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1.
J Prosthodont ; 32(1): 3-4, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36688524
2.
Sensors (Basel) ; 23(2)2023 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-36679555

RESUMEN

Childhood obesity is a public health concern in the United States. Consequences of childhood obesity include metabolic disease and heart, lung, kidney, and other health-related comorbidities. Therefore, the early determination of obesity risk is needed and predicting the trend of a child's body mass index (BMI) at an early age is crucial. Early identification of obesity can lead to early prevention. Multiple methods have been tested and evaluated to assess obesity trends in children. Available growth charts help determine a child's current obesity level but do not predict future obesity risk. The present methods of predicting obesity include regression analysis and machine learning-based classifications and risk factor (threshold)-based categorizations based on specific criteria. All the present techniques, especially current machine learning-based methods, require longitudinal data and information on a large number of variables related to a child's growth (e.g., socioeconomic, family-related factors) in order to predict future obesity-risk. In this paper, we propose three different techniques for three different scenarios to predict childhood obesity based on machine learning approaches and apply them to real data. Our proposed methods predict obesity for children at five years of age using the following three data sets: (1) a single well-child visit, (2) multiple well-child visits under the age of two, and (3) multiple random well-child visits under the age of five. Our models are especially important for situations where only the current patient information is available rather than having multiple data points from regular spaced well-child visits. Our models predict obesity using basic information such as birth BMI, gestational age, BMI measures from well-child visits, and gender. Our models can predict a child's obesity category (normal, overweight, or obese) at five years of age with an accuracy of 89%, 77%, and 89%, for the three application scenarios, respectively. Therefore, our proposed models can assist healthcare professionals by acting as a decision support tool to aid in predicting childhood obesity early in order to reduce obesity-related complications, and in turn, improve healthcare.


Asunto(s)
Obesidad Pediátrica , Niño , Humanos , Estados Unidos , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/epidemiología , Índice de Masa Corporal , Sobrepeso , Factores de Riesgo , Aprendizaje Automático
3.
Nutrients ; 15(2)2023 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-36678136

RESUMEN

The 2020-2025 Dietary Guidelines for Americans (DGA) recommends less than 10% of total daily calories come from added sugars. However, many adults overconsume added sugars putting them at risk for poor health outcomes. We examined characteristics of high added sugars consumers among US adults (≥20 years) and described their top 10 sources of added sugars intake using National Health and Nutrition Examination Survey 2015-2018 data (n = 9647). We defined high consumers as consuming >15% of daily calories from added sugars (1.5 times higher than the DGA). We used the National Cancer Institute method to estimate usual intake of energy and percent of calories from added sugars. Top 10 sources were identified based on their percentage contribution to total added sugars intake on a given day. T-tests were used to examine differences by age, sex, race/ethnicity, education, income, marital status, and weight status. Overall, mean usual total energy intake and added sugars intake was 2068 kcal/day and 264 kcal/day, respectively, and 30% of adults were classified as high consumers. The prevalence of high added sugars consumers was significantly higher among 20-30-year-olds (29%), 31-50-year-olds (33%), and 51-70-year-olds (29%) than those aged ≥70 years (22%); non-Hispanic Black (39%) and non-Hispanic White (31%) adults than Hispanics (26%); adults with <high school (37%), high school/GED (38%), or some college (34%) than adults with college or higher (15%); adults living in lower-income households (39% for federal poverty income ratio < 130% and 35% for 130%-<350%) than high-income households (21%). The prevalence of high consumers did not differ by sex or weight status. Top sources of added sugars were sweetened beverages (42%), tea (12%), sweet bakery products (11%), and jams/syrups/sugars (7%). Our findings can inform intervention efforts to decrease added sugars intake to support health.


Asunto(s)
Sacarosa en la Dieta , Humanos , Adulto , Estados Unidos , Encuestas Nutricionales , Etnicidad , Ingestión de Energía , Dieta
4.
JAMA Netw Open ; 6(1): e2249378, 2023 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-36598786

