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1.
Support Care Cancer ; 32(8): 497, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38980476

RESUMO

PURPOSE: Patients with dihydropyrimidine dehydrogenase (DPD) deficiency are at high risk for severe and fatal toxicity from fluoropyrimidine (FP) chemotherapy. Pre-treatment DPYD testing is standard of care in many countries, but not the United States (US). This survey assessed pre-treatment DPYD testing approaches in the US to identify best practices for broader adoption. METHODS: From August to October 2023, a 22-item QualtricsXM survey was sent to institutions and clinicians known to conduct pre-treatment DPYD testing and broadly distributed through relevant organizations and social networks. Responses were analyzed using descriptive analysis. RESULTS: Responses from 24 unique US sites that have implemented pre-treatment DPYD testing or have a detailed implementation plan in place were analyzed. Only 33% of sites ordered DPYD testing for all FP-treated patients; at the remaining sites, patients were tested depending on disease characteristics or clinician preference. Almost 50% of sites depend on individual clinicians to remember to order testing without the assistance of electronic alerts or workflow reminders. DPYD testing was most often conducted by commercial laboratories that tested for at least the four or five DPYD variants considered clinically actionable. Approximately 90% of sites reported receiving results within 10 days of ordering. CONCLUSION: Implementing DPYD testing into routine clinical practice is feasible and requires a coordinated effort among the healthcare team. These results will be used to develop best practices for the clinical adoption of DPYD testing to prevent severe and fatal toxicity in cancer patients receiving FP chemotherapy.


Assuntos
Deficiência da Di-Hidropirimidina Desidrogenase , Di-Hidrouracila Desidrogenase (NADP) , Humanos , Estados Unidos , Di-Hidrouracila Desidrogenase (NADP)/metabolismo , Deficiência da Di-Hidropirimidina Desidrogenase/diagnóstico , Neoplasias/tratamento farmacológico , Antimetabólitos Antineoplásicos/efeitos adversos , Inquéritos e Questionários , Fluoruracila/efeitos adversos , Fluoruracila/administração & dosagem
2.
JAMA Netw Open ; 7(7): e2418217, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38980678

RESUMO

Importance: Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. Objective: To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). Design, Setting, and Participants: The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Interventions: Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Main Outcomes and Measures: Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Results: Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). Conclusions and Relevance: In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. Trial Registration: ClinicalTrials.gov Identifier: NCT03385629.


Assuntos
Cárie Dentária , Atenção Primária à Saúde , Humanos , Pré-Escolar , Masculino , Feminino , Atenção Primária à Saúde/estatística & dados numéricos , Criança , Cárie Dentária/terapia , Medicaid/estatística & dados numéricos , Ohio , Estados Unidos , Assistência Odontológica para Crianças/estatística & dados numéricos , Assistência Odontológica para Crianças/métodos , Saúde Bucal/estatística & dados numéricos
3.
JAMA Netw Open ; 7(7): e2420724, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38980673

RESUMO

Importance: For people with type 2 diabetes (T2D), out-of-pocket medication costs may influence medication choice, adherence, and overall diabetes management and progression. Little is known about how these costs change as insured people enter Medicare at age 65 years, when coinsurance in the coverage gap and catastrophic phases of Part D coverage can be increased greatly by use of insulin and newer, branded medications (eg, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 agonists, and sodium-glucose cotransporter 2 inhibitors). Objective: To identify whether reaching age 65 years is associated with T2D medication out-of-pocket costs and utilization. Design, Setting, and Participants: This retrospective cohort study (2012-2020) featuring 7 years of follow-up used prescription drug claims data from the TriNetX Diamond Network. Participants included people in the US with diagnosed T2D, and claims for T2D medications were observed both before and after age 65 years. Data analysis was performed from October 2022 to September 2023. Exposure: Reaching age 65 years, according to participants' year of birth. Main Outcomes and Measures: The primary outcome was patient out-of-pocket costs for T2D drugs per quarter (inflation adjusted to 2020 dollars). Utilization, measured as binary utilization of specific classes, and the number of claims for mutually exclusive classes and combinations of classes were also examined. All outcomes were examined using regression discontinuity design. Results: In claims data for 129 997 individuals with T2D diagnosed at ages 58 to 72 years (mean [SD] age, 65.50 [2.95] years; 801 235 female [50.9%]), reaching age 65 years was associated with an increase of $23.04 (95% CI, $19.86-$26.22) in mean quarterly out-of-pocket costs for T2D drugs, and an increase of $56.36 (95% CI, $51.48-$61.23) at the 95th percentile of spending, after utilization adjustment. Utilization decreased by 5.3% at age 65 years, from 3.40 claims per quarter (95% CI, 3.38-3.42 claims per quarter) to 3.22 claims per quarter (95% CI, 3.21-3.24 claims per quarter), but a shift in composition of utilization, including increased insulin use, was associated with additional increases in patient costs. Conclusions and Relevance: In this cohort study of individuals with T2D, the increase in spending upon reaching age 65 years (when most people enroll in Medicare) was associated with patient coinsurance in the coverage gap and catastrophic coverage phases of Medicare Part D. The increased patient cost burden at age 65 years and a modest reduction in overall T2D drug utilization suggest that as people with T2D age into Medicare, there is potentially an increase in nonadherence and diabetes complications.


