Is Electronic Information Exchange Associated With Lower 30-Day Readmission Charges Among Medicare Beneficiaries?

OBJECTIVE: Fragmented readmissions, when admission and readmission occur at different hospitals, are associated with increased charges compared with nonfragmented readmissions. We assessed if hospital participation in health information exchange (HIE) was associated with differences in total charges in fragmented readmissions. DATA SOURCE: Medicare Fee-for-Service Data, 2018. STUDY DESIGN: We used generalized linear models with hospital referral region and readmission month fixed effects to assess relationships between information sharing (same HIE, different HIEs, and no HIE available) and total charges of 30-day readmissions among fragmented readmissions; analyses were adjusted for patient-level clinical/demographic characteristics and hospital-level characteristics. DATA EXTRACTION METHODS: We included beneficiaries with a hospitalization for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues with a 30-day readmission for any reason. PRINCIPAL FINDINGS: In all, 279,729 admission-readmission pairs were included, 27% of which were fragmented (n=75,438); average charges of fragmented readmissions were $64,897-$71,606. Compared with fragmented readmissions where no HIE was available, the average marginal effects of same-HIE and different-HIE admission-readmission pairs were -$2329.55 (95% CI: -7333.73, 2674.62) and -$3905.20 (95% CI: -7592.85, -307.54), respectively. While the average marginal effects of different-HIE pairs were lower than those for no-HIE fragmented readmissions, the average marginal effects of same-HIE and different-HIE pairs were not significantly different from each other. CONCLUSIONS: There were no statistical differences in charges between fragmented readmissions to hospitals that share an HIE or that do not share an HIE compared with hospitals with no HIE available.

Care fragmentation and readmission mortality and length of stay before and during the COVID-19 pandemic: data from the National Readmissions Database, 2018-2020.

IMPORTANCE: A quarter of all 30-day readmissions involve fragmented care, where patients return to a different hospital than their original admission; these readmissions are associated with increased in-hospital mortality and longer lengths-of-stay (LOS). The stress on healthcare systems at the beginning of the COVID-19 pandemic could worsen care fragmentation and related outcomes. OBJECTIVE: To compare fragmented readmissions in 2020 versus 2018-2019 and assess whether mortality and LOS in fragmented readmissions differed in the two time periods. DESIGN: Observational study SETTING: National Readmissions Database (NRD), 2018-2020 PARTICIPANTS: All adults (> 18 y/o) with 30-day readmissions MAIN OUTCOMES AND MEASURES: We examined the percentage of fragmented readmissions over 2018-2020. Using unadjusted and adjusted logistic and linear regressions, we estimated the associations between fragmented readmissions and in-hospital mortality and LOS. RESULTS: 24.0-25.7% of readmissions in 2018-2020 and 27.3%-31.0% of readmissions for COVID-19 were fragmented. 2018-2019 fragmented readmissions were associated with 18-20% higher odds of in-hospital mortality compared to nonfragmented readmissions. Fragmented readmissions for COVID-19 were associated with an 18% increase in in-hospital mortality (AOR 1.18, 95% CI 1.12, 1.24). The LOS of fragmented readmissions in March-November 2018-2019 were on average 0.81 days longer, while fragmented readmissions between March-November of 2020 were associated with a 0.88-1.03 day longer LOS. CONCLUSIONS AND RELEVANCE: A key limitation is that the NRD does not contain information on several patient/hospital-level factors that may be associated with the outcomes of interest. We observed increased fragmentation during COVID-19, but its impact on in-hospital mortality and LOS remained consistent with previous years.

Gender differences in learning and study strategies impact medical students' preclinical and USMLE step 1 examination performance.

BACKGROUND: Evaluation of students' learning strategies can enhance academic support. Few studies have investigated differences in learning strategies between male and female students as well as their impact on United States Medical Licensing Examination® (USMLE) Step 1 and preclinical performance. METHODS: The Learning and Study Strategies Inventory (LASSI) was administered to the classes of 2019-2024 (female (n = 350) and male (n = 262)). Students' performance on preclinical first-year (M1) courses, preclinical second-year (M2) courses, and USMLE Step 1 was recorded. An independent t-test evaluated differences between females and males on each LASSI scale. A Pearson product moment correlation determined which LASSI scales correlated with preclinical performance and USMLE Step 1 examinations. RESULTS: Of the 10 LASSI scales, Anxiety, Attention, Information Processing, Selecting Main Idea, Test Strategies and Using Academic Resources showed significant differences between genders. Females reported higher levels of Anxiety (p < 0.001), which significantly influenced their performance. While males and females scored similarly in Concentration, Motivation, and Time Management, these scales were significant predictors of performance variation in females. Test Strategies was the largest contributor to performance variation for all students, regardless of gender. CONCLUSION: Gender differences in learning influence performance on STEP1. Consideration of this study's results will allow for targeted interventions for academic success.

