Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients.

Objectives: The study aimed to estimate the effects of National Volume-based Drug Procurement (NVBP) policy on drug utilization and medical expenditures of hypertension patients in public medical institutions in mainland China. Methods: This study used patient-level data based on electronic health records retrieved from the hospital information system of Nanjing Hospital of Chinese Medicine. Data on patients with hypertension who received care at this institution between 2016 and 2021 was used for analysis. Segmented linear regression models incorporating Interrupted Time Series (ITS) analysis were adopted to examine the effects of NVBP policy on drug utilization and health expenditures of eligible patients. Drug utilization volume and health expenditures were the primary outcomes used to assess the policy effects, and were measured using the prescription proportion of each drug class and the overall per-encounter treatment costs. Results: After the implementation of NVBP policy, the volume of non-winning drugs decreased from 54.42% to 36.25% for outpatient care and from 35.62% to 15.65% for inpatient care. The ITS analysis showed that the volume of bid-winning drugs in outpatient and inpatient settings increased by 9.55% (p < 0.001) and 6.31% (p < 0.001), respectively. The volume changes in non-volume based purchased (non-VBP) drugs differed between outpatients and inpatients. The proportion of non-VBP drugs immediately increased by 5.34% (p = 0.002) overall, and showed an upward trend in the outpatient setting specially (p < 0.001) during the post-intervention period. However, no significant differences were observed in the proportion of non-VBP drugs in inpatient setting (p > 0.05) in term of level change (p > 0.05) or trend change (p > 0.05). The average per-visit expenditures of outpatients across all drug groups exhibited an upward trend (p < 0.05) post policy intervention. In addition, a similar increase in the overall costs for chemical drugs were observed in inpatient settings (coefficient = 2,599.54, p = 0.036), with no statistically significant differences in the regression slope and level (p = 0.814). Conclusion: The usage proportion of bid-winning drugs increased significantly post policy intervention, indicating greater use of bid-winning drugs and the corresponding substitution of non-winning hypertensive drugs. Drug expenditures for outpatients and health expenditures per visit for inpatients also exhibited an upward trend, suggesting the importance of enhanced drug use management in Traditional Chinese Medicine hospital settings.

[Effects of branched-chain amino acid supplementation on skeletal muscle proteolytic pathways after exercise-induced muscle injury in rats].

OBJECTIVE: To explore the role of branched-chain amino acid(BCAA) supplementation on muscle damage and the regulation of Krüppel-like factor 15(KLF15) and nuclear factor kappa B(NF-κB) mediated proteolytic pathways after an acute eccentric exercise. METHODS: Male SD rats were divided into placebo group(PLA) and BCAA group(BCAA) randomly, 32 rats per group. Both group were then placed into subgroups: placebo and pre-exercise group(PC), placebo and immediately after exercise group(PE), placebo and 6 h after exercise group(PE6), placebo and 12 h after exercise group(PE12), BCAA and pre-exercise group(BC), BCAA and immediately after exercise group(BE), BCAA and 6 h after exercise group(BE6), BCAA and 12 h after exercise group(BE12), 8 rats per group. Rats in BCAA groups were supplied with BCAA(1 g/(kg·d·BW), 3 days) before the exercise day and placebo groups with equal volume of distilled water. The exercised groups performed a 2 h eccentric exercise on treadmill(16 m/min, -16° slope). Blood and gastrocnemius were collected according to the time points. RT-qPCR was used to measure the mRNA expression of KLF15, NF-κB, FoxO1, Atrogin-1 and MuRF1 in gastrocnemius. RESULTS: (1) No damage was found in myocytes of BC and PC group. The process of morphological damage in BCAA group was relatively faster. (2) The mRNA expression levels of KLF15, FoXO1, Atrogin-1 and MuRF1 in PE were higher than those in PC(P<0.05, P<0.01), NF-κB and Atrogin-1 in PE12 were higher than those in PC(P<0.05). The mRNA expression levels of FoXO1 in BE were higher than those in BC(P<0.05). Compared with PE, the mRNA expression levels of KLF15, Atrogin-1 and MuRF1 in BE were lower(P<0.05, P<0.01), NF-κB and Atrogin-1 in BE12 were lower than those in PE12(P<0.05). The level of serum 3-MH in PE12 group was higher than that in PC group(P<0.05). CONCLUSION: The proteolysis of skeletal muscle after high-intensity eccentric exercise is mediated by two different pathways: KLF15 and NF-κB, whose activation is time-dependent. BCAA may reduce skeletal muscle proteolysis by lowering the level of gene transcription in the KLF15 and NF-κB related protein degradation pathway, which occurs immediately after exercise.