RESUMEN

Importance: Advanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams. Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of such prescriptions. Objective: To calculate the proportion of surgical opioid prescriptions written by APCs and to compare the total and daily dosages of these prescriptions with those written by surgeons. Design, Setting, and Participants: This cross-sectional study used the Optum's De-Identified Clinformatics Data Mart, which contains deidentified claims from patients with private insurance and Medicare Advantage plans across the US. Adults and children who underwent 1 of 31 inpatient and outpatient surgical procedures from January 1, 2017, through November 30, 2019, were identified. The analysis was limited to procedures with 1 or more perioperative opioid prescriptions, defined as an opioid prescription dispensed within 3 days of the index date of surgery. Data were analyzed from April 1, 2021, to July 31, 2022. Exposures: Prescriber specialty. Main Outcomes and Measures: The outcome was the proportion of perioperative opioid prescriptions and refill prescriptions written by APCs. Linear regression was used to compare the total dosage of perioperative opioid prescriptions written by APCs vs surgeons measured in morphine milligram equivalents (MMEs). Models were adjusted for demographic characteristics, comorbidities, opioid-naive status, year of index date, hospitalization or observation status, surgical complications, and surgeon specialty. Analyses were conducted at the procedure level, and patients with multiple procedures were included. Results: Analyses included 628 197 procedures for 581 387 patients (358 541 females [57.1%]; mean [SD] age, 56 [18] years). Overall, APCs wrote 119 266 (19.0%) of the 628 197 perioperative opioid prescriptions and 59 679 (25.1%) of the 237 740 refill prescriptions. Perioperative opioid prescriptions written by APCs had higher total dosages compared with those written by surgeons (adjusted difference, 40.0 MMEs; 95% CI, 31.3-48.7 MMEs). This difference persisted in a subgroup analysis limited to opioid-naïve patients (adjusted difference, 15.7 MMEs; 95% CI, 13.9-17.5 MMEs). Conclusions and Relevance: In this cross-sectional analysis, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. While surgeons wrote most perioperative opioid prescriptions that were intended for perioperative analgesia, higher total dosages from APCs suggest that opioid stewardship initiatives that support the role of APCs may be warranted.


Asunto(s)
Medicare Part C , Cirujanos , Adulto , Femenino , Niño , Humanos , Anciano , Estados Unidos , Persona de Mediana Edad , Analgésicos Opioides/uso terapéutico , Estudios Transversales , Prescripciones de Medicamentos , Pautas de la Práctica en Medicina
5.
BMC Pediatr ; 23(1): 31, 2023 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-36658521

RESUMEN

BACKGROUND: Sudden Unexpected Infant Deaths (SUID) can occur between 1 month and 1 year of age and are inequitably distributed with a greater burden in populations with numerous health disparities. Modifying the infant sleep environment to promote safe sleep is the most effective risk reduction strategy to reduce SUID. The provision of baby boxes with a mattress and infant supplies has been part of a larger anti-poverty social justice maternity package for decades in Finland. While infant mortality rates have generally improved after the maternity package was introduced, little is known about whether the provision of the baby box increased safe sleep practices. The purpose of the study was to evaluate whether the provision of a Finnish-style baby box reinforced safe infant sleep practice in the home in a low-resource community in Ecuador. METHODS: In this longitudinal randomized controlled trial all participants received the same safe sleep education in their third trimester of pregnancy (n = 100). This was followed by randomization into two groups; the control received a diaper bag and newborn gifts, and the intervention group received a baby box and the same gifts at each timepoint. Four infant sleep practices (room sharing, bed sharing/co-sleeping, position, and soft items in the sleep environment) were assessed at 1 month and 1 months post-delivery during a home visit where safe sleep education was also reinforced with both groups. RESULTS: Those in the baby box group were 2.5 times more likely to report safe sleep practices compared with mothers in the diaper bag group at 1 month (odds ratio [OR] = 2.45 and 95% confidence interval [CI]: 1.03-5.86; χ2 = 4.1, p = .043). The group difference was also present at 6-months post-birth: those in the baby box group were 2.9 times more likely to report safe sleep practices compared with those in the diaper bag group (OR = 2.86 and 95% CI: 1.16-7.05; χ2 = 5.2, p = .022). CONCLUSIONS: While not all participants used the box regularly, the mothers who received the box were more likely to practice safe sleep at 1 month and 6 months. This suggests the baby box may have served as an important prompt towards safer infant sleep practice. TRIAL REGISTRATION: (Clinical Trial Registry, per clinicaltrials.gov : not applicable under 42 CFR 11.22(b) as the study Facility Location was not in the United States (took place in Ecuador), does not involve FDA IND or IDE, and does not involve a drug, biological or device product that is manufactured in and exported from the US for study in another country. The University of San Francisco Quito, Research Ethics Committee in Human Beings approved the study, #2017- 127 M. The University of Kentucky Office of Research Integrity also approved the study, IRB # 42965).


Asunto(s)
Muerte Súbita del Lactante , Lactante , Recién Nacido , Niño , Humanos , Femenino , Estados Unidos , Embarazo , Ecuador , Muerte Súbita del Lactante/prevención & control , Madres , Sueño , Mortalidad Infantil , Cuidado del Lactante
6.
BMC Med ; 21(1): 25, 2023 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-36658548