Assuntos
Diabetes Mellitus Tipo 2 , Gastos em Saúde , Hipoglicemiantes , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Idoso , Estados Unidos , Masculino , Feminino , Hipoglicemiantes/uso terapêutico , Hipoglicemiantes/economia , Estudos Retrospectivos , Gastos em Saúde/estatística & dados numéricos , Medicare/economia , Pessoa de Meia-Idade , Custos de Medicamentos/estatística & dados numéricos , Medicare Part D/economia , Medicare Part D/estatística & dados numéricos
4.
J Occup Environ Med ; 66(7): e321-e322, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38975948

RESUMO

ABSTRACT: Clinical practices that provide workers' compensation care and other services related to managing work-related illnesses and injuries have long been challenged in receiving appropriate payment for their professional work. The American College of Occupational and Environmental Medicine (ACOEM) has provided excellent guidelines for coding and billing via its various documents that have been provided over the years. However, despite these guidelines, payors have been slow to adopt occupational specific coding guidelines to justify higher professional payment. With the move to a Centers for Medicare & Medicaid Services (CMS)-sponsored time-based coding option in 2011, the occupational and environmental medicine (OEM) clinics have been able to finally not only document but recoup the value of those services that go beyond the simple patient interface, being able to capture those activities that truly provide high value in the management of workers' medical issues.


Assuntos
Codificação Clínica , Indenização aos Trabalhadores , Indenização aos Trabalhadores/economia , Humanos , Estados Unidos , Codificação Clínica/normas , Medicina do Trabalho , Guias de Prática Clínica como Assunto , Documentação/normas , Doenças Profissionais/terapia , Doenças Profissionais/economia , Centers for Medicare and Medicaid Services, U.S. , Traumatismos Ocupacionais/terapia , Traumatismos Ocupacionais/economia
5.
PLoS One ; 19(7): e0296139, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38968193

RESUMO

BACKGROUND: Chronic inflammation may increase susceptibility to pneumonia. RESEARCH QUESTION: To explore associations between clinical comorbidities, serum protein immunoassays, and long-term pneumonia risk. METHODS: Framingham Heart Study Offspring Cohort participants ≥65 years were linked to their Centers for Medicare Services claims data. Clinical data and 88 serum protein immunoassays were evaluated for associations with 10-year incident pneumonia risk using Fine-Gray models for competing risks of death and least absolute shrinkage and selection operators for covariate selection. RESULTS: We identified 1,370 participants with immunoassays and linkage to Medicare data. During 10 years of follow up, 428 (31%) participants had a pneumonia diagnosis. Chronic pulmonary disease [subdistribution hazard ratio (SHR) 1.87; 95% confidence interval (CI), 1.33-2.61], current smoking (SHR 1.79, CI 1.31-2.45), heart failure (SHR 1.74, CI 1.10-2.74), atrial fibrillation/flutter (SHR 1.43, CI 1.06-1.93), diabetes (SHR 1.36, CI 1.05-1.75), hospitalization within one year (SHR 1.34, CI 1.09-1.65), and age (SHR 1.06 per year, CI 1.04-1.08) were associated with pneumonia. Three baseline serum protein measurements were associated with pneumonia risk independent of measured clinical factors: growth differentiation factor 15 (SHR 1.32; CI 1.02-1.69), C-reactive protein (SHR 1.16, CI 1.06-1.27) and matrix metallopeptidase 8 (SHR 1.14, CI 1.01-1.30). Addition of C-reactive protein to the clinical model improved prediction (Akaike information criterion 4950 from 4960; C-statistic of 0.64 from 0.62). CONCLUSIONS: Clinical comorbidities and serum immunoassays were predictive of pneumonia risk. C-reactive protein, a routinely-available measure of inflammation, modestly improved pneumonia risk prediction over clinical factors. Our findings support the hypothesis that prior inflammation may increase the risk of pneumonia.


