSTO) method, which accounted for the spatiotemporal heterogeneity of potential OHCAs. To highlight the effectiveness of the proposed model, we applied the proposed method to Washington DC using user-generated anonymized mobile device location data. The results demonstrated that optimization-based planning provided an improved AED coverage level. We further evaluated the effectiveness of adding additional AEDs by analyzing the cost-coverage increment curve. In general, our framework provides a systematic approach for municipalities to integrate inclusive planning and budget-limited efficiency into their final decision-making. Given the high practicality and adaptability of the framework, the OSTO is highly amenable to different healthcare facilities' deployment tasks with flexible demand and resource restraints.
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Objective: We aimed to assess the association between meditation practice and cognitive function over time among middle-aged and older adults. Method: We included Health and Retirement Study (HRS) participants assessed for meditation practice in the year 2000 as part of the HRS alternative medicine module (n = 1,160) and were followed up for outcomes over 2000-2016 period. We examined the association between meditation ≥ twice a week vs none/less frequent practice and changes in the outcomes of recall, global cognitive function, and quantitative reasoning using generalized linear regression models. Stratified analyses among persons with/without self-reported baseline depressive symptoms were conducted to assess the link between meditation and cognitive outcomes. Results: Among our full study sample, meditation ≥ twice a week was not significantly associated with total recall [ß; 95% CI: -0.97, 0.57; p = 0.61], global cognitive function [ß; 95% CI: -1.01, 1.12; p = 0.92], and quantitative reasoning [ß; 95% CI: -31.27, 8.32; p = 0.26]. However, among those who did not have self-reported depressive symptoms at baseline, meditation ≥ twice a week was associated with improvement in cognitive outcomes such as total recall [ß; 95% CI: 0.03, 0.18; p = 0.01] and global cognitive function [ß; 95% CI: 0.05, 0.40; p = 0.01] over time. Conclusions: Frequent meditation practice might have a protective effect on cognitive outcomes over time, but this protection could be limited to those without self-reported baseline depressive symptoms. Future studies could incorporate more precise meditation practice assessment, investigate the effect of meditation on cognitive outcomes over time, and include more rigorous study designs with randomized group assignment. Pre-registration: This study is not preregistered.
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OBJECTIVES: This study explores racial and ethnic differences in 1) receiving tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) as treatment for ischemic stroke and 2) outcomes and quality of care after use of tPA or EVT in the US. MATERIALS AND METHODS: An observational analysis of 89,035 ischemic stroke patients from the 2019 National Inpatient Sample was conducted. We performed weighted logistic regressions between race and ethnicity and 1) tPA and EVT utilization and 2) in-hospital mortality. We also performed a weighted Poisson regression between race and ethnicity and length of stay (LOS) after tPA or EVT. RESULTS: Non-Hispanic (NH) Black patients had significantly lower odds of receiving tPA (Adjusted odds ratio [AOR] = 0.85, 95 % Confidence Internal [C.I.]: 0.80-0.91) and EVT (AOR = 0.75, 95 % CI: 0.70-0.82) than NH White patients. Minority populations (including but not limited to NH Black, Hispanic, Pacific Islander, Native American, and Asian) had significantly longer hospital LOS after treatment with tPA or EVT. We did not find a significant difference between race/ethnicity and in-hospital mortality post-tPA or EVT. CONCLUSIONS: While we failed to find a difference in in-hospital mortality, racial and ethnic disparities are still evident in the decreased usage of tPA and EVT and longer LOSs for racial and ethnic minority patients. This study calls for interventions to expand the utilization of tPA and EVT and advance quality of care post-tPA or EVT in order to improve stroke care for minority patients.
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AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Estados Unidos , Ativador de Plasminogênio Tecidual/efeitos adversos , Etnicidade , Fibrinolíticos/efeitos adversos , AVC Isquêmico/tratamento farmacológico , Grupos Minoritários , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapiaRESUMO
BACKGROUND: Although increasing physical activity (PA) has been suggested to prevent and manage cognitive decline and dementia, its economic impact on healthcare systems and society is largely unknown. This study aimed to summarize evidence on the cost-effectiveness of PA interventions to prevent and manage cognitive decline and dementia. METHODS: Electronic databases, including PubMed/MEDLINE, Embase, and ScienceDirect, were searched from January 2000 to July 2023. The search strategy was driven by a combination of subject-heading terms related to physical activity, cognitive function, dementia, and cost-effectiveness. Selected studies were included in narrative synthesis, and extracted data were presented in narrative and tabular forms. The risk of bias in each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. RESULTS: Five of the 11 identified studies focused on individuals with existing dementia. Six of the 11 identified studies focused on individuals with no existing dementia, including 3 on those with mild cognitive impairment (MCI), and 3 on those with no existing MCI or dementia. PA interventions focused on individuals with no existing dementia were found to be cost-effective compared to the control group. Findings were mixed for PA interventions implemented in individuals with existing dementia. CONCLUSIONS: PA interventions implemented before or during the early stage of cognitive impairment may be cost-effective in reducing the burden of dementia. More research is needed to investigate the cost-effectiveness of PA interventions in managing dementia. Most existing studies used short-term outcomes in evaluating the cost-effectiveness of PA interventions in the prevention and management of dementia; future research should consider adding long-term outcomes to strengthen the study design.