RESUMEN

BACKGROUND: Predicting the likely size of future SARS-CoV-2 waves is necessary for public health planning. In England, voluntary "plan B" mitigation measures were introduced in December 2021 including increased home working and face coverings in shops but stopped short of restrictions on social contacts. The impact of voluntary risk mitigation behaviours on future SARS-CoV-2 burden is unknown. METHODS: We developed a rapid online survey of risk mitigation behaviours ahead of the winter 2021 festive period and deployed in two longitudinal cohort studies in the UK (Avon Longitudinal Study of Parents and Children (ALSPAC) and TwinsUK/COVID Symptom Study (CSS) Biobank) in December 2021. Using an individual-based, probabilistic model of COVID-19 transmission between social contacts with SARS-CoV-2 Omicron variant parameters and realistic vaccine coverage in England, we predicted the potential impact of the SARS-CoV-2 Omicron wave in England in terms of the effective reproduction number and cumulative infections, hospital admissions and deaths. Using survey results, we estimated in real-time the impact of voluntary risk mitigation behaviours on the Omicron wave in England, if implemented for the entire epidemic wave. RESULTS: Over 95% of survey respondents (NALSPAC = 2686 and NTwins = 6155) reported some risk mitigation behaviours, with vaccination and using home testing kits reported most frequently. Less than half of those respondents reported that their behaviour was due to "plan B". We estimate that without risk mitigation behaviours, the Omicron variant is consistent with an effective reproduction number between 2.5 and 3.5. Due to the reduced vaccine effectiveness against infection with the Omicron variant, our modelled estimates suggest that between 55% and 60% of the English population could be infected during the current wave, translating into between 12,000 and 46,000 cumulative deaths, depending on assumptions about severity and vaccine effectiveness. The actual number of deaths was 15,208 (26 November 2021-1 March 2022). We estimate that voluntary risk reduction measures could reduce the effective reproduction number to between 1.8 and 2.2 and reduce the cumulative number of deaths by up to 24%. CONCLUSIONS: Predicting future infection burden is affected by uncertainty in disease severity and vaccine effectiveness estimates. In addition to biological uncertainty, we show that voluntary measures substantially reduce the projected impact of the SARS-CoV-2 Omicron variant but that voluntary measures alone would be unlikely to completely control transmission.


Asunto(s)
COVID-19 , SARS-CoV-2 , Estados Unidos , Niño , Humanos , Estudios Longitudinales , COVID-19/epidemiología , COVID-19/prevención & control , Inglaterra/epidemiología
7.
Womens Health (Lond) ; 19: 17455057221147380, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36660909

RESUMEN

BACKGROUND: There are persistent racial/ethnic disparities in the occurrence of severe maternal morbidity. Patient-centered medical home care has the potential to address disparities in maternal outcomes. OBJECTIVES: To examine (1) the association between receiving patient-centered medical home care and severe maternal morbidity outcomes and (2) the interaction of race/ethnicity on patient-centered medical home status and severe maternal morbidity. DESIGN/METHODS: Using 2007 to 2016 data from the Medical Expenditures Panel Survey, we conducted a cross-sectional study to estimate the association between receipt of care from a patient-centered medical home and the occurrence of severe maternal morbidity, and racial-specific (White, Black, Asian, Other) relative risks of severe maternal morbidity. Our study used race as a proxy measure for exposure racism. We identified mothers (⩾15 years) who gave birth during the study period. We identified patient-centered medical home qualities using 11 Medical Expenditures Panel Survey questions and severe maternal morbidities using medical claims, and calculated generalized estimating equation models to estimate odds ratios of severe maternal morbidity and 95% confidence intervals. RESULTS: Among all mothers who gave birth (N = 2801; representing 5,362,782 US lives), only 25% received some exposure patient-centered medical home care. Two percent experienced severe maternal morbidity, and this did not differ statistically (p = 0.11) by patient-centered medical home status. However, our findings suggest a 85% decrease in the risk of severe maternal morbidity among mothers who were defined as always attending a patient-centered medical home (odds ratios: 0.15; 95% confidence interval:0.01-1.87; p = 0.14) and no difference in the risk of severe maternal morbidity among mothers who were defined as sometimes attending a patient-centered medical home (odds ratios: 1.00; 95% confidence interval:0.16-6.42; p = 1.00). There was no overall interaction effect in the model between race and patient-centered medical home groups (p = 0.82), or ethnicity and patient-centered medical home groups (p = 0.62) on the severe maternal morbidity outcome. CONCLUSION: While the rate of severe maternal morbidity was similar to US rates, few mothers received care from a patient-centered medical home which may be due to underreporting. Future research should further investigate the potential for patient-centered medical home-based care to reduce odds of severe maternal morbidity across racial/ethnic groups.


Asunto(s)
Etnicidad , Gastos en Salud , Femenino , Humanos , Embarazo , Estados Unidos/epidemiología , Estudios Transversales , Grupos Raciales , Atención Dirigida al Paciente
8.
Vet Rec ; 192(2): 60, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36661158
9.
J Dent Res ; 102(2): 121-124, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36661330

RESUMEN

Elizabeth Dianne Rekow, BSME, MSME, MBA, DDS, MS, Certificate in Orthodontics, and PhD (1944-2022), was a dental science futurist pursuing brave new paths during her career. She was one of the pivotal scientists who initiated the CAD/CAM movement in the 1980s and went on to focus on digital dentistry for the rest of her career. Her professional contributions involved seven patents, 92 peer-reviewed publications, 10 book contributions, 31 proceeding contributions, and well over 100 national and international presentations. She was an avid supporter of women in science. Her greatest contribution was her expansive imagination. She served as 35th president of the American Association for Dental, Oral, and Craniofacial Research in 2006-2007 and 88th president of the International Association for Dental Research in 2011-2012. The present article reviews key elements of her career and includes testimonies from friends about her special relationships.