Assuntos
Biomarcadores , Pneumonia , Humanos , Feminino , Pneumonia/sangue , Pneumonia/epidemiologia , Masculino , Biomarcadores/sangue , Idoso , Fatores de Risco , Proteínas Sanguíneas/análise , Estudos de Coortes , Idoso de 80 Anos ou mais , Estados Unidos/epidemiologia , Comorbidade
6.
BMJ Open ; 14(7): e084549, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38969366

RESUMO

OBJECTIVE: The association between the Triglyceride-Glucose (TyG) Index and mortality rates in patients with cardiovascular disease (CVD) remains unclear. This study investigates the association between the TyG index and the incidence of all-cause and CVD-specific mortality among individuals with a history of CVD. DESIGN: Population-based cohort study. SETTING: Data were sourced from the US National Health and Nutrition Examination Survey (2007-2018) and linked mortality data, with follow-up continuing until 31 December 2019. PARTICIPANTS: The study population comprised 3422 individuals aged 20 years or older with a documented history of CVD. OUTCOME MEASURES: We examined the association between the TyG index and the risk of all-cause and cardiovascular mortality. RESULTS: Over a median follow-up of 5.79 years, 1030 deaths occurred, including 339 due to CVD. Cox regression analysis, adjusted for multiple confounders, showed that individuals in the highest TyG index quartile, compared with those in the lowest, had HRs of 0.76 (95% CI: 0.60 to 0.96) for all-cause mortality and 0.58 (95% CI: 0.39 to 0.89) for CVD mortality. There was a significant inverse relationship between higher TyG index levels and lower mortality risks. For each unit increase in the TyG index, the adjusted HRs for all-cause and CVD mortality decreased by 18% (HR 0.82; 95% CI: 0.71 to 0.94) and 27% (HR 0.73; 95% CI: 0.57 to 0.92), respectively. CONCLUSIONS: TyG index values are negatively associated with all-cause and CVD mortality risks among individuals with previous CVD. Further interventional studies are needed to clarify the impact of TyG levels on cardiovascular health.


Assuntos
Glicemia , Doenças Cardiovasculares , Inquéritos Nutricionais , Triglicerídeos , Humanos , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Estados Unidos/epidemiologia , Adulto , Glicemia/análise , Idoso , Estudos de Coortes , Fatores de Risco , Causas de Morte , Modelos de Riscos Proporcionais
7.
BMC Prim Care ; 25(1): 242, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38969987