Impact of policy changes of Medicare-rebated telehealth services on medical abortions provided at a family planning service during the coronavirus (COVID-19) pandemic.

This study reviewed data on the mode of delivery of medical abortion care (via face-to-face or telehealth) at a Family Planning service during the coronavirus (COVID-19) pandemic; April 2020 to March 2022. This was considered over time, in the context of changing eligibility criteria for Medicare-rebated telehealth services as well as patient demographic data. The study demonstrated that when Medicare rebates for telehealth are available for all those requiring abortion care, telehealth contributes to care provision alongside face-to-face services, and is more likely to be utilised by people living in regional and remote areas.

[Spatial Distribution and Risk Assessment of Heavy Metals in Surface Sediments from the Middle and Upper Reaches of the Yangtze River].

The hydrological regime of rivers significantly changes after dam impoundment, which in turn affects the particle composition and heavy metal fractions of the river sediments. From June to July 2019, the sediments from 26 sampling sections were collected along the main stream of the Yangtze River from Panzhihua City in the upper reaches of the Yangtze River to Hukou City in the middle reaches of the Yangtze River. The concentrations and fractions of As, Cd, Co, Cr, Cu, Ni, Pb, and Zn were measured using the BCR three-step extraction procedure. The pollution status and potential ecological risk of heavy metals in sediments were evaluated using the geo-accumulation index, the sediment quality guideline, and the risk assessment coding method (RAC). The results showed that the average particle size of sediments in the upper reaches of the Yangtze River (Jinsha River cascade reservoir section and the Three Gorges reservoir section) decreased from upstream to downstream, the total concentrations of As and Zn increased, and the variation trend in the middle reaches was not obvious. The content of clay particles was significantly positively correlated with the acid-soluble fraction concentrations of Cd and Ni. Cd was mainly in the residual fraction (59.26%) and acid-soluble fraction (24.67%). Large parts of Cr and Ni were residual fractions accounting for 92.41% and 83.41%, respectively. As, Co, Cu, Pb, and Zn were mainly in the residual fraction and the reducible fraction. The order of decrease for the pollution degree (Igeo) of As, Cd, Co, Cr, Ni, and Zn was the Jinsha River, the middle reaches of the Yangtze River, and the Three Gorges Reservoir. The decrease order of bioavailability (RAC) of Cd, Co, Cr, Cu, Ni, and Zn was the Three Gorges Reservoir, the Jinsha River, and the middle reaches of the Yangtze River. The bioavailability of As and Pb decreased in the order of the middle reaches of the Yangtze River, the Three Gorges, and the Jinsha River. According to the classification of the RAC, Cd in the Three Gorges Reservoir area exhibited a high risk with the RAC accounting for 48.44%. Cu, Ni, and Zn showed a low or medium risk.

Assessment of a Calibration-Free Method of Cuffless Blood Pressure Measurement: A Pilot Study.

This study proposes a low-cost, high-sensitivity sensor of beat-to-beat local pulse wave velocity (PWV), to be used in a cuffless blood pressure monitor (BPM). OBJECTIVE: We design an adaptive algorithm to detect the feature of the pulse wave, making it possible for two sensors to measure the local PWV in the radial artery at a short distance. Unlike the cuffless BPM that needs to use a regression model for calibration. METHOD: We encapsulate the piezoelectric sensor material in a cavity and design an analog front-end circuit. This study used color ultrasound imaging equipment to measure radial arterial parameters, including the diameter and wall thickness, to aid the estimation of blood pressure (BP) using the Moens-Korteweg (MK) equation of hemodynamics. RESULTS: We compared the blood pressure estimated by the MK equation with the reference BP measured using an aneroid sphygmomanometer in a test group of 32 people, resulting in a mean difference of systolic BP of -0.63 mmHg, and a standard deviation of ±5.14 mmHg, a mean difference of mean arterial pressure (MAP) of 0.97 mmHg, with a standard deviation of ±3.54 mmHg, and a mean difference of diastolic BP of -1.14 mmHg, with a standard deviation of ±4.08 mmHg. This study has verified its compliance with ISO 81060-2. CONCLUSIONS: A new type of wearable continuous calibration-free BPM can replace the situation that requires the use of traditional ambulatory BPM and reduce patient discomfort. CLINICAL IMPACT: In this study can provide long-term continuous blood pressure monitoring in the hospital.

