Tag: nevin manimala

Health Aff (Millwood). 2025 Jun;44(6):754-760. doi: 10.1377/hlthaff.2024.01220.

ABSTRACT

In lieu of hiring physicians, hospitals often contract with medical groups and pay stipends to clinicians to supplement professional services reimbursements from insurers and patients. We measured the prevalence and magnitude of stipends from California hospitals to emergency medicine and anesthesiology clinicians in Hospital Annual Financial Disclosure Reports from the period 2002-21. The prevalence and average magnitudes of stipends, even standardizing for service volume, have risen in both specialties. In 2021, stipends to emergency medicine and anesthesiology clinicians were paid by 81 percent and 57 percent of hospitals in California, respectively. The mean amount hospitals spent on stipends were $4.1 million for emergency medicine and $2.9 million for anesthesiology annually in 2021, among hospitals with any stipend. Standardizing for service volume, the mean amount across all hospitals was $91.42 per emergency visit and $40.11 per fifteen minutes of anesthesiology services in 2021. These findings inform policy discussions on hospital labor costs and professional reimbursement.

PMID:40456039 | DOI:10.1377/hlthaff.2024.01220

Health Aff (Millwood). 2025 Jun;44(6):650-658. doi: 10.1377/hlthaff.2024.01527.

ABSTRACT

The Medicare prescription drug plan redesign under the Inflation Reduction Act of 2022 aims to simplify the Part D benefit while capping out-of-pocket spending for Part D-covered drugs. Whether and which Medicare beneficiaries will see savings from the redesigned benefit is unclear. We evaluated plan coverage and cost sharing for commonly used brand-name and generic drugs to estimate potential out-of-pocket spending changes for beneficiaries using the same drug and plan in both 2024 and 2025. We found that beneficiaries filling prescriptions for high-cost drugs would have expected mean savings of approximately $1,400 between 2024 and 2005. Beneficiaries who had spending lower than the out-of-pocket cap of $2,000 would have less consistent savings as a result of plans increasing the use of coinsurance versus copayments for preferred brands and increases in premiums among some stand-alone Part D plans. The variability across plans in expected out-of-pocket spending and premiums under the redesigned drug benefit reinforces the need for Medicare beneficiaries to shop for plans that best match their expected medication use.

PMID:40456037 | DOI:10.1377/hlthaff.2024.01527

Health Aff (Millwood). 2025 Jun;44(6):684-692. doi: 10.1377/hlthaff.2024.01536.

ABSTRACT

Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA. Using data from the 2015-20 restricted Medicare Current Beneficiary Survey with information on beneficiaries’ perceptions of access, cost, and quality, plus MA contract star ratings and plan generosity data, we assessed factors associated with disenrolling from an MA plan. Enrollees’ self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to-traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

PMID:40456034 | DOI:10.1377/hlthaff.2024.01536

J Med Internet Res. 2025 Jun 2;27:e65868. doi: 10.2196/65868.

ABSTRACT

BACKGROUND: Lifestyle interventions are a critical component of weight loss programs, yet digital, personalized, and theory- and evidence-based lifestyle interventions remain limited.

OBJECTIVE: This study aimed to investigate the effects of a combination of various dietary approaches and digital technology-based exercise on the body composition of college students with obesity.

METHODS: A total of 129 college students with obesity (mean age 18.3, SD 0.7 years; mean weight 89.9, SD 13.6 kg; mean BMI 30.6, SD 3.3 kg/m²) were initially recruited for this study. After excluding 2 participants, 127 students with obesity were ultimately included in the statistical analysis. An 8-week weight loss intervention was conducted with the students, combining exercise and various digitally supported dietary approaches. Body composition indicators (muscle mass and fat mass) were assessed before and after the intervention. Participants were divided into 3 experimental groups (twice-weekly fasting [TWF], low-calorie diet [LCD], and time-restricted feeding [TRF]). Between-group comparisons were made using a 1-way ANOVA, while within-group comparisons used a repeated-measures ANOVA. Linear mixed-effects models were used to examine the interaction effects between sex and time, as well as between sex and group.

RESULTS: All groups showed significant decreases in weight and BMI, and the TRF group also showed a significant decrease in BMI (P=.002), but there were significant sex differences. The male TWF group showed the largest decrease in weight (mean difference [MD] -4.86 kg; P<.001), BMI (MD -1.1 kg/m²; P<.001), visceral fat mass (MD -0.607 kg; P=.003) and subcutaneous fat mass (MD -1.987 kg; P<.001) at 8 weeks. Improvements in weight (MD -5.662 kg; P<.001) and BMI (MD -1.587 kg/m²; P<.001) were more pronounced in the LCD group of female participants (P<.001). Muscle mass declined significantly in male participants in the TRF group at 4 weeks (P<.001) but stabilized at 8 weeks (P=.87). Linear mixed effects models showed that the sex and diet interaction significantly affected subcutaneous fat mass (P=.02). The effect of TRF on muscle mass in male participants peaked at 4 weeks (P<.001), with no significant difference from the control group at 8 weeks (P=.91).