RESUMO

BACKGROUND: Persons with diabetes have 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from priority health disparities populations. Federally qualified health centers (FQHCs) struggle to implement CRC screening programs for average risk patients. Strategies to effectively prioritize and optimize CRC screening for patients with diabetes in the primary care safety-net are needed. METHODS: Guided by the Exploration, Preparation, Implementation and Sustainment Framework, we conducted a stakeholder-engaged process to identify multi-level change objectives for implementing optimized CRC screening for patients with diabetes in FQHCs. To identify change objectives, an implementation planning group of stakeholders from FQHCs, safety-net screening programs, and policy implementers were assembled and met over a 7-month period. Depth interviews (n = 18-20) with key implementation actors were conducted to identify and refine the materials, methods and strategies needed to support an implementation plan across different FQHC contexts. The planning group endorsed the following multi-component implementation strategies: identifying clinic champions, development/distribution of patient educational materials, developing and implementing quality monitoring systems, and convening clinical meetings. To support clinic champions during the initial implementation phase, two learning collaboratives and bi-weekly virtual facilitation will be provided. In single group, hybrid type 2 effectiveness-implementation trial, we will implement and evaluate these strategies in a in six safety net clinics (n = 30 patients with diabetes per site). The primary clinical outcomes are: (1) clinic-level colonoscopy uptake and (2) overall CRC screening rates for patients with diabetes assessed at baseline and 12-months post-implementation. Implementation outcomes include provider and staff fidelity to the implementation plan, patient acceptability, and feasibility will be assessed at baseline and 12-months post-implementation. DISCUSSION: Study findings are poised to inform development of evidence-based implementation strategies to be tested for scalability and sustainability in a future hybrid 2 effectiveness-implementation clinical trial. The research protocol can be adapted as a model to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT05785780) on March 27, 2023 (last updated October 21, 2023).


Assuntos
Neoplasias Colorretais , Diabetes Mellitus , Detecção Precoce de Câncer , Provedores de Redes de Segurança , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Atenção Primária à Saúde , Estados Unidos/epidemiologia
8.
BMC Womens Health ; 24(1): 391, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38970037

RESUMO

BACKGROUND: The racial/ethnic and gender disparities in cardiovascular disease (CVD) morbidity and mortality in the United States are evident. Across nearly every metric, non-Hispanic Black women have poorer overall cardiovascular health. Emerging evidence shows a disproportionately high burden of increased CVD risk factors in Black women of childbearing age, which has a far-reaching impact on both maternal and child outcomes, resulting in premature onset of CVD and further widens the racial disparities in CVD. There is growing recognition that the fundamental driver of persistent racial/ethnic disparities in CVD, as well as disparities in behavioral risk factors such as physical activity and sleep, is structural racism. Further, the lived personal experience of racial discrimination not only has a negative impact on health behaviors, but also links to various physiological pathways to CVD risks, such as internalized stress resulting in a pro-inflammatory state. Limited research, however, has examined the interaction between daily experience and health behaviors, which are influenced by upstream social determinants of health, and the downstream effect on biological/physiological indicators of cardiovascular health in non-pregnant Black women of childbearing age. METHODS/DESIGN: The BLOOM Study is an observational study that combines real-time ambulatory assessments over a 10-day monitoring period with in-depth cross-sectional lab-based physiological and biological assessments. We will use a wrist-worn actigraphy device to capture 24-h movement behaviors and electronic ecological momentary assessment to capture perceived discrimination, microaggression, and stress. Blood pressure will be captured continuously through a wristband. Saliva samples will be self-collected to assess cortisol level as a biomarker of psychological stress. Lab assessments include a fasting venous blood sample, and assessment of various indices of peripheral and cerebral vascular function/health. Participants' address or primary residence will be used to obtain neighborhood-level built environmental and social environmental characteristics. We plan to enroll 80 healthy Black women who are between 18 and 49 years old for this study. DISCUSSION: Results from this study will inform the development of multilevel (i.e., individual, interpersonal, and social-environmental levels) lifestyle interventions tailored to Black women based on their lived experiences with the goal of reducing CVD risk. GOV IDENTIFIER: NCT06150989.


Assuntos
Negro ou Afro-Americano , Doenças Cardiovasculares , Humanos , Feminino , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Adulto , Determinantes Sociais da Saúde , Adulto Jovem , Comportamentos Relacionados com a Saúde , Pessoa de Meia-Idade , Estados Unidos , Racismo/psicologia , Fatores de Risco , Disparidades nos Níveis de Saúde , Saliva/química
9.
Sci Rep ; 14(1): 15781, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982174

RESUMO

Tobacco smoke exposure has been demonstrated to impede bone remodeling and diminish bone density, yet research regarding its correlation with parathyroid hormone (PTH) remains limited. This study aims to investigate the relationship between tobacco smoke exposure and serum PTH levels in adults aged 20 years and older. This study included 7,641 participants from two cycles of the National Health and Nutrition Examination Survey (NHANES, United States, 2003- 2006). Reflect tobacco smoke exposure through serum cotinine levels, and use an adjusted weighted multivariate linear regression model to test the independent linear relationship between serum cotinine and PTH. Stratified analysis was conducted to validate the sensitivity of the conclusions. Smooth curve fitting and threshold effect analysis were performed to assess the non-linear relationship. After comprehensive adjustment using weighted multivariate regression analysis, a negative correlation was found between serum cotinine and PTH levels. The interaction p-values in subgroup analyses were all greater than 0.05. Moreover, smooth curve fitting indicated a non-linear relationship between serum cotinine and PTH, with a turning point observed. Our research indicates that tobacco smoke exposure is negatively correlated and independent of serum parathyroid hormone levels, indicating that long-term tobacco smoke exposure may lead to parathyroid dysfunction in adults.


Assuntos
Cotinina , Inquéritos Nutricionais , Hormônio Paratireóideo , Poluição por Fumaça de Tabaco , Humanos , Hormônio Paratireóideo/sangue , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Cotinina/sangue , Estados Unidos/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Idoso , Adulto Jovem
10.
Sci Rep ; 14(1): 15808, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982237

RESUMO

Hearing difficulty (HD) may be associated with an increased frequency of emergency department (ED) visits among older adults. The COVID-19 pandemic has adversely affected the health of older adults. However, less is known about the characteristics of ED visits by older adults with HD during the pandemic. This study examines the association between self-reported HD severity and ED visits during the pandemic. This population-based cross-sectional study used self-reported data on HD and the characteristics of respondents aged 65 years or older from three cycles of the National Health Interview Survey from 2020 to 2022. Data were analysed from February 23, 2023, to March 22, 2023. The primary outcome was self-reported ED visits in the past 12 months. This study employed generalised linear models to examine the relationship between ED visits (dependent variable) and HD in older adults, and the effect sizes were expressed as rate ratios. Key independent variables included the reasons for ED visit. Covariates such as demographic characteristics and socio-economic status were controlled for to account for potential confounding effects. During the pandemic, older adults with HD commonly visited the ED because of chronic pain (82.8%), frailty (77.9%), trouble falling/staying asleep (73.2%), hypertension (67.4%), and arthritis (60.1%), all of which were 1.5-times more likely in these adults than in those with normal hearing (chronic pain: adjusted rate ratio [ARR], 1.64 [95% CI 1.44-1.93]; frailty: ARR, 1.57 [95% CI 1.16-1.87]; trouble falling/staying asleep: ARR, 1.51 [95% CI 1.21-1.82]; hypertension: ARR, 1.01 [95% CI 0.92-1.23]; arthritis: ARR, 1.39 [95% CI 1.31-1.57]. Older adults with HD were more likely to visit the ED for chronic pain, frailty, trouble falling/staying asleep, hypertension, and arthritis than those with normal hearing during the COVID-19 pandemic. Our findings will be help for healthcare providers to be aware of these potential barriers and to implement strategies to ensure that patients with hearing difficulties can access necessary emergency care effectively.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Humanos , COVID-19/epidemiologia , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Masculino , Feminino , Estudos Transversais , Estados Unidos/epidemiologia , Idoso de 80 Anos ou mais , Perda Auditiva/epidemiologia , Pandemias , SARS-CoV-2 , Visitas ao Pronto Socorro
11.
BMC Health Serv Res ; 24(1): 781, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982401

RESUMO

BACKGROUND: Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization. METHODS: A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage. RESULTS: For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04). CONCLUSIONS: Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.


Assuntos
Acessibilidade aos Serviços de Saúde , Medicaid , Cuidado Pré-Natal , Viagem , Humanos , Feminino , Cuidado Pré-Natal/estatística & dados numéricos , Gravidez , Viagem/estatística & dados numéricos , Estudos Retrospectivos , Adulto , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Estados Unidos , South Carolina , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
12.
Pediatr Rheumatol Online J ; 22(1): 64, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38982530

RESUMO

BACKGROUND: The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network. METHODS: A mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles. RESULTS: US and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite limited perceived benefit to their academic portfolios. Based on AMIGO's success, a counterpart program for adult rheumatology, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018. CONCLUSIONS: Despite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties.