Assessment of Crosslinkers between Peptide Antigen and Carrier Protein for Fusion Peptide-Directed Vaccines against HIV-1.

Conjugate-vaccine immunogens require three components: a carrier protein, an antigen, and a crosslinker, capable of coupling antigen to carrier protein, while preserving both T-cell responses from carrier protein and B-cell responses from antigen. We previously showed that the N-terminal eight residues of the HIV-1 fusion peptide (FP8) as an antigen could prime for broad cross-clade neutralizing responses, that recombinant heavy chain of tetanus toxin (rTTHC) as a carrier protein provided optimal responses, and that choice of crosslinker could impact both antigenicity and immunogenicity. Here, we delve more deeply into the impact of varying the linker between FP8 and rTTHC. In specific, we assessed the physical properties, the antigenicity, and the immunogenicity of conjugates for crosslinkers ranging in spacer-arm length from 1.5 to 95.2 Å, with varying hydrophobicity and crosslinking-functional groups. Conjugates coupled with different degrees of multimerization and peptide-to-rTTHC stoichiometry, but all were well recognized by HIV-fusion-peptide-directed antibodies VRC34.01, VRC34.05, PGT151, and ACS202 except for the conjugate with the longest linker (24-PEGylated SMCC; SM(PEG)24), which had lower affinity for ACS202, as did the conjugate with the shortest linker (succinimidyl iodoacetate; SIA), which also had the lowest peptide-to-rTTHC stoichiometry. Murine immunizations testing seven FP8-rTTHC conjugates elicited fusion-peptide-directed antibody responses, with SIA- and SM(PEG)24-linked conjugates eliciting lower responses than the other five conjugates. After boosting with prefusion-closed envelope trimers from strains BG505 clade A and consensus clade C, trimer-directed antibody-binding responses were lower for the SIA-linked conjugate; elicited neutralizing responses were similar, however, though statistically lower for the SM(PEG)24-linked conjugate, when tested against a strain especially sensitive to fusion-peptide-directed responses. Overall, correlation analyses revealed the immunogenicity of FP8-rTTHC conjugates to be negatively impacted by hydrophilicity and extremes of length or low peptide-carrier stoichiometry, but robust to other linker parameters, with several commonly used crosslinkers yielding statistically indistinguishable serological results.

Market implied volatility and natural disasters: international evidence.

Using daily data, we provide fresh international evidence that an occurrence of natural disaster is accompanied by an increase in the market implied volatility of the main equity index in the same country contemporaneously and in the future. The relation between market implied volatility and natural disaster is a short-run relationship, mainly driven by the subsample of countries with a low frequency of disaster or with developed financial markets. Our analysis shows that in contrast to ex post volatility measures, implied volatility can reflect more climate physical risk information, which provides insight for multinational equity investment in coping with environmental physical risk. Our findings provide insight for multinational equity investment in coping with climate physical risk.

Opportunities for strengthening sexual health education in schools: Findings from a student needs assessment in NSW.

ISSUE ADDRESSED: Comprehensive sexuality education (CSE) is important for the sexual and reproductive health of young people. To better understand young people's views and experiences of sexual health education in NSW, a student needs assessment survey was conducted in 2017. METHODS: This paper presents the findings from 1603 NSW students in Years 8-12 following online recruitment. Descriptive analyses explored students' views and experiences in relation to sources of sexual health information, education providers, school-based topics covered and resources drawn on. RESULTS: Findings indicate that school, parents, friends and social media are students' most common sources of information on sexual and reproductive health. Approximately one-third of students reported wanting more information on topics related to relationships, reproductive health, consent and sexual decision-making and sexual harassment, abuse and bullying, and two-thirds of transgender and gender diverse students wanted more information on gender identity. For the topics which students reported receiving the least information about at school, they were most likely to seek this out on social media and websites. CONCLUSION: Findings provide valuable insight for improving CSE in NSW. The influence of social media, parents and the internet should be taken into consideration when developing resources and programme content. Professional development for educators could contribute to improving the quality of CSE delivered. Accurate and up to date resources must be utilised to support student engagement and effective learning.