Asunto(s)
Diseño Asistido por Computadora , Humanos , Femenino , Estados Unidos
10.
Adv Skin Wound Care ; 36(2): 78-84, 2023 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-36662040

RESUMEN

OBJECTIVE: To describe the demographic factors, hospitalization-related factors, comorbid states, and social determinants of health among racial groups in a sample of patients with a primary or secondary diagnosis of pressure injury (PI) admitted to New Jersey hospitals during the year 2018. METHODS: Researchers conducted a retrospective analysis of the Health Care Utilization Project's 2018 New Jersey State Inpatient Database. Patients with a primary or secondary diagnosis of PI (sacrum, buttocks, or heels; N = 17,781) were included in the analytic sample. Analysis compared patients who identified as Black (n = 3,515) with all other racial groups combined (n = 14,266). RESULTS: A higher proportion of Black patients were admitted for a PI (P < .001) and had higher proportions of stage 4 PIs (P < .001) but a lower proportion of stage 1 PIs (P < .001). Higher proportions of Black patients were younger, resided in lower income communities, and identified Medicaid as their primary payor source. CONCLUSIONS: Results highlight the racial disparities that exist among patients with PIs in this diverse state and may represent a much larger problem. Clinical research examining the impact of skin tone rather than by racial group is needed. The impact of racial disparities on social determinants of health with regard to PIs remains largely unknown, but its importance cannot be underestimated.


Asunto(s)
Hospitalización , Grupos Raciales , Estados Unidos/epidemiología , Humanos , Estudios Retrospectivos , Medicaid , Pacientes Internos
11.
Urolithiasis ; 51(1): 34, 2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36662293

RESUMEN

Percutaneous nephrolithotomy (PNL) has been used in the treatment of urolithiasis for more than 20 years. However, bibliometric analysis of the global use of PNL for urolithiasis is rare. We retrieved the literatures on PNL and urolithiasis from Web of science core collection database. VOSviewer was used to analyze keywords, citations, publications, co-authorship, themes, and trend topics. A total of 3103 articles were analyzed, most of which were original ones. The most common keywords were "percutaneous nephrology" and "urolithiasis", both of which were closely related to "ureteroscopy". Journal of Urology and Zeng Guohua from the First Affiliated Hospital of Guangzhou Medical University were the most published journal and author in this field. The most productive country was the United States, and its closest partners were Canada, China, and Italy. The five hot topics were the specific application methods and means, risk factors of urolithiasis, the development of treatment technology of urolithiasis, the characteristics, composition, and properties of stones, and the evaluation of curative effect. This study aimed to provide a new perspective for PNL treatment of urolithiasis and provided valuable information for urologic researchers to understand their research hotspots, cooperative institutions, and research frontiers.


Asunto(s)
Nefrolitotomía Percutánea , Urolitiasis , Humanos , Estados Unidos , Nefrolitotomía Percutánea/efectos adversos , Bibliometría , Urolitiasis/cirugía , Italia , Publicaciones
12.
JAMA Netw Open ; 6(1): e2251745, 2023 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-36662526

RESUMEN

Importance: Neighborhood variables may be factors in the excessive burden of prostate cancer among African American men. Objective: To examine associations between neighborhood deprivation, circulating immune-oncology markers, and prostate cancer among African American and European American men. Design, Setting, and Participants: A case-control study was conducted between January 1, 2005, and January 1, 2016. Participants included men with prostate cancer and age- and race-frequency-matched population controls. Participants were recruited at the Baltimore Veterans Affairs Medical Center and University of Maryland Medical Center; controls were obtained through the Maryland Motor Vehicle Administration database. National Death Index follow-up was performed through December 31, 2020, and data analysis was conducted from February 1, 2022, through October 31, 2022. Exposures: 2000 Census-tract Neighborhood Deprivation Index as a standardized score. Main Outcomes and Measures: Primary outcomes included prostate cancer, all-cause mortality, and disease-specific mortality. Secondary outcomes included the National Comprehensive Cancer Network risk score and serum proteomes for 82 immune-oncology markers with pathway annotation. Results: Participants included men with prostate cancer (n = 769: 405 African American, 364 European American men) and age- and race-frequency-matched population controls (n = 1023: 479 African American, 544 European American men). The median survival follow-up was 9.70 years (IQR, 5.77 years), with 219 deaths. Among 884 African American men, mean (SD) age at recruitment was 63.8 (7.6) years; mean (SD) age at recruitment among 908 European American men was 66.4 (8.1) years. In the multivariable logistic regression analysis with individual socioeconomic status adjustment, neighborhood deprivation was associated with 55% increased odds of prostate cancer among African American men (odds ratio [OR], 1.55; 95% CI, 1.33-1.81), but was not associated with the disease among European American men. Residing in the most-deprived vs least-deprived neighborhoods corresponded to 88% higher disease odds (OR, 1.88; 95% CI, 1.30-2.75) among all men and an approximate 3-fold increase among African American men (OR, 3.58; 95% CI, 1.72-7.45), but no association was noted among European American men. In Cox proportional hazard regression analyses, socioeconomic status-adjusted neighborhood deprivation was associated with an increased all-cause mortality only among African American men (hazard ratio [HR], 1.28; 95% CI, 1.08-1.53), whereas it was associated with metastatic disease and a 50% increased hazard of a prostate cancer-specific death among all men (HR, 1.50; 95% CI, 1.07-2.09). In analyses restricted to controls, neighborhood deprivation was associated with increased activity scores of serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression. Conclusions and Relevance: The findings of this study suggest that deprived neighborhood residency may increase the risk of African American men for prostate cancer and a related mortality, potentially through its association with systemic immune function and inflammation.