Implementing a student-centered stroke intervention and prevention education program; evaluating motivation, cognitive load, and performance among middle school students.

Background: In this study, we investigated the association between motivation, cognitive load, difficulty, and performance in a stroke education outreach program implemented for middle school students. Methods: Various interactive instructional activities were developed to engage students throughout the program to assess cognitive and intrinsic load arising from learner implementation of various tasks in a stroke education program for middle school kids. Performance was measured using a post-test to assess knowledge gained by the 6th, 7th, and 8th-grade middle school students. A short questionnaire was also administered to collect data on students' motivation using the ARCS model to asses attention, relevance, confidence, and satisfaction. In addition, we evaluated difficulty level and cognitive load. The relationship between performance and motivation was assessed using Pearson's correlation. Results: In our results, there was no significant difference (p > 0.05) in performance between the 6th, 7th, and 8th-grade students. The difference in performance, cognitive load (mental effort and difficulty), or motivation between the 6th, 7th, and 8 t-grade students was not significant (p > 0.05). The correlation between motivation and performance was significant (r = 0.87, p = 0.001), while the correlation between mental effort and performance was not significant (r = 0.34, p = 0.270). Also, the correlation between difficulty and performance was not significant (r = 0.38, p = 0.361). In the ARCS motivation model, attention, and confidence received the lowest mean scores (3.9), while relevance received the highest score (4.3). Conclusion: Our findings reveal the importance of implementing novel activities to enhance students' motivation to improve performance in the implementation of stroke education outreach programs for middle school students.

Current Concepts in the Management of Sanfilippo Syndrome (MPS III): A Narrative Review.

Sanfilippo syndrome is a childhood-onset (1-4 years) autosomal recessive lysosomal storage disease that presents as a neurodegenerative disease by targeting the brain and spinal cord. It is also known as mucopolysaccharidosis III. Mucopolysaccharidosis III is divided into four subtypes (A, B, C, or D). It can cause delayed speech, behavior problems, and features of autism spectrum disorder. Sanfilippo syndrome is of a higher prevalence within consanguineous families that carry its gene alteration. If both parents have a nonfunctional copy of a gene linked to this condition, their children will have a 25% (1 in 4) chance of developing the disease. In Saudi Arabia, the incidence rate is estimated at 2 per 100,000 live births. Recent research focused on promising treatment approaches, such as gene therapy, modified enzyme replacement therapy, and stem cells. These approaches work by exogenous administration of the proper version of the mutant enzyme (enzyme replacement therapy), cleaning the defective enzyme in individuals with glycolipid storage disorders (substrate reduction therapy), or using a pharmacological chaperone to target improperly folded proteins. However, there is currently no approved curative medication for Sanfilippo syndrome that can effectively halt or reverse the disorder.

Longitudinal associations between ambient PM2.5 exposure and lipid levels in two Indian cities.

Background: Exposure to ambient PM2.5 is known to affect lipid metabolism through systemic inflammation and oxidative stress. Evidence from developing countries, such as India with high levels of ambient PM2.5 and distinct lipid profiles, is sparse. Methods: Longitudinal nonlinear mixed-effects analysis was conducted on >10,000 participants of Centre for cArdiometabolic Risk Reduction in South Asia (CARRS) cohort in Chennai and Delhi, India. We examined associations between 1-month and 1-year average ambient PM2.5 exposure derived from the spatiotemporal model and lipid levels (total cholesterol [TC], triglycerides [TRIG], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]) measured longitudinally, adjusting for residential and neighborhood-level confounders. Results: The mean annual exposure in Chennai and Delhi was 40 and 102 µg/m3 respectively. Elevated ambient PM2.5 levels were associated with an increase in LDL-C and TC at levels up to 100 µg/m3 in both cities and beyond 125 µg/m3 in Delhi. TRIG levels in Chennai increased until 40 µg/m3 for both short- and long-term exposures, then stabilized or declined, while in Delhi, there was a consistent rise with increasing annual exposures. HDL-C showed an increase in both cities against monthly average exposure. HDL-C decreased slightly in Chennai with an increase in long-term exposure, whereas it decreased beyond 130 µg/m3 in Delhi. Conclusion: These findings demonstrate diverse associations between a wide range of ambient PM2.5 and lipid levels in an understudied South Asian population. Further research is needed to establish causality and develop targeted interventions to mitigate the impact of air pollution on lipid metabolism and cardiovascular health.

Effect of Addition of a Mixture of Ethyl Esters of Polyunsaturated Fatty Acid of Linseed Oil to Liquid Feed on Performance and Health of Dairy Calves.

This study aimed to determine the effect of supplementing liquid feeds with a mixture of ethyl esters of polyunsaturated fatty acid of linseed oil (EEPUFA; α-linolenic acid-64.5%, linoleic acid-16.1%, and oleic acid-19.4%) on feed intake, body weight gain, feed efficiency, and health of dairy calves. Thirty-six healthy female Holstein-Friesian calves (7 d of age, 41.2 ± 4.0 kg) were assigned to one of two treatment groups (18 calves per group), i.e., control or EEPUFA, and fed liquid feed (whole milk (WM) or milk replacer (MR)) either without or with 10 mL/d of EEPUFA supplementation, respectively, for 56 days (till 63 d of age). Average daily intake of WM and MR was similar between treatments (p = 0.94). Average daily total DM intake and average daily starter feed DM intake were higher for the EEPUFA group (p = 0.05 and p = 0.01, respectively). The average daily body weight gain was also higher for the EEPUFA group (55 g/d; p = 0.03), although final body weight turned out not to be significantly different between groups (75.6 kg vs. 79.0 kg, control vs. EEPUFA, respectively; p = 0.20). Supplementation of liquid feeds with EEPUFA did not affect feed efficiency (p = 0.37) and most of investigated health parameters. However, the percentage of days with diarrhea relative to the number of days receiving treatment was higher in the control group than the EEPUFA group (76 vs. 42, respectively; p = 0.04). Although the results of this preliminary study are promising, further research is needed to establish the dose effect of EEPUFA on the performance and health of calves.

Comparative Efficacy of Non-Invasive Therapies in Temporomandibular Joint Dysfunction: A Systematic Review.

Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This systematic review aims to comprehensively assess the effectiveness of non-invasive treatment modalities for TMJ dysfunction, prioritizing a definitive protocol to ensure patient safety and enhance quality of life. Employing the PRISMA guidelines, we meticulously analyzed 20 studies from a pool of 1,417 articles sourced from databases such as PubMed, Google Scholar, ScienceDirect, and Medline. These studies underscore the multifarious nature of TMD and the varied responses to treatments such as physical therapy, laser therapy, ultrasound and electrical stimulation, splint therapy, injections, and arthrocentesis. Notably, the review highlights the paramount importance of precise diagnosis, often through surface electromyography, followed by a tailored treatment approach integrating manual therapy, counseling, and splint therapy. The systematic analysis revealed that while certain treatments such as transcutaneous electrical nerve stimulation and low-level laser therapy showed limited efficacy, combination therapies, especially those involving manual therapy, counseling, and splint therapy, demonstrated substantial improvement in reducing pain, depression, and anxiety. The findings advocate for a non-invasive, patient-centric approach, emphasizing education and symptom management before considering more invasive procedures such as injections and arthrocentesis. The review identifies the need for more comprehensive, longitudinal studies to establish a standardized, evidence-based treatment protocol for TMJ dysfunction, aiming to improve patient outcomes holistically.

Recent Progress in Folic Acid Detection Based on Fluorescent Carbon Dots as Sensors: A Review.