Preoperative Assessment for Event-Free Survival With Hepatoblastoma in Pediatric Patients by Developing a CT-Based Radiomics Model.

Objective: To explore a CT-based radiomics model for preoperative prediction of event-free survival (EFS) in patients with hepatoblastoma and to compare its performance with that of a clinicopathologic model. Patients and Methods: Eighty-eight patients with histologically confirmed hepatoblastoma (mean age: 2.28 ± 2.72 years) were recruited from two institutions between 2002 and 2019 for this retrospective study. They were divided into a training cohort (65 patients from institution A) and a validation cohort (23 patients from institution B). Radiomics features were extracted manually from pretreatment CT images in the portal venous (PV) phase. The least absolute shrinkage and selection operator (LASSO) Cox regression model was applied to construct a "radiomics signature" and radiomics score (Rad-score) for EFS prediction. Then, a nomogram incorporating the Rad-score, updated staging system, and significant variables of clinicopathologic risk (age, alpha-fetoprotein (AFP) level, histology subtype, tumor diameter) as the radiomic model, clinicopathologic model, and combined clinicopathologic-radiomic model were built for EFS estimation in the training cohort, the performance of which was assessed in an external-validation cohort with respect to clinical usefulness, discrimination, and calibration. Results: Nine survival-relevant features were selected for a radiomics signature and Rad-score building. Multivariable analysis revealed that histology subtype (P = 0.01), PV (P = 0.001) invasion, and metastasis (P = 0.047) were independent risk factors of EFS. Patients were divided into low- and high-risk groups based on the Rad-score with a cutoff of 0.08 according to survival outcome. The radiomics signature-incorporated nomogram showed good performance (P < 0.001) for EFS estimation (C-Index: 0.810; 95% CI: 0.738-0.882), which was comparable with that of the clinicopathological model for EFS estimation (C-Index: 0.81 vs. 0.85). The radiomics-based nomogram failed to show incremental prognostic value compared with that using the clinicopathologic model. The combined model (radiomics signature plus clinicopathologic parameters) showed significant improvement in the discriminatory accuracy, along with good calibration and greater net clinical benefit, of EFS (C-Index: 0.88; 95% CI: 0.829-0.933). Conclusion: The radiomics signature can be used as a prognostic indicator for EFS in patients with hepatoblastoma. A combination of the radiomics signature and clinicopathologic risk factors showed better performance in terms of EFS prediction in patients with hepatoblastoma, which enabled precise clinical decision-making.

Alzheimer's Disease and Alzheimer's Disease-Related Dementias in Older African American and White Veterans.

BACKGROUND: Racial disparity in the epidemiology of Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) has been reported. However, less is known about this disparity among Veterans. OBJECTIVE: To estimate the racial disparity in AD/ADRD among the Veterans. METHODS: Of the 5,413,418 Veterans≥65 years receiving care at the Veterans Health Administration (1999-2016), 4,045,269 were free of prevalent AD/ADRD, schizophrenia, or bipolar disorder at baseline. Of these, 432,469 were African American. Race was self-identified and incident AD/ADRD during 20 (median 6.7) years of follow-up was ascertained using International Classification of Diseases codes. RESULTS: Patients had a mean age of 70.4 (±6.6) years and 97.8% were men. Age-sex-adjusted incidence of AD/ADRD per 1,000 person-year was 19.3 and 10.8 for African American and white Veterans, respectively (age-sex-adjusted hazard ratio associated with African American race, 1.77; 95% confidence interval, 1.75-1.79; p < 0.0001). This association remained essentially unchanged after multivariable adjustment (hazard ratio, 1.67; 95% confidence interval, 1.65-1.69; p < 0.0001). Among the key baseline characteristics that were significant predictors of AD/ADRD in both races, stroke was a significantly stronger predictor among African Americans, and Hispanic ethnicity and depression among whites (p-value for all interaction,<0.0001). CONCLUSION: The findings of a higher incidence of AD/ADRD among African American Veterans is consistent with the findings in the general population reported in the literature, although the overall incidence appears to be lower than that in the general population. Future studies need to examine this disparity in incidence as well as the between-race heterogeneity in AD/ADRD risk.