Asunto(s)
Neoplasias de la Próstata , Masculino , Humanos , Estados Unidos/epidemiología , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Neoplasias de la Próstata/epidemiología , Inflamación
13.
JAMA Netw Open ; 6(1): e2251833, 2023 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-36662525

RESUMEN

Importance: Immunocompromised individuals are at increased risk for severe outcomes due to SARS-CoV-2 infection. Given the varying and complex nature of COVID-19 vaccination recommendations, it is important to understand COVID-19 vaccine uptake in this vulnerable population. Objective: To assess mRNA COVID-19 vaccine uptake and factors associated with uptake among immunocompromised individuals from December 14, 2020, through August 6, 2022. Design, Setting, and Participants: This cohort study was conducted with patients of Kaiser Permanente Southern California (KPSC), an integrated health care system in the US. The study included patients aged 18 years or older who were immunocompromised (individuals with an immunocompromising condition or patients who received immunosuppressive medications in the year prior to December 14, 2020) and still met criteria for being immunocompromised 1 year later. Exposures: Age, sex, self-identified race and ethnicity, prior positive COVID-19 test result, immunocompromising condition, immunomodulating medication, comorbidities, health care utilization, and neighborhood median income. Main Outcomes and Measures: Outcomes were the number of doses of mRNA COVID-19 vaccine received and the factors associated with receipt of at least 4 doses, estimated by hazard ratios (HRs) and 95% Wald CIs via Cox proportional hazards regression. Statistical analyses were conducted between August 9 and 23, 2022. Results: Overall, 42 697 immunocompromised individuals met the study eligibility criteria. Among these, 18 789 (44.0%) were aged 65 years or older; 20 061 (47.0%) were women and 22 635 (53.0%) were men. With regard to race and ethnicity, 4295 participants (10.1%) identified as Asian or Pacific Islander, 5174 (12.1%) as Black, 14 289 (33.5%) as Hispanic, and 17 902 (41.9%) as White. As of the end of the study period and after accounting for participant censoring due to death or disenrollment from the KPSC health plan, 78.0% of immunocompromised individuals had received a third dose of mRNA COVID-19 vaccine. Only 41.0% had received a fourth dose, which corresponds to a primary series and a monovalent booster dose for immunocompromised individuals. Uptake of a fifth dose was only 0.9% following the US Centers for Disease Control and Prevention (CDC) recommendation to receive a second monovalent booster (ie, fifth dose). Adults aged 65 years or older (HR, 3.95 [95% CI, 3.70-4.22]) were more likely to receive at least 4 doses compared with those aged 18 to 44 years or 45 to 64 years (2.52 [2.36-2.69]). Hispanic and non-Hispanic Black adults (HR, 0.77 [95% CI, 0.74-0.80] and 0.82 [0.78-0.87], respectively, compared with non-Hispanic White adults), individuals with prior documented SARS-CoV-2 infection (0.71 [0.62-0.81] compared with those without), and individuals receiving high-dose corticosteroids (0.88 [0.81-0.95] compared with those who were not) were less likely to receive at least 4 doses. Conclusions and Relevance: These findings suggest that adherence to CDC mRNA monovalent COVID-19 booster dose recommendations among immunocompromised individuals was low. Given the increased risk for severe COVID-19 in this vulnerable population and the well-established additional protection afforded by booster doses, targeted and tailored efforts to ensure that immunocompromised individuals remain up to date with COVID-19 booster dose recommendations are warranted.


Asunto(s)
COVID-19 , Estados Unidos/epidemiología , Adulto , Masculino , Humanos , Femenino , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Estudios de Cohortes , SARS-CoV-2 , Etnicidad
14.
JAMA Health Forum ; 4(1): e225125, 2023 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-36662505

RESUMEN

Importance: There is insufficient research on the costs of patient falls in health care systems, a leading source of nonreimbursable adverse events. Objective: To report the costs of inpatient falls and the cost savings associated with implementation of an evidence-based fall prevention program. Design, Setting, and Participants: In this economic evaluation, a matched case-control study used the findings from an interrupted time series analysis that assessed changes in fall rates following implementation of an evidence-based fall prevention program to understand the cost of inpatient falls. An economic analysis was then performed to assess the cost benefits associated with program implementation across 2 US health care systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adults hospitalized in participating units were included in the analysis. Data analysis was performed from October 2021 to November 2022. Interventions: Evidence-based fall prevention program implemented in 33 medical and surgical units in 8 hospitals. Main Outcomes and Measures: Primary outcome was cost of inpatient falls. Secondary outcome was the costs and cost savings associated with the evidence-based fall prevention program. Results: A total of 10 176 patients who had a fall event (injurious or noninjurious) with 29 161 matched controls (no fall event) were included in the case-control study and the economic analysis (51.9% were 65-74 years of age, 67.1% were White, and 53.6% were male). Before the intervention, there were 2503 falls and 900 injuries; after the intervention, there were 2078 falls and 758 injuries. Based on a 19% reduction in falls and 20% reduction in injurious falls from the beginning to the end of the postintervention period, the economic analysis demonstrated that noninjurious and injurious falls were associated with cost increases of $35 365 and $36 776, respectively. The implementation of the evidence-based fall prevention program was associated with $14 600 in net avoided costs per 1000 patient-days. Conclusions and Relevance: This economic evaluation found that fall-related adverse events represented a clinical and financial burden to health care systems and that the current Medicare policy limits reimbursement. In this study, costs of falls only differed marginally by injury level. Policies that incentivize organizations to implement evidence-based strategies that reduce the incidence of all falls may be effective in reducing both harm and costs.


Asunto(s)
Accidentes por Caídas , Pacientes Internos , Anciano , Adulto , Humanos , Masculino , Estados Unidos , Femenino , Accidentes por Caídas/prevención & control , Análisis Costo-Beneficio , Estudios de Casos y Controles , Medicare
15.
JAMA Health Forum ; 4(1): e224904, 2023 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-36662504

RESUMEN

This Viewpoint describes the new voluntary Center for Medicare and Medicaid Innovation Enhancing Oncology Model for cancer bundled payments, explores its likelihood of success, and discusses potential shortcomings.


Asunto(s)
Medicare , Neoplasias , Anciano , Humanos , Estados Unidos , Mecanismo de Reembolso , Neoplasias/genética , Neoplasias/terapia , Oncología Médica
16.
JAMA Netw Open ; 6(1): e2251863, 2023 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-36662522

RESUMEN

Importance: Individuals diagnosed with cancer have elevated suicide risks compared with the general population. National estimates of suicide risks among individuals with cancer are lacking in the US, and knowledge about risk factors is limited. Objective: To provide contemporary estimates of suicide risks associated with cancer and to identify sociodemographic and clinical factors associated with suicide risks among individuals diagnosed with cancer. Design, Setting, and Participants: A population-based cohort of individuals diagnosed with cancer from January 1, 2000, to December 31, 2016, from 43 states in the US were followed up through December 31, 2016. Standardized mortality ratios (SMRs) were calculated adjusting for attained age at death, sex, and race and ethnicity groups to compare suicide risks in the cancer cohort vs the general US population. Cox proportional hazards regression models were fitted to identify cancer-specific risk factors of suicide among the cancer cohort. Analyses were conducted from October 27, 2020, to May 13, 2022. Main Outcomes and Measures: The main outcomes were risk of suicide death compared with the general population, measured by the standardized mortality ratio; and risk of suicide death associated with sociodemographic and clinical factors among individuals with cancer. Exposure: Diagnosis of cancer. Results: Among a total of 16 771 397 individuals with cancer, 8 536 814 (50.9%) were 65 years or older at cancer diagnosis, 8 645 631 (51.5%) were male, 13 149 273 (78.4%) were non-Hispanic White, and 20 792 (0.1%) died from suicide. The overall SMR for suicide was 1.26 (95% CI, 1.24-1.28), with a decreasing trend (from an SMR of 1.67 [95% CI, 1.47-1.88] in 2000 to 1.16 [95% CI, 1.11-1.21] in 2016). Compared with the general population, elevated suicide risks were observed in the cancer cohort across all sociodemographic groups, with particularly high SMRs among Hispanic individuals (SMR, 1.48; 95% CI, 1.38-1.58), Medicaid-insured individuals (SMR, 1.72; 95% CI, 1.61-1.84), Medicare-insured individuals 64 years or younger (SMR, 1.94; 95% CI, 1.80-2.07), or uninsured individuals (SMR, 1.66; 95% CI, 1.53-1.80). Moreover, the highest SMR was observed in the first 6 months after the cancer diagnosis (SMR, 7.19; 95% CI, 6.97-7.41). Among individuals diagnosed with cancer, relatively higher suicide risks (ie, hazard ratios) were observed for cancer types with a poor prognosis and high symptom burden in the first 2 years after diagnosis, including cancers of oral cavity and pharynx, esophagus, stomach, brain and other nervous system, pancreas, and lung. After 2 years, individuals with cancers subject to long-term quality-of-life impairments, such as oral cavity and pharynx, leukemia, female breast, uterine, and bladder, had higher suicide risks. Conclusions and Relevance: In this cohort study of individuals with cancer, elevated suicide risks remained despite a decreasing trend during the past 2 decades. Suicide risks varied by sociodemographic and clinical factors. Timely symptom management and targeted psychosocial interventions are warranted for suicide prevention in individuals diagnosed with cancer.


Asunto(s)
Neoplasias , Suicidio , Humanos , Masculino , Femenino , Anciano , Estados Unidos/epidemiología , Estudios de Cohortes , Medicare , Neoplasias/epidemiología , Neoplasias/psicología , Suicidio/psicología
17.
JAMA Netw Open ; 6(1): e2250974, 2023 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-36662528

RESUMEN

Importance: Preference signals were to be implemented in over 15 specialties during the 2022-2023 residency match. Analyzing results from the implementation of signals during the American Urological Association (AUA) urology match may inform future behavior. Objective: To characterize applicant and program signal usage and results in the Society of Academic Urology and AUA databases with respect to interview invites and rank list creation. Design, Setting, and Participants: This cohort study involved all applicants and residencies in the 2021-2022 AUA match with data analysis conducted in April through July 2022. Exposures: Five signals indicating interest. Main Outcomes and Measures: Using verified match and survey data reported by applicants and programs, a logistic regression was performed on applicant factors associated with obtaining an interview-the main outcome (using inclusion on rank list as a proxy): age, gender, degree (MD or DO), dispersal of signal, US senior status, racial minority group status, Latino ethnicity, international medical graduate status, presence of a home program, AUA geographic section, and US Medical Licensing Examination Step 1 score. Applicant signal dispersal strategies were stratified by applicant and program competitiveness, as well as program behavior upon receipt of signal with respect to extending interviews and rank list ordering of applicants. Results: A total of 2659 signals were sent by 553 candidates (mean [SD] age, 27.4 [2.9] years; 179 female [32.4%], 243 racial minority candidates [61.2%]) submitting rank lists for 364 positions at 143 programs. Programs received a median (IQR) of 352 (295-411) applications and were signaled to a median of 16 (8-26) times each. In a logistic regression estimating interview status, geographic proximity (OR, 3.25; 95% CI, 2.05-5.15; P = .001) and signal status (OR, 6.04; 95% CI, 3.50-10.40; P < .001) were associated with receiving an interview. Using multiple imputation by chained equations to impute missing data and broadening the data set, male gender (OR, 0.64; 95% CI, 0.45-0.92; P = .04) and international medical graduate status (OR, 0.35; 95% CI, 0.15-0.81; P = .04) were negative variables, while MD degree (OR, 2.36; 95% CI, 1.27-4.36; P = .02) and US senior status (OR, 1.91; 95% CI, 1.13-3.23; P = .04) were positive variables. Conclusions and Relevance: This study of the usage and trends of the newly added preference signals reported the most common strategies for signal dispersal; in an analysis of factors involved in obtaining an interview, geographic similarity between applicant and program and preference signal usage were associated with successful applications.


Asunto(s)
Internado y Residencia , Urología , Humanos , Masculino , Femenino , Estados Unidos , Adulto , Estudios de Cohortes , Encuestas y Cuestionarios , Grupos Minoritarios
18.
Prof Case Manag ; 28(2): 55-59, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36662658

RESUMEN

PURPOSE OF THE STUDY: To evaluate the relationship between a case manager-led pneumonia care bundle at skilled nursing facilities (SNFs) and 30-day hospital readmissions for pneumonia. PRIMARY PRACTICE SETTINGS: The primary practice settings included patients hospitalized with pneumonia at 2 community hospitals between October 2018 and June 2019 and who were subsequently transferred to an SNF. METHODOLOGY AND SAMPLE: A retrospective cohort study was completed comparing patients in the preintervention cohort who received pneumonia standard of care versus patients in the postintervention cohort who received a case manager-led evidence-based pneumonia care bundle at an SNF. From October 2018 to June 2019, patients admitted with pneumonia to 2 community hospitals in Northwest New Jersey were enrolled in the preintervention cohort. Patients admitted with pneumonia from January 2020 to June 2021 were enrolled in the postintervention group. The primary outcome was to reduce 30-day readmission rates for all patients discharged from the hospital to an SNF with pneumonia. RESULTS: Ninety-nine patients were enrolled in the preintervention cohort and 34 patients were enrolled in the postinterventions cohort. Thirty-day readmission rates were lower in the postintervention cohort (24.2% vs. 17.7%). This reduction in readmission rates was clinically significant, demonstrating a 27% reduction for all patients discharged from the hospital to an SNF with pneumonia. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Individualized pneumonia self-management education can be easily implemented in SNFs to improve quality-of-care outcomes for patients. Our health care system collaborates with several SNFs to decrease 30-day hospital readmission. The pneumonia care bundle includes specific measures to improve the transition of care for patients with pneumonia by decreasing the variability of patient care after discharge from the hospital to an SNF. It was hypothesized that to decrease readmissions from the SNFs, we needed to address the quality of care provided by the SNFs by using a 2-prong approach; education of SNF staff on the pneumonia care bundle, and in-person weekly follow-up visits in the SNF until discharge from the SNF to the patient's home.


Asunto(s)
Gestores de Casos , Paquetes de Atención al Paciente , Estados Unidos , Humanos , Estudios Retrospectivos , Medicare , Hospitalización , Readmisión del Paciente , Alta del Paciente , Instituciones de Cuidados Especializados de Enfermería
19.
Prof Case Manag ; 28(2): 60-73, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36662660

RESUMEN

PURPOSE OF STUDY: Racial and ethnic minorities with socioeconomic disadvantages are vulnerable to 30-day hospital readmissions. A 16-week quality improvement (QI) project aimed to decrease readmissions of the vulnerable patient populations through tailored discharge planning. The project evaluated the effectiveness of using a 25-item checklist to increase patients' and caregivers' health knowledge, skills, and willingness for self-care and decrease readmissions. PRIMARY PRACTICE SETTING: The project took place in an inner-city teaching hospital in the Mid-Atlantic region. METHODOLOGY AND PARTICIPANTS: A casual comparative design compared readmissions of the before-intervention group (May 1-July 31, 2021) and the after-intervention group (August 1-October 31, 2021). A pre- and postintervention design evaluated the effectiveness of a 25-item checklist by analyzing the differences of Patient Activation Measure (PAM) pre- and postintervention survey scores and levels in the after-intervention group. Participants were General Medicine Unit patients 18 years or older who had Medicare Fee-for-Service, resided in 10 zip codes near the hospital, and were discharged home. RESULTS: Of 30 patients who received the intervention, one patient was readmitted compared with 11 readmissions from 58 patients who did not receive the intervention. The readmission rate was decreased from 19% to 4% during the 16-week project: 11 (19%) versus 1 (4%), p = .038. After receiving the intervention, patients' PAM scores were increased by 8.55, t(22) = 2.67, p < .014. Three patients had a lower postintervention survey level, whereas 12 patients obtained a higher postintervention survey level (p = .01). The increase in scores and levels supported that the intervention effectively improved patients' self-management knowledge, skill, and willingness for self-care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The QI project showed that the hospital could partner with patients at high risk for readmission and their caregivers. Accurate evaluation of patients' health knowledge, skills, and willingness for self-care was essential for sufficient discharge planning. Tailored use of the checklist improved patients' self-activation and functionally facilitated patients' and caregivers' care needs and capabilities. The checklist was statistically and clinically effective in decreasing 30-day hospital readmissions of vulnerable patient populations.


Asunto(s)
Alta del Paciente , Readmisión del Paciente , Anciano , Humanos , Estados Unidos , Cuidadores , Medicare , Autocuidado
20.
Artículo en Inglés | MEDLINE | ID: mdl-36674152

RESUMEN

(1) Background: This study aims to describe the primary sources of e-cigarettes among young people and to explore how these sources may differ by individual-level characteristics. (2) Methods: Data were obtained from a cross-sectional, continuous tracking survey of participants. The analytic sample includes current e-cigarette users (aged 15-20 years) surveyed from January to August 2022 (N = 1296). Respondents provided information on e-cigarette source of acquisition, device type, and flavors used, as well as sociodemographic and residential characteristics. Chi-square tests were used to determine differences in source of acquisition by age, gender, race/ethnicity, United States (US) census region, urban-rural classification, flavors used, and device type. (3) Results: Although most current e-cigarette users obtained their devices through a social source (56.9%), a considerable proportion obtained e-cigarettes from a retail source (43.1%). The primary retail sources of e-cigarette acquisition were vape shops (22.0%) and gas station/convenience stores (15.9%). Source of e-cigarette acquisition differed by age, gender, US census region, flavors used, and device type, such that a lower proportion of those who were younger, female, residing in the West, and used vape pens had reported obtaining e-cigarettes via retail sources. (4) Conclusions: Results indicate that a significant proportion of youth report obtaining e-cigarettes from retail sources, despite the federal, state, and local policies that prohibit the sale of any tobacco products to those under the age of 21. Comprehensive retail regulations to help restrict tobacco product access are needed to reduce e-cigarette use among young people.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Vapeo , Humanos , Adolescente , Femenino , Estados Unidos , Estudios Transversales , Mercadotecnía/métodos , Encuestas y Cuestionarios
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