CONCLUSIONS: This study demonstrated that 3 diet-combined exercise regimens produced sex-specific improvements in body composition in college students with obesity. Male participants achieved maximum visceral fat mass loss after 8 weeks with TWF combined with exercise, whereas female participants achieved greater total body fat loss with LCD combined with exercise. The effectiveness of the closed-loop monitoring-feedback behavior modification was verified by digital technology through intelligent monitoring to improve dietary compliance and a real-time feedback mechanism to enhance the effect of the intervention. The sex and diet interaction significantly affected subcutaneous fat mass; women who used LCD and TRF needed additional protein supplementation. Digital technology shows great potential in obesity management and is worth promoting.

PMID:40455565 | DOI:10.2196/65868

Kardiologiia. 2025 Jun 2;65(5):70-74. doi: 10.18087/cardio.2025.5.n2827.

ABSTRACT

AIM: To study the prevalence of cardiovascular risk factors (RFs) associated with obesity in young people studying at a multidisciplinary university, as well as to analyze the awareness of students about the potential relationship between these RFs and cardiovascular diseases.

MATERIAL AND METHODS: This cross-sectional study included in the final analysis 1158 students of the Moscow State University without known chronic non-communicable diseases (CNCDs). Participants filled out a standard “Questionnaire for persons under 65 years of age to identify CNCDs, their RFs, and the use of non-prescribed narcotic drugs and psychotropic substances”, which included a question to identify individuals with a high level of physical activity (PA), as well as an additional questionnaire with open-ended questions on RFs for cardiovascular diseases (CVDs).

RESULTS: The prevalence of obesity in young people studying at the multidisciplinary university was 5.0%, overweight 13.6%, and abdominal obesity (AO) 12.7%. Correlation analysis showed that the body mass index (BMI) had weak but significant relationships with systolic blood pressure (r = 0.434; p &lt; 0.001), total cholesterol (r = 0.170; p &lt; 0.001), and blood glucose (r = 0.185; p &lt; 0.001). Young people with obesity consumed significantly less vegetables and fruits than those with normal BMI (p=0.032). There were more smokers among overweight and obese patients (p=0.019), probably due to an unhealthy behavior pattern in general. Unhealthy diet was named as a RF for CVD by ⅔ of the surveyed young people; more than ¾ were aware of the negative impact of low PA on the cardiovascular system. Obesity was named as a RF by less than 20% of the respondents regardless of gender. The awareness of students with obesity or overweight about obesity as a RF for CVD was generally higher than in the general group (p&lt;0.001). However, only 41.3% of those with a BMI of 30 kg/m2 or more named obesity as a RF for CVD.

CONCLUSION: Understanding the prevalence of behavioral RFs for CVD, awareness of the related risks, and the need to maintain health among young people is critical for prevention of CVD. Interventions targeting university students should promote healthy eating behavior, increased PA, and weight control.

PMID:40455557 | DOI:10.18087/cardio.2025.5.n2827

Kardiologiia. 2025 Jun 2;65(5):28-34. doi: 10.18087/cardio.2025.5.n2719.

ABSTRACT

OBJECTIVE: Analyze the clinical characteristics and resuscitation outcomes of patients with in-hospital cardiac arrest (IHCA) and explore the factors affecting the success rate of cardiopulmonary resuscitation in IHCA patients.

MATERIAL AND METHODS: A retrospective observational study was conducted. Patients who received resuscitative treatment for IHCA between September 2022 and December 2023 were evaluated. Clinical data and prognostic information were collected and analyzed, including age, gender, underlying diseases, time of cardiac arrest, cause of cardiac arrest, presence of shockable rhythm, application of defibrillation, duration of CPR (&gt;30 min), presence of endotracheal intubation, cumulative dose of adrenaline, and resuscitation outcomes (return of spontaneous circulation, survival to discharge).

RESULTS: A total of 323 IHCA patients were included in this study. After CPR treatment, 246 had return of spontaneous circulation (ROSC), with 90 surviving to discharge. Coronary artery disease, shockable initial rhythm, presence of a shockable rhythm during resuscitation, defibrillation, and absence of emergency endotracheal intubation differed statistically between the ROSC and non-ROSC groups (univariate analysis, p &lt; 0.001) Age was a statistically significant determinant of whether patients survived to discharge (p &lt; 0.05). Multivariate logistic regression analysis showed that CPR duration ≥ 30 min was an independent risk factor for ROSC, while younger age, application of emergency endotracheal intubation, and lower cumulative dose of adrenaline were independent protective factors for ROSC (p &lt; 0.05).

CONCLUSION: Age lower than 60 years old, application of defibrillation, and emergency endotracheal intubation are positively associated with increased likelihood of ROSC. Age is an independent risk factor negatively related to survival after discharge. Clinicians should pay close attention to these factors to improve the outcomes of cardiopulmonary resuscitation patients.