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Disfunção Cognitiva , Demência , Humanos , Análise Custo-Benefício , Disfunção Cognitiva/prevenção & controle , Cognição , Exercício Físico , Demência/prevenção & controleRESUMO
This study compares and contrasts how key factors influence Americans' trust in different types of media (broadcast, print, and social) as COVID-19 information sources and how people's media trust is associated with their adoption of preventive measures. Our results from a national survey (sample = 2571) showed that age, political party affiliation, and race and ethnicity and income level were significantly associated with people's trust in different media types as COVID information sources. Elder adults trusted print and broadcast media more, while younger adults trusted social media more. Democrats and Lean Democrats had more trust in all three forms of media than Republicans and Lean Republicans. Asians had the highest levels of trust in all three media types, while Whites had the lowest level of trust in broadcast and social media. Trust in broadcast media was found to be associated with facial mask wearing, but trust in social media, however, did not contribute to the adoption of any COVID-19 preventive measures. This study contributes to a general understanding of media trust and mediated health communication and provides nuanced understanding of how demographic factors shape media trust and the consequence of media trust during a historical pandemic.
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COVID-19 , Adulto , Humanos , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Confiança , Meios de Comunicação de Massa , Pandemias/prevenção & controle , Fonte de InformaçãoRESUMO
Oxide-based resistive random access memory (RRAM) is standing out in both non-volatile memory and the emerging field of neuromorphic computing, with the consequence of increasing performance demands. Rare-earth doping is often used as an effective means for performance modulation. In this work, the modulation mechanism of the resistive switching (RS) behaviors in trivalent rare-earth Gd-doped HfO2-based RRAM has been carefully investigated using first-principles calculations. The results of electronic structure analysis show that Gd doping would lead to a change in the local geometry of the m-HfO2 defect system and would enhance the Coulomb interaction between the atoms around Gd and oxygen vacancy (VO), which may be one of the reasons for the enhanced conductivity of the HfO2-based RRAM after Gd doping. Thermodynamic and kinetic study results indicate that there is a strong interaction between Gd and its surrounding VO defects, and this strong interaction would not only attract more oxygen vacancies (VOs) to be generated near the dopant Gd, but also increase the migration energy barrier of the +2 charged VOs around the Gd doping site, thus suppressing the random generation of VO filaments, which leads to a better uniformity of the switching parameters during the RS process and improves the performance stability of the devices. The results of this work will provide new insights into modulating the RS behaviors and improving the device performance of HfO2-based RRAM through doping engineering.
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BACKGROUND: Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life. OBJECTIVE: We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data. METHODS: The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs). RESULTS: A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RRâ=â0.78, 95% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication. CONCLUSION: Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.
Assuntos
Anti-Hipertensivos , Hipertensão , Humanos , Anti-Hipertensivos/uso terapêutico , Cognição , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Aposentadoria , Fatores de RiscoRESUMO
Previous research has documented the association between racial discrimination and poor sleep quality. However, few studies have examined this association during the COVID-19 pandemic when racial discrimination is on the rise due to structural injustice and racism against people of color. Using data from the Health, Ethnicity, and Pandemic (HEAP) Study, a nationally representative survey of US adults, we assessed the association between racial discrimination and sleep quality among overall adults and by race and ethnicity. We found that racial discrimination during the pandemic was significantly associated with higher risks of poor sleep quality among non-Hispanic Black (OR = 2.19, 95% CI: 1.13-4.25) and Asian (OR = 2.75, 95% CI: 1.53-4.94) participants, but not among the other groups. The results suggested that sleep quality among Black and Asian populations may have been disproportionately affected by racial discrimination during the pandemic. Further study is needed to assess the causal relationship between racial discrimination and sleep quality.