Assuntos
Mentores , Pediatria , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Reumatologia , Humanos , Reumatologia/educação , Pediatria/educação , Estados Unidos , Canadá , Tutoria/métodos , Estudos Longitudinais , Masculino
14.
Allergy Asthma Proc ; 45(4): 247-254, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38982603

RESUMO

Background: Hereditary angioedema (HAE) is a rare genetic condition characterized by painful and often debilitating swelling attacks. Little is known about the differences in outcomes between patients with HAE types I or II (type I: HAE caused by C1 esterase inhibitor deficiency; type II: HAE caused by C1 esterase inhibitor dysfunction), with decreased or dysfunctional C1 esterase inhibitor (C1-INH), and those with normal C1-INH (nC1-INH-HAE). Objective: To compare physician- and patient-reported real-world outcomes in patients with HAE types I/II versus patients with nC1-INH-HAE. Methods: Data were drawn from the Adelphi HAE Disease Specific ProgrammeTM a real-world, cross-sectional survey of HAE-treating physicians and their patients in the United States conducted between July and November 2021. Physicians reported patient disease activity and severity, and recent attack history. Patient-reported outcomes were collected. Bivariate tests used were either the Student's t-test, the Fisher exact test, or Mann-Whitney U test. Results: Physicians (N = 67) provided data on 368 patients (92.4% HAE types I/II and 7.6% nC1-INH-HAE). Physicians reported that a higher proportion of patients with nC1-INH-HAE had moderate or high disease activity and moderate or severe disease severity both at diagnosis and at data collection versus those with HAE types I/II. Patients with nC1-INH-HAE versus patients with HAE types I/II experienced increased attack severity (34.6% versus 4.4%) and hospitalization rate during the most recent attack (39.3% versus 6.6%), and reported lower health status and quality of life, via the European Quality of Life 5 Dimension 5 Level (US tariff) and Angioedema Quality of Life, respectively. On average, 25% of the patients with nC1-INH-HAE reported absenteeism and work or activity impairment due to HAE compared with 2.7% of patients with HAE types I/II. Both patient groups reported improvements in disease activity and severity from diagnosis to the time of data collection. Conclusion: These real-world findings suggest that patients with nC1-INH-HAE have increased disease activity and severity, and experience greater impairment to their quality of life, work, and daily functioning than patients with HAE types I/II. Powered statistical analyses are required to confirm these findings.


Assuntos
Angioedemas Hereditários , Proteína Inibidora do Complemento C1 , Medidas de Resultados Relatados pelo Paciente , Médicos , Humanos , Feminino , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Proteína Inibidora do Complemento C1/genética , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/epidemiologia , Índice de Gravidade de Doença , Angioedema Hereditário Tipos I e II/diagnóstico , Adulto Jovem , Qualidade de Vida , Estados Unidos/epidemiologia , Idoso , Adolescente
15.
J Parasitol ; 110(4): 263-275, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38982636

RESUMO

Histomoniasis, caused by the protozoan, Histomonas meleagridis, is an economically important disease of turkeys, and it also affects several other species of domesticated and wild Galliformes, including chickens. Under natural conditions, the parasite is transmitted through eggs of a nematode, Heterakis gallinarum, that shares its hosts with Hi. meleagridis. The protozoan infects tissues of both male and female He. gallinarum and eventually is carried within the worm egg. Histomonas meleagridis more readily infects and develops in chickens, and the proximity of chicken farms is a major risk factor for outbreaks in turkeys. Chemoprophylaxis had controlled Hi. meleagridis in turkeys very successfully, but histomoniasis has recently reemerged in turkeys because anti-histomonal drugs are no longer permitted by the United States Food and Drug Administration because of the concerns for residual toxins in poultry meat. Horizontal transmission of the protozoan in the absence of worm eggs remains a mystery because the flagellate trophozoite excreted in the feces of turkeys is not viable for any length of time. A proposed resistant stage of the protozoan has not yet been conclusively demonstrated. Here we review the discovery of the protozoan and the current status of the disease and its control.


Assuntos
Doenças das Aves Domésticas , Infecções Protozoárias em Animais , Perus , Animais , Perus/parasitologia , Doenças das Aves Domésticas/parasitologia , Doenças das Aves Domésticas/história , Doenças das Aves Domésticas/epidemiologia , Doenças das Aves Domésticas/transmissão , Infecções Protozoárias em Animais/epidemiologia , Infecções Protozoárias em Animais/parasitologia , Infecções Protozoárias em Animais/história , Infecções Protozoárias em Animais/transmissão , Estados Unidos/epidemiologia , História do Século XX , Trichomonadida/isolamento & purificação , Feminino , Masculino , História do Século XXI
17.
Headache ; 64(7): 750-763, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38982663

RESUMO

OBJECTIVE: To assess the prevalence and impact of neck pain during headache among respondents with migraine in the multicountry Chronic Migraine Epidemiology and Outcomes - International (CaMEO-I) Study. BACKGROUND: Neck pain among individuals with migraine is highly prevalent and contributes to disability. METHODS: The CaMEO-I was a prospective, cross-sectional, web-based study conducted in Canada, France, Germany, Japan, United Kingdom, and the United States. A demographically representative sample of participants from each country completed a screening survey to evaluate headache characteristics. Respondents with headache were identified as having migraine or non-migraine headache based on modified International Classification of Headache Disorders, third edition, criteria; those with migraine completed a detailed survey with migraine-specific assessments. Results were stratified by the presence or absence of neck pain with headache (NPWH). For these analyses, data were pooled across the six countries. RESULTS: Of 51,969 respondents who reported headache within the past 12 months, 14,492 (27.9%) were classified as having migraine; the remaining 37,477 (72.1%) had non-migraine headache. Overall, 9896/14,492 (68.3%) of respondents with migraine headache reported NPWH, which was significantly higher (p < 0.001) than the proportion of respondents with non-migraine headache who reported NPWH (13,536/37,477 [36.1%]). Among respondents with migraine, moderate-to-severe disability was significantly more prevalent for those with NPWH versus without (47.7% [4718/9896] vs. 28.9%, p < 0.001). Respondents with NPWH versus without also had significantly greater work productivity losses, at a median (interquartile range [IQR]) of 50.0 (20.0, 71.3) vs. 30.0 (0.0, 60.0) (p < 0.001), lower quality of life (Migraine-Specific Quality of Life questionnaire version 2.1, median [IQR] Role Function-Restrictive domain score 60.0 [42.9, 74.3] vs. 68.6 [54.3, 82.9], p < 0.001), higher prevalence of depression and anxiety symptoms (depression, 40.2% [3982/9896] vs. 28.2% [1296/4596], p < 0.001); anxiety, 41.2% [4082/9896] vs. 29.2% [1343/4596], p < 0.001), higher prevalence of cutaneous allodynia during headache (54.0% [5345/9896] vs. 36.6% [1681/4596], p < 0.001), and higher prevalence of poor acute treatment optimization (61.1% [5582/9129] vs. 53.3% [2197/4122], p < 0.001). CONCLUSIONS: Nearly 70% of respondents with migraine reported NPWH. Individuals with migraine with neck pain during their headaches had greater disability, depression, anxiety, and cutaneous allodynia (during headache) than those without neck pain during their headaches. They also had diminished quality of life and work productivity, and poorer response to acute treatment compared with those without neck pain.


Assuntos
Transtornos de Enxaqueca , Cervicalgia , Humanos , Transtornos de Enxaqueca/epidemiologia , Estudos Transversais , Masculino , Feminino , Cervicalgia/epidemiologia , Adulto , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Estados Unidos/epidemiologia , Adulto Jovem , Canadá/epidemiologia
18.
Hum Vaccin Immunother ; 20(1): 2370087, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38982712