PMID:40455552 | DOI:10.18087/cardio.2025.5.n2719

Kardiologiia. 2025 Jun 2;65(5):9-15. doi: 10.18087/cardio.2025.5.n2893.

ABSTRACT

Aim To evaluate the effect of intensive lipid-lowering therapy (LLT), including inclisiran prescribed in the acute phase of ST-segment elevation myocardial infarction (STEMI), on lipid profile in patients with extremely high risk (EHR) of cardiovascular complications (CVC).Material and methods This prospective single-center clinical study included 20 patients (mean age 58.45±2.43 years, 75% men) with EHR of CVC and STEMI. All patients were prescribed combination LLT, including inclisiran. Lipid profile parameters were assessed 8±1 days after the initiation of therapy. Statistical analysis was performed with a STATISTICA 13.3 software.Results Analysis of the lipid-lowering effect of inclisiran showed a significant decrease in total cholesterol from 5.13±0.29 to 2.81±0.26 mmol/l (45.2%; p&lt;0.001) and low-density lipoprotein cholesterol (LDL-C) from 3.59±0.23 to 1.60±0.23 mmol/l (55.4%; p&lt;0.001).Conclusion The study showed a possibility of achieving statistically and clinically significant reduction in LDL-C in patients with EHR of CVC in the acute period of STEMI with the combination therapy including inclisiran during the inpatient treatment.

PMID:40455549 | DOI:10.18087/cardio.2025.5.n2893

Health Psychol. 2025 Jun 2. doi: 10.1037/hea0001529. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to examine the extent to which pediatric emergency department visits and admissions are preventable and whether caregiver-reported social factors predict future preventable visits.

METHOD: Caregivers of hospitalized children (N = 249) completed a predischarge survey regarding health care utilization and social drivers of health (e.g., adverse childhood experiences and experiences of racial discrimination). Chart reviews were conducted 365 days postdischarge to capture the presence and frequency of acute medical events (AMEs; i.e., readmissions and emergency department visits). Three methods of determining the preventability of AMEs were used to examine the relationship between preventable AMEs and medical status, demographic characteristics, and social drivers of health.

RESULTS: Of the youth who experienced an AME, over half (67%) experienced one or more events classified as “preventable” by at least one method. Statistically significant predictors associated with preventable events included age under 1 (OR = 4.17), complex/chronic medical status (OR = 3.03), other children in the home with health concerns (OR = 1.85), and the presence of a neurocognitive disorder (OR = 2.97). Higher caregiver education (incidence rate ratio [IRR] = 0.31) was related to fewer preventable events overall. Child mental health condition (IRR = 18.62), having a deceased caregiver (IRR = 4.35), and child experiences of racial or ethnic discrimination (IRR = 6.01) were related to more preventable readmissions.

CONCLUSION: A substantial number of AMEs may be preventable. Caregiver reports of social factors should be included in risk assessments to inform tailored interventions and discharge plans based on unique family characteristics. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455540 | DOI:10.1037/hea0001529

J Exp Psychol Learn Mem Cogn. 2025 Jun 2. doi: 10.1037/xlm0001492. Online ahead of print.

ABSTRACT

Statistical structures and our ability to exploit them are a ubiquitous component of daily life. Yet, we still do not fully understand how we track these sophisticated statistics and the role they play in sensory processing. Predictive coding frameworks hypothesize that for stimuli that can be accurately anticipated based on prior experience, we rely more strongly on our internal model of the sensory world and are more “surprised” when that expectation is unmet. The present study used this phenomenon to probe listeners’ sensitivity to probabilistic structures generated using rapid 50 ms tone-pip sequences that precluded conscious prediction of upcoming stimuli. Over three experiments, we measured listeners’ sensitivity and response time to deviants of a frequency outside the expected range. Predictable sequences were generated using either a triplet-based or network-style structure, and deviant detection contrasted against the same set of tones but in a random, unpredictable order. All experiments found structured sequences enhanced deviant detection relative to random sequences. Additionally, Experiment 2 used three different instantiations of the community structure to demonstrate that the level of uncertainty in the structured sequences modulated deviant saliency. Finally, Experiment 3 placed the deviant within an established community or immediately after a transition between communities, where the perceptual boundary should generate momentary uncertainty. However, this manipulation did not impact performance. Together, these results demonstrate that probabilistic contexts generated from statistical structures modulate the processing of an ongoing auditory signal, leading to an improved ability to detect unexpected deviant stimuli, consistent with the predictive coding framework. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455536 | DOI:10.1037/xlm0001492

Psychol Trauma. 2025 Jun 2. doi: 10.1037/tra0001926. Online ahead of print.

ABSTRACT

OBJECTIVE: Trauma exposure is associated with elevated risk for psychotic-like experiences, including subthreshold hallucinations and delusions. Dissociative symptoms may link these two experiences and warrant further exploration.

METHOD: The present study examined if dissociative symptoms accounted for additional variance in the association between posttraumatic stress disorