[Comparison of the predictive value of Padua and the IMPEDE assessment scores for venous thromboembolism in patients with newly diagnosed multiple myeloma: A single institution experience].

Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.

Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012-2015.

OBJECTIVES: This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. METHODS: This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. RESULTS: Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80-0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52-0.58). CONCLUSION FOR PRACTICE: Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. KNOWLEDGE TRANSFER STATEMENT: The current study updated the previous findings with more recent multiyear PRAMS data (2012-2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

Glioma grading and IDH1 mutational status: assessment by intravoxel incoherent motion MRI.

AIM: To assess the diagnostic performance of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs), and predicting the isocitrate dehydrogenase 1 (IDH1) mutational status. MATERIALS AND METHODS: IVIM imaging was performed preoperatively in 42 patients with gliomas using 10 b-values (0-1,200 s/mm2) in a 3 T MRI machine. The perfusion fraction (f), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and apparent diffusion coefficient (ADC) were calculated within the tumours and in the contralateral normal white matter, and the values were compared between the HGGs and LGGs, and between IDH1 wild-type and mutated-type gliomas. In addition, the receiver operating characteristic (ROC) was also analysed. RESULTS: When compared to LGGs, HGGs had lower ADC (0.989×10-3 versus 1.243×10-3 mm2/s, p<0.001), smaller D (0.849×10-3 versus 1.062×10-3 mm2/s, p=0.001), larger D* (9.731×10-3 versus 5.442×10-3 mm2/s, p=0.006), and bigger f-values (0.204 versus 0.130, p<0.001) within the tumours. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.937, 0.898, 0.770, and 0.838, respectively. Among the LGGs, tumours with the IDH1 mutation had a higher ADC (1.286×10-3 mm2/s), when compared to the wild-type IDH1 (1.122×10-3 mm2/s, p=0.003), with an AUC of 0.936. In HGGs, tumours with the IDH1 mutation had higher ADC (1.056×1010-3 versus 0.946×10-3 mm2/s, p=0.030), smaller D* (6.204×10-3 versus 11.999×10-3 mm2/s, p=0.023) and smaller f-values (0.143 versus 0.244, p<0.001), with an AUC of 0.766, 0.841 and 0.992, respectively. CONCLUSION: Glioma grading can be differentiated and IDH1 mutational status can be predicted using IVIM.

[Assessing the efficiency of schistosomiasis control programs in Jiangsu Province from 2005 to 2015 using data envelopment analysis (Malmquist index method)].

OBJECTIVE: To assess the total factor productivity (TFP) of schistosomiasis control programs in Jiangsu Province, so as to provide insights into sustainable schistosomiasis control. METHODS: The data envelopment analysis-Malmquist index method was employed to analyze the human resources and financial investments in schistosomiasis control programs from health sectors in each schistosomiasis-endemic city of Jiangsu Province from 2005 to 2015, and assess the outputs of each schistosomiasis control project. RESULTS: The overall productive efficiency of schistosomiasis control programs in Jiangsu Province showed an increasing tendency, and the mean fluctuation of annual TFP was 2.3%. The comprehensive technical efficiency, including pure efficiency and scale efficiency, appeared a steady increase with minor fluctuations, and the mean fluctuation of annual comprehensive technical efficiency was 3.8%. The growth rate of technical progress fluctuated greatly from 2005 to 2011, and showed a steady increase from 2012 to 2015, which became a major contributor to the growth of TFP. A higher growth rate of TFP was seen in Huai ' an and Changzhou cities, which showed a greater comprehensive technical efficiency, and a large fluctuation was observed in the growth rate of technical progress in Yancheng, Nanjing, Huai ' an and Yangzhou cities. CONCLUSIONS: There is a continuous improvement in the technical level of schistosomiasis control programs in Jiangsu Province, and technical application and supervision and management capacity also show a steady increase. In addition, the application of new techniques and new strategies contributes greatly to TFP growth. In the future, the investment into new techniques and new strategies should be increased to ensure the sustainable schistosomiasis control in Jiangsu Province.

[Status of grass-roots schistosomiasis control professionals in Jiangsu Province: a cross-sectional study].

OBJECTIVE: To understand the status of grass-roots schistosomiasis control professionals in Jiangsu Province, so as to provide scientific evidence for the rational resource allocation and the improvement of capability building. METHODS: A cross-sectional survey was conducted by telephone interview and e-mail among city- and county-level disease prevention and control institutions that undertook schistosomiasis control activities in Jiangsu Province, and the age, educational background, major, duration of working, professional title and professional capability were descriptively analyzed. RESULTS: There were totally 274 fulltime schistosomiasis control professionals working at grass-roots institutions in Jiangsu Province, with a mean age of (43.19 ± 9.47) years. The least professionals were below 30 years of age (12.77%, 35/274), and the most professionals were aged from 41 to 50 years (36.86%, 101/274). Among the 274 professionals, 43.07% (118/274) had duration of working of less than 10 years, 62.04% (170/274) had a bachelor degree, and 40.88% (112/274) had the medium-level professional title. CONCLUSIONS: A schistosomiasis control team with a relatively high academic degree and professional title has been built at the grassroot level in Jiangsu Province. However, capability building remains to be improved through the participation of more young professionals and professional training with adaptation to local conditions.

[Health economic evaluation of a 23 value pneumococcal polysaccharide vaccination pilot programme among elderly chronic obstructive pulmonary disease patients in China].

Objective: From the perspective of health economics, to evaluate 23 pneumococcal polysaccharide vaccination programme among chronic obstructive pulmonary disease (COPD) patient. Methods: In the pilot counties of the project of integrated care pathway for COPD patient (Hanbin district of Hanzhong city in Shanxi Province, Qianjian district of Qingqing city, Huandao district of Qindao city in Shangdong Province, Wen county of Jiaozuo city in Henan Province), information of insurance participants of New Rural Cooperative Medical System (NRCS) was collected by local NRCM information system, which included general information as well as records of medical care and medical fee. Nonprobability sampling method was applied to select a total of 860 objects, who were over 60 years old with local household registration, hospitalized within one recent year due to COPD acute exacerbation, and without vaccination of 23 voluntary pneumococcal polysaccharide vaccine within 3 years. A quasi-experimental design without control group was adopted. Objects were vaccinated with 23-valent pneumococcal polysaccharide vaccine from January to December in 2013, then were followed up from January in 2014 for one year. Data of effectiveness and medical cost was collected by self-designed questionnaire and (Chinese version). Paired rank sum test applied to test the difference of quality of life, number and direct medical cost of treatment (including outpatient treatment and hospitalization) due to COPD acute exacerbation, one year before and after intervention. The incremental cost-effectiveness ratio (ICER) and cost-benefit ratio (CBR) of the programme were calculated. Results: By January 2014, eight hundred sixty objects were vaccinated. By January 2015, seven hundred eighty eight objects were followed up, with 72 cases withdrawed (8.4%). On average, COPD patients reduced 1.12±2.51 treatments due to acute exacerbation, including 0.28±2.09 outpatient treatments and 0.85±1.15 hospitalizations. Total medical cost was saved by 3 610.21 per capita yuan, including outpatient cost of 241.41 yuan and hospitalization cost of 269.82 yuan; Quality of life was gained by 0.03 QALY gain per capita. The ICER was dominant and CBR was 12.00. Conclusion: COPD patients vaccinated with 23-valent pneumococcal polysaccharide vaccine within one year reduced treatments due to acute exacerbation. The vaccination was cost effective and cost saving , and we suggest the vaccine should be covered in the public health program or health insurance scheme in conditional region.

Associations of depression with impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes in Chinese adults.

AIM: To examine the association between depression and impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes in middle-aged and elderly Chinese people, and whether depression was associated with different treatment regimens or durations of diabetes. METHODS: A cross-sectional study was performed among 229,047 adults living in the community aged ≥ 40 years from 25 centres in China. The self-reported depression rating scale Patient Health Questionnaire 9 (PHQ-9) was used to diagnose probable and sub-threshold depression. Glucose metabolism status was determined according to World Health Organization 1999 diagnostic criteria. RESULTS: The numbers of participants with normal glucose regulation, impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes were 120,458, 59,512, 24,826 and 24,251, respectively. The prevalence of sub-threshold depression in the total sample of participants was 4.8% (4.8%, 4.8%, 4.4% and 5.6% from normal glucose regulation to previously diagnosed diabetes, respectively), and the prevalence of probable depression was 1.1% (1.1%, 1.0%, 0.9% and 1.8% from normal glucose regulation to previously diagnosed diabetes, respectively). Compared with participants with normal glucose regulation, those with previously diagnosed diabetes had increased odds of probable depression [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.39-1.87] and sub-threshold depression (OR = 1.14, 95% CI 1.06-1.24), after adjustment for multiple confounding factors. Newly diagnosed diabetes or impaired glucose regulation was not associated with depression. Among those with previously diagnosed diabetes, insulin treatment was associated with greater odds of depression compared with no treatment or oral anti-diabetic medicine. CONCLUSION: Previously diagnosed diabetes, but not newly diagnosed diabetes or impaired glucose regulation, was associated with a higher prevalence of depression. Patients receiving insulin were more likely to have depression than those not receiving treatment or being treated with oral anti-diabetic medicine.

Is out-of-pocket cost a barrier to receiving repeat tests for chlamydia and gonorrhoea?

We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006-2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90-180 days and 181-395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.

Distribution of killer cell immunoglobulin-like receptor genes and combinations with HLA-C ligands in an isolated Han population in southwest China.

Human natural killer cells express killer cell immunoglobulin-like receptors (KIRs), which interact with human leukocyte antigen (HLA) class I molecules. KIR/HLA combinations play an important role in innate and adaptive immunity. In the current study, 16 KIR genes were analyzed in an isolated Han group living in the Fengyandong (FYDH) region in the Yunnan province of southwest China. The framework KIR genes 3DL2, 3DL3, 3DP1, and 2DL4 were found in all individuals. A total of 22 distinct KIR genotypes were observed, four of which were unknown previously. Genotype 1 (N = 52, 55.9%) was the predominant genotype. Analysis of inhibitory and activating KIR and HLA-C ligands showed that all individuals displayed at least one inhibitory or activating KIR/HLA-C pair. One KIR/HLA-C pair was the most frequent (67/93), followed by two pairs (21/93), and three pairs (6/93). The comparison of KIR and HLA frequencies between FYDH and a local Han population showed that the two populations showed similar frequencies for the KIR genes. In contrast, the distribution of HLA alleles and haplotypes showed significant differences between them.

Health risk assessment of organochlorine contaminants in fish from a major lake (Baiyangdian Lake) in North China.

Organochlorine contaminants (OCs) in fish were determined to evaluate the potential risk to humans consuming fish originating in Baiyangdian Lake, North China. Relatively low levels of PCBs, HCHs and DDTs were observed, with mean concentrations ranging from 0.28 to 3.28 ng/g, wet weight. Among various fish species tested, the highest burden of OCs was recorded in northern snakehead (7.39 ng/g, wet weight) and the lowest was in grass carp (2.04 ng/g, wet weight). The hazard ratios (HRs), based on noncancer risk were all less than 1.0, while the HRs based on cancer risk exceeded 1.0 only for PCBs based on the 90th percentile concentration.

Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas.

OBJECTIVE: The objective of this study was to test whether the association between primary care and income inequality on all-cause, heart disease and cancer mortality at county level differs in urban (Metropolitan Statistical Area-MSA) compared with non-urban (non-MSA) areas. STUDY DESIGN: The study consisted of a cross-sectional analysis of county-level data stratified by MSA and non-MSA areas in 1990. Dependent variables included age and sex-standardized (per 100,000) all-cause, heart disease and cancer mortality. Independent variables included primary care resources, income inequality, education levels, unemployment, racial/ethnic composition and income levels. METHODS: One-way analysis of variance and multivariate ordinary least squares regression were employed for each health outcome. RESULTS: Among non-MSA counties, those in the highest income inequality category experienced 11% higher all-cause mortality, 9% higher heart disease mortality, and 9% higher cancer mortality than counties in the lowest income inequality quartile, while controlling for other health determinants. Non-MSA counties with higher primary care experienced 2% lower all-cause mortality, 4% lower heart disease mortality, and 3% lower cancer mortality than non-MSA counties with lower primary care. MSA counties with median levels of income inequality experienced approximately 6% higher all-cause mortality, 7% higher heart disease mortality, and 7% higher cancer mortality than counties in the lowest income inequality quartile. MSA counties with low primary care (less than 75th percentile) had significantly lower levels of all-cause, heart disease and cancer mortality than those counties with high primary care. CONCLUSIONS: In non-MSA counties, increasing primary physician supply could be one way to address the health needs of rural populations. In MSA counties, the association between primary care and health outcomes appears to be more complex and is likely to require intervention that focuses on multiple fronts.

Primary care, infant mortality, and low birth weight in the states of the USA.

STUDY OBJECTIVE: The study tests the extent to which primary care physician supply (office based primary care physicians per 10 000 population) moderates the association between social inequalities and infant mortality and low birth weight throughout the 50 states of the USA. DESIGN: Pooled cross sectional, time series analysis of secondary data. Analyses controlled for state level education, unemployment, racial/ethnic composition, income inequality, and urban/rural differences. Contemporaneous and time lagged covariates were modelled. SETTING: Eleven years (1985-95) of data from 50 US states (final n = 549 because of one missing data point). MAIN RESULTS: Primary care was negatively associated with infant mortality and low birth weight in all multivariate models (p<0.0001). The association was consistent in contemporaneous and time lagged models. Although income inequality was positively associated with low birth weight and infant mortality (p<0.0001), the association with infant mortality disappeared with the addition of sociodemographic covariates. CONCLUSIONS: In US states, an increased supply of primary care practitioners-especially in areas with high levels of social disparities-is negatively associated with infant mortality and low birth weight.

Community Health Centers and racial/ethnic disparities in healthy life.

This study examined disparities in health status among individuals of different racial and ethnic groups cared for by the nation's community health centers (CHCs) and compared these results with the findings for individuals using non-CHC sites as their usual source of care. The sample consisted of CHC users from the 1994 CHC User Survey and non-CHC users from the 1994 National Health Interview Survey. Bivariate comparisons were made between individuals' race/ethnicity and their experience of healthy life, an integrated measure that incorporates both activity limitation and self-perceived health status. Multiple regressions were followed to examine the independent association of race/ethnicity with healthy life experience for both CHC and non-CHC users while controlling for sociodemographic correlates of health. Among CHC users, racial and ethnic minorities did not have worse health than whites, but among non-CHC users there were significant racial and ethnic disparities: whites experienced significantly healthier life than both blacks and non-white Hispanics. These findings persisted after controlling for sociodemographic correlates of health. The results indicate that while racial/ethnic disparities in health persist nationally, these disparities do not exist within CHCs, safety-net providers with an explicit mission to serve vulnerable populations.

The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas.

OBJECTIVES: This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites. METHODS: We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas. RESULTS: Both income inequality and primary care physician supply were significantly associated with White mortality (P < .01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Black mortality remained significant (P < .01), but the effect of primary care physician supply was no longer significant (P > .10), particularly in areas with high income inequality. CONCLUSIONS: Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.

The convergence of vulnerable characteristics and health insurance in the US.

This study defines vulnerability as a multi-dimensional construct, reflected in the convergence of predisposing, enabling, and need attributes of risk. Using race, income, and self-perceived health status as indicators and based on eight rounds of the US 1996 panel of the Medical Expenditure Panel Survey, the study examined how the interactions of these vulnerable characteristics affect insurance coverage, a critical measure of health care access. The results of the study demonstrate insurance coverage does vary with the extent of vulnerability. While race and income significantly influence insurance coverage, respectively, there was relatively little disparity in insurance due to health status. Between race and income, income was a more significant predictor of lack of insurance coverage since low-income people regardless of race and health were significantly more likely to be uninsured or partially insured. However, it is important to note that minorities were disproportionately over-represented in the low-income or bad health groups so that any adverse association between income, bad health, and insurance status would affect minorities significantly more than whites. Among those with insurance, the most vulnerable group, the minority-low-income-bad health group or those with all the three vulnerability indicators, were most likely to be publicly insured. A policy implication is to target limited resources on insurance coverage for the more vulnerable groups, those with a convergence or cluster of predisposing, enabling, and need attributes of risk.

Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care.

Reducing and eliminating health status disparities by providing access to appropriate health care is a goal of the nation's health care delivery system. This article reviews the literature that demonstrates a relationship between access to appropriate health care and reductions in health status disparities. Using comprehensive site-level data, patient surveys, and medical record reviews, the authors present an evaluation of the ability of health centers to provide such access. Access to a regular and usual source of care alone can mitigate health status disparities. The safety net health center network has reduced racial/ethnic, income, and insurance status disparities in access to primary care and important preventive screening procedures. In addition, the network has reduced low birth weight disparities for African American infants. Evidence suggests that health centers are successful in reducing and eliminating health access disparities by establishing themselves as their patients' usual and regular source of care. This relationship portends well for reducing and eliminating health status disparities.