RESUMO

The immune response to inactivated influenza vaccines (IIV) is influenced by multiple factors, including hemagglutinin content and egg-based manufacturing. Only two US-licensed vaccines are manufactured without egg passage: cell culture-based inactivated vaccine (ccIIV) and recombinant vaccine (RIV). We conducted a randomized open-label trial in central Wisconsin during the 2018-19 and 2019-20 seasons to compare immunogenicity of sequential vaccination. Participants 18-64 years old were randomized 1:1:1 to receive RIV, ccIIV or IIV in strata defined by number of influenza vaccine doses in the prior 3 years. They were revaccinated with the same product in year two. Paired serum samples were tested by hemagglutination inhibition against egg-adapted and cell-grown vaccine viruses. Serologic endpoints included geometric mean titer (GMT), mean fold rise, and percent seroconversion. There were 373 participants randomized and vaccinated in 2018-19; 332 were revaccinated in 2019-20. In 2018-19, RIV and ccIIV were not more immunogenic than IIV against A/H1N1. The post-vaccination GMT against the cell-grown 3C.2a A/H3N2 vaccine virus was higher for RIV vs IIV (p = .001) and RIV vs ccIIV (p = .001). The antibody response to influenza B viruses was similar across study arms. In 2019-20, GMT against the cell-grown 3C.3a A/H3N2 vaccine virus was higher for RIV vs IIV (p = .03) and for RIV vs ccIIV (p = .001). RIV revaccination generated significantly greater backboosting to the antigenically distinct 3C.2a A/H3N2 virus (2018-19 vaccine strain) compared to ccIIV or IIV. This study adds to the evidence that RIV elicits a superior immunologic response against A/H3N2 viruses compared to other licensed influenza vaccine products.


Assuntos
Anticorpos Antivirais , Testes de Inibição da Hemaglutinação , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana , Vacinas de Produtos Inativados , Vacinas Sintéticas , Humanos , Vacinas contra Influenza/imunologia , Vacinas contra Influenza/administração & dosagem , Adulto , Anticorpos Antivirais/sangue , Adulto Jovem , Influenza Humana/prevenção & controle , Influenza Humana/imunologia , Feminino , Masculino , Pessoa de Meia-Idade , Vacinas de Produtos Inativados/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Adolescente , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas Sintéticas/imunologia , Vacinas Sintéticas/administração & dosagem , Vírus da Influenza A Subtipo H3N2/imunologia , Wisconsin , Vacinação/métodos , Vírus da Influenza B/imunologia , Imunogenicidade da Vacina , Técnicas de Cultura de Células , Estados Unidos , Formação de Anticorpos/imunologia , Imunização Secundária/métodos , Ovos
19.
Hum Vaccin Immunother ; 20(1): 2364493, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38982719

RESUMO

Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017-2018 and 2018-2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017-2018 and 2018-2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017-2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580-$1,103,358,799). In 2018-2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778-$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.


Assuntos
Efeitos Psicossociais da Doença , Hospitalização , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Humanos , Infecções por Vírus Respiratório Sincicial/economia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto , Feminino , Pessoa de Meia-Idade , Masculino , Adulto Jovem , Idoso , Adolescente , Idoso de 80 Anos ou mais , Custos de Cuidados de Saúde/estatística & dados numéricos
20.
Int J Rheum Dis ; 27(7): e15255, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38982881

RESUMO

BACKGROUND: The Oxidative Balance Score (OBS) is a systematic tool to assess the effects of diet and lifestyle in relation to oxidative stress. The association between OBS and gout has not been reported previously. We conducted a cross-sectional study to investigate the complex association between OBS and gout in US adults. METHODS: In all, 10 492 participants were included in this study. The exposure variable was OBS, which was scored by 16 dietary and four lifestyle factors. Multivariate logistic regression, subgroup analysis, and restricted cubic spline (RCS) regression were used to analyze the association between OBS and gout. RESULTS: Compared with the lowest OBS quartile group (Q1), the multivariate corrected odds ratio (OR) (95% confidence interval [C]) for the highest quartile of OBS (Q4) was 0.72 (0.52-1.00) (p = .13 for trend); furthermore, the RCS showed a negative linear relationship between OBS and gout (p-nonlinear = .606). CONCLUSION: In conclusion, the risk of gout is higher with high OBS. The prevalence of gout decreased with higher OBS. Diabetes may alter this negative correlation.


Assuntos
Gota , Inquéritos Nutricionais , Estresse Oxidativo , Humanos , Gota/epidemiologia , Gota/diagnóstico , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto , Prevalência , Estilo de Vida , Medição de Risco , Dieta/efeitos adversos , Idoso
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