Folic acid (FA) is a water-soluble vitamin found in diverse natural sources and is crucial for preserving human health. The risk of health issues due to FA deficiency underscores the need for a straightforward and sensitive FA detection methodology. Carbon dots (CDs) have gained significant attention owing to their exceptional fluorescence performance, biocompatibility, and easy accessibility. Consequently, numerous research studies have concentrated on developing advanced CD fluorescent probes to enable swift and precise FA detection. Despite these efforts, there is still a requirement for a thorough overview of the efficient synthesis of CDs and their practical applications in FA detection to further promote the widespread use of CDs. This review paper focuses on the practical applications of CD sensors for FA detection. It begins with an in-depth introduction to FA and CDs. Following that, based on various synthetic approaches, the prepared CDs are classified into diverse detection methods, such as single sensing, visual detection, and electrochemical methods. Furthermore, persistent challenges and potential avenues are highlighted for future research to provide valuable insights into crafting effective CDs and detecting FA.

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia.

BACKGROUND: Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters. METHODS: A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. RESULTS: Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. CONCLUSIONS: There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Diabetes disparities in the United States: Trends by educational attainment from 2001 to 2020.

INTRODUCTION: Tracking changes in socioeconomic disparities in diabetes in the US is important to evaluate progress in health equity and guide prevention efforts. Disparities in diabetes prevalence by educational attainment from 2001 to 2020 were investigated. METHODS: Using a serial cross-sectional design, data from 33,220 adults aged 30 to 79 assessed in nine rounds of the National Health and Nutrition Examination Surveys between 2001 to 2020 were analyzed in 2023-4. Diabetes was defined as self-reported prior diagnosis, elevated glycated hemoglobin (HbA1c≥6.5%), or use of diabetes medications. Marginalized age- and covariate-adjusted prevalence differences (PD) and prevalence ratios (PR) of diabetes by educational attainment (less than high school graduation, high school graduation, some college education or associate degree, or college graduation [reference]) by calendar period (2001-04, 2005-08, 2009-12, 2013-16, 2017-20) were derived from logistic regression models. RESULTS: From 2001 to 2020, age-adjusted diabetes prevalence was consistently higher among adults without a college degree. Adults without a high school diploma exhibited the largest disparities in both 2001-04 (PD 8.0%; 95%CI 5.6-10.5 and PR 2.1; 95%CI 1.5-2.6) and 2017-20 (PD 11.0%; 95%CI 6.7-15.2 and PR 2.1; 95%CI 1.5-2.7). Between 2001-04 and 2017-20, the absolute disparity in diabetes increased only among adults with a high school diploma (PD 1.7% 95%CI -0.5-3.9 vs PD 8.8%; 4.1-13.4, respectively), while the PR did not change in any group. Education-related disparities in diabetes were attenuated after accounting for socio-demographic factors and BMI. CONCLUSIONS: From 2001 to 2020, national education-related disparities in diabetes prevalence have shown no signs of narrowing.

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data.

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Knowledge of Back Pain and Spinal Disorders Among the General Population in the Western Region of Saudi Arabia.

Introduction  Low back pain (LBP) is one of the most common global health problems and the second most common reason for seeking medical advice. However, most LBP does not indicate a serious disorder. Over half of the Saudi Arabian population experiences LBP at least once in their lives. Therefore, it is important to assess and understand how people manage this health problem. This study assessed back pain and spinal disorder knowledge among the general population in Saudi Arabia's western region. Methods This was a cross-sectional study of the general population in western Saudi Arabia. The data were collected using an online, self-administered, Arabic version of the validated questionnaire about LBP. A statistical analysis of the collected data was performed using a software program. Results A total of 754 eligible participants completed the questionnaire. Less than half of the participants could correctly define acute and chronic LBP and sciatica. Only 19.2% of participants were aware that medical history and clinical examinations are used to diagnose LBP. Young participants, university graduates, and unmarried participants had good LBP knowledge. Conclusion This study showed that the general population of Saudi Arabia in the Western region needs more knowledge about the definitions of acute and chronic LBP. However, they had fair knowledge about the aggravating factors and triggers of LBP. Young participants had better knowledge about LBP. Awareness campaigns with brochures and flyers can be used to increase the population's knowledge.

Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan.

Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in living donor transplantation, Jordan's organ donation after brain death program remains inactive, making it challenging to meet organ demand and placing many patients on long transplant waiting lists. As of 2020, only 14.2% of the patients with end-stage kidney disease have access to a living donor. The scarcity of compatible living donors exacerbates Jordan's organ shortage, leaving patients with extended waits and uncertain transplant prospects. Due to the lack of living donors and the inactive brain death donation program, additional options are needed to meet organ demand. Kidney paired exchange (KPE), emerges as a potential solution to the problem of donor shortage and donor-recipient incompatibility. By allowing living donors to direct their donated organs to different compatible recipients, KPE offers the promise of expanding transplant opportunities for patients without suitable living donors. However, the current Jordanian law restricting living kidney donation to fifth-degree relatives further limits the pool of potential donors, aggravating the organ shortage situation. This article explores the feasibility of implementing KPE in Jordan and proposes an approach to implementing KPE in Jordan, considering ethical and legal aspects to substantially increase kidney transplants.

Molecular Mechanisms Associated with the Development of the Metritis Complex in Dairy Cattle.

The metritis complex (MC), a group of post-partum uterine diseases, is associated with increased treatment costs and reduced milk yield and fertility. The goal of this study was to identify genetic variants, genes, or genomic regions that modulate MC disease. A genome-wide association study was performed using a single-locus mixed linear model of 1967 genotypes (624,460 SNPs) and metritis complex records. Then, in-silico functional analyses were performed to detect biological mechanisms and pathways associated with the development of MC. The ATP8A2, COX16, AMN, and TRAF3 genes, located on chromosomes 12, 10, and 21, were associated with MC at p ≤ 0.0001. These genes are involved in the regulation of cholesterol metabolism in the stromal tissue of the uterus, which can be directly associated with the mode of transmission for pathogens causing the metritis complex. The modulation of cholesterol abundance alters the efficiency of virulence factors and may affect the susceptibility of the host to infection. The SIPA1L1, DEPDC5, and RNF122 genes were also significantly associated with MC at p ≤ 0.0001 and are involved in the PI3k-Akt pathway, responsible for activating the autophagic processes. Thus, the dysregulation of these genes allows for unhindered bacterial invasion, replication, and survival within the endometrium.

Can ChatGPT Replace an Otolaryngologist in Guiding Parents on Tonsillectomy?

Background: ChatGPT is an artificial intelligence tool, which utilizes machine learning to analyze and generate human-like text. The user-friendly accessibility of this tool enables patients conveniently access medical information without intricate terminology challenges. The objective of this study was to assess the accuracy of ChatGPT in providing insights into indications and management of complications after tonsillectomy, a common pediatric otolaryngology procedure. Methods: The responses generated by ChatGPT were compared to the "Clinical practice guidelines: tonsillectomy in children-executive summary" developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). An assessment was carried out by presenting predetermined questions regarding indications and complications post tonsillectomy to ChatGPT, followed by a comparison of its responses with the established guideline by 2 otolaryngology experts. The responses of both parties were reviewed by the senior author. Results: A total of 16 responses generated by ChatGPT were assessed. After a comprehensive review, it was concluded that 15 out of 16 (93.8%) responses demonstrated a high degree of reliability and accuracy, closely adhering to the standard established by the AAO-HNSF guideline. Conclusion: The results validate the potential of using ChatGPT to enhance healthcare delivery making guidelines more accessible to patients while also emphasizing the importance of ensuring the provision of accurate and reliable medical advice to patients.

Multiple cardiovascular risk factor care in 55 low- and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults.

The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009-2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40-69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8-66.4]) than those with hypertension only (47.4% [45.3-49.6]) or diabetes only (46.7% [44.1-49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8-41.8] using antihypertensive and 42.3% [95% CI: 39.4-45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1-27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4-18.8]), followed by diabetes (13.3% [10.7-15.8]) and hypertension-diabetes (6.6% [5.4-7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors.

Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims.

Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

A histology guide for performing human cadaveric studies: SQIP 2024 what to look for with light microscopy.

Histological observation under light microscopy has long been used in human cadaveric studies. However, it can distort the interpretations of findings if not used appropriately; there is no guide for its proper use. The aim of this article is to revisit and discuss the correct use of histology in human cadaveric studies, following discussions with experts in multiple fields of medicine, and to create the first guide for such usage. We reached a consensus with the experts, agreeing that when this principle (structure, quantification, interaction, position: SQIP) is applied to histological observations, the findings will be interpreted correctly. Appropriate use of this recommendation can make human cadaveric studies more accurate and informative. This is the first histology guide for human cadaveric studies.