Quantitative assessment of diffusion kurtosis imaging depicting deep myometrial invasion: a comparative analysis with diffusion-weighted imaging.

PURPOSE: We aimed to investigate histogram analysis of diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) to distinguish between deep myometrial invasion and superficial myometrial invasion in endometrial carcinoma (EC). METHODS: A total of 118 pathologically confirmed EC patients with preoperative DWI were included. The data were postprocessed with a DKI (b value of 0, 700, 1400, and 2000 s/mm2) model for quantitation of apparent diffusion values (D) and apparent kurtosis coefficient values (K) for non-Gaussian distribution. The apparent diffusion coefficient (ADC) was postprocessed with a conventional DWI model (b values of 0 and 800 s/mm2). A whole-tumor analysis approach was used. Comparisons of the histogram parameters of D, K, and ADC were carried out for the deep myometrial invasion and superficial myometrial invasion subgroups. Diagnostic performance of the imaging parameters was assessed. RESULTS: The Dmean, D10th, and D90th in deep myometrial invasion group were significantly lower than those in superficial invasion group (P < 0.001, P < 0.001, and P = 0.023, respectively), as well as the ADCmean, ADC10th, and ADC90th (P = 0.001, P = 0.001, and P = 0.042, respectively). The Kmean and K90th were significantly higher in deep invasion group than those in superficial myometrial invasion group (P = 0.002 and P = 0.026, respectively). The D10th, Kmean, and ADC10th had a relatively higher area under the curve (AUC) (0.72, 0.66, and 0.71, respectively) than other parameters for distinguishing deep myometrial invasion of EC. D10th showed a relatively higher AUC than ADC10th for the differentiation of lesions with deep myometrial invasion from those with superficial myometrial invasion (0.72 vs. 0.71), but the variation was not statistically significant (P = 0.35). CONCLUSION: Distribution of DKI and conventional DWI parameters characterized by histogram analysis may represent an indicator for deep myometrial invasion in EC. Both DKI and DWI models showed relatively equivalent effectiveness.

Promoting cervical screening among women experiencing homelessness and socio-economic disadvantage in Sydney.

ISSUE ADDRESSED: Australia's national cervical screening program has reduced rates of cervical cancer morbidity and mortality. However, these benefits have not been experienced by all women. A Cervical Cancer Screening Project was implemented with lay health educators to address inequitable screening access by women experiencing socio-economic disadvantage. METHODS: Resources and a training program were developed and piloted with the specialist homelessness services workforce in Sydney, NSW. Data was collected to inform their development and evaluation through interviews, focus groups, self-administered surveys and analysis of NSW Pap Test Register data. RESULTS: Women reported low familiarity with the term 'cervical screening'. They identified a good patient-doctor relationship, and seeing a female practitioner, as screening enablers. While the majority reported having cervical screening before, NSW Pap Test Register data showed only 74% had screened previously and of those, 69% were overdue. Homelessness service workers expressed interest in talking with clients about cervical screening, and reported increased knowledge and confidence following training. CONCLUSION: The homelessness sector is an appropriate venue to access women who are disadvantaged and under-screened. However, increasing workforce capacity to discuss screening does not lead to increased screening for women accessing these services. Further efforts are required. SO WHAT?: Access to cervical screening by women experiencing disadvantage remains a challenge. Sustained multi-faceted health promotion efforts are required to increase access. These should be informed by additional research exploring barriers and enablers for this group of women.

Bleeding assessment in haemophilia carriers-High rates of bleeding after surgical abortion and intrauterine device placement: A multicentre study in China.

INTRODUCTION: An increased bleeding tendency has been shown in female haemophilia carriers compared to healthy females. Bleeding assessment tools (BATs) have mainly been performed in western cultures. It is unclear how they perform in populations with different healthcare, health/wellness concepts and awareness, as well as family planning practices. AIM: To (a) describe and compare the bleeding symptoms in carriers with healthy females, particularly for bleeding after surgical abortion and intrauterine device (IUD) placement which are performed frequently for family planning in China; (b) quantify scores of International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT) and Chinese-BAT (C-BAT) developed to include surgical abortion and IUD placement as separate categories in Chinese haemophilia carriers; (c) correlate bleeding scores (BS) with factor levels. METHODS: We conducted a multicentre, cross-sectional study on obligate haemophilia carriers and healthy controls using ISTH-BAT and C-BAT. RESULTS: We enrolled 125 haemophilia carriers and 106 controls. Carriers, compared to controls, had significantly higher median BS (3 vs 1 by both ISTH-BAT and C-BAT) and lower factor level (63.5 vs 101.8 IU/dL). Bleeding after surgical abortion and IUD placement was significantly associated with carrier status. Bleeding scores from neither ISTH-BAT nor C-BAT showed significant correlation with factor levels. CONCLUSION: Haemophilia carriers in China experienced abnormal bleeding. Unique to the Chinese carriers is significant bleeding after surgical abortion (3rd highest incidence of bleeding symptom) and IUD placement (4th highest). However, both ISTH-BAT and C-BAT exhibited no correlation between BS and factor levels in this population and neither could identify carriers with low factor level (of <50 IU/dL).

A Clinical TB Detection Method Based on Molecular Typing Technique with Quality Control.

The gold standard for diagnosing pulmonary Mycobacterium tuberculosis (TB) is the detection of tubercle bacillus in patient sputum samples. However, current methods either require long waiting times to culture the bacteria or have a risk of getting false-positive results due to cross-contamination. In this study, a method to detect tubercle bacillus based on the molecular typing technique is presented. This method can detect genetic units, variable number of tandem repeat (VNTR), which are the characteristic of tuberculosis (TB), and performs quality control using a mathematical model, ensuring the reliability of the results. Compared to other methods, the proposed method was able to process and diagnose a large volume of samples in a run time of six hours, with high sensitivity and specificity. Our method is also in the pipeline for implementation in clinical testing. Reliable and confirmed results are stored into a database, and these data are used to further refine the model. As the volume of data processed from reliable samples increases, the diagnostic power of the model improves. In addition to improving the quality control scheme, the collected data can be also used to support other TB research, such as that regarding the evolution of the tubercle bacillus.

Young internal migrants' major health issues and health seeking barriers in Shanghai, China: a qualitative study.

BACKGROUND: China is experiencing a sizeable rural-urban flow, which may influence the health of internal migrant youth deeply. Disadvantages in the city are highly likely to contribute to health issues among the young internal migrant population. The current qualitative study is to explore how internal migrant young people view the health issues they face, and the services and opportunities they could seek in their host community. METHODS: Data were collected from 90 internal migrant youth aged between 15 and 19 years old and 20 adult service providers who worked with them in a community of Shanghai, where the population of internal migrants was relatively large. Four types of qualitative research methods were used, including key informant interviews with adults, in-depth interviews with adolescents, a photovoice activity with adolescents and community mapping & focus group discussions with adolescents. Guided by the ecological systems framework and the acculturation theory, thematic analysis was conducted using ATLAS.Ti 7.0 software. RESULTS: While younger migrants had a limited understanding of health, elder migrant youths were more sensitive to societal and political factors related to their health. Mental health and health risk behaviors such as smoking, violence and premarital unsafe sex were thought as major health issues. Internal migrant youths rarely seek health information and services initiatively from formal sources. They believed their health concerns weren't as pressing as the pressure coming from the high cost of living, the experience of being unfairly treated and the lack of opportunities. Participants also cited lack of family and social support, lack of awareness and supportive policies to get access to community and public services as impacting health factors. CONCLUSIONS: The study's findings provide the insight to the social contexts which influence the health experience, health seeking behaviors, and city adaptation of young internal migrants in their host community. This research stresses the importance of understanding social networks and structural barriers faced by migrant youth in vulnerable environments. A multidimensional social support is essential for internal migrant youth facing present and potential health risks.

Cost-effectiveness of olanzapine in the first-line treatment of schizophrenia in China.

OBJECTIVES: This study aimed to analyze (1) the cost-effectiveness of olanzapine orally disintegrating tablet (ODT) compared to olanzapine standard oral tablet (SOT) and (2) the cost-effectiveness of olanzapine-SOT compared to aripiprazole-SOT for patients with schizophrenia in China. METHODS: A microsimulation model was adapted from a healthcare payers' perspective. The model ran over a 1-year time horizon, using quarterly cycles. The costs of adverse events were acquired through a clinical expert panel. The average bidding prices in China of olanzapine-ODT, olanzapine-SOT, aripiprazole-SOT, and other switch alternatives were used. Inpatient and outpatient medical costs were sourced from the Urban Employee Basic Medical Insurance database in Tianjin. Additionally, adherence, efficacy, safety, and utility data were taken from the literature. Uncertainty of parameters were assessed through one-way and probabilistic sensitivity analyses. RESULTS: The total annual costs per patient in aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are USD 2,296.05, USD 1,940.05, and USD 2,292.81, respectively. The average number of relapses per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm, are 0.734, 0.325, and 0.198, respectively. The quality-adjusted life years (QALYs) gained per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are 0.714, 0.737, and 0.758, respectively. Consequently, (1) the incremental cost-effectiveness ratios (ICERs) of administrating olanzapine-ODT over olanzapine-SOT are USD 2,791.96 per relapse avoided and USD 16,798.39 per QALY gained; and (2) the ICERs of using olanzapine-SOT over aripiprazole-SOT are USD -870.39 per relapse avoided and USD -15,477.93 per QALY gained. All ICERs are under the willingness-to-pay threshold in China of USD 25,772.67. The sensitivity analyses confirmed the robustness of the results. CONCLUSION: As the first-line treatment for schizophrenia in China, olanzapine-ODT is cost-effective compared to olanzapine-SOT and olanzapine-SOT is cost-effective compared to aripiprazole-SOT.

Healthcare Utilization and Missed Workdays for Parents of Children With Traumatic Brain Injury.

BACKGROUND: We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI). METHODS: Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values. RESULTS: Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts. CONCLUSION: Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.

2018 Salary Survey of AMIA Members: Factors Associated with Higher Salaries.

Greater transparency in salaries overall and in factors associated with differing salaries can help students and professionals plan their careers, discover biases and obstacles, and help advance professional disciplines broadly. In March 2018, we conducted the first salary survey of American Medical Informatics Association members. Our goal was to summarize salary information and provide a nuanced view pertaining to the diverse biomedical informatics community. To identify factors associated with higher salaries, we reviewed average salaries for different groups (physician status, academic status, and different leadership positions) by gender. We also fitted multiple linear regression models for all participants (N = 201) and for gender, physician- and academic-status subgroup. The mean (standard deviation) salary was $181,774 ($99,566). Men earned more than women on average, and especially among professionals from academic settings. More years working in informatics and full-time employment were two factors that were consistently associated with higher salary.

The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults.

Inadequate health literacy (HL) is associated with impaired healthcare choices leading to poor quality-of-care. Our primary purpose was to estimate the prevalence of inadequate HL among two populations of AARP® Medicare Supplement insureds: sicker and healthier populations; to identify characteristics of inadequate HL; and to describe the impact on patient satisfaction, preventive services, healthcare utilization, and expenditures. Surveys were mailed to insureds in 10 states. Multivariate regression models were used to identify characteristics and adjust outcomes. Among respondents (N = 7334), 23% and 16% of sicker and healthier insureds, respectively, indicated inadequate HL. Characteristics of inadequate HL included male gender, older age, more comorbidities, and lower education. Inadequate HL was associated with lower patient satisfaction, lower preventive service compliance, higher healthcare utilization and expenditures. Inadequate HL is more common among older adults in poorer health, further compromising their health outcomes; thus they may benefit from expanded educational or additional care coordination interventions.

Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan.

PURPOSE OF THE STUDY: Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. PRIMARY PRACTICE SETTING: Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). METHODOLOGY AND SAMPLE: The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. RESULTS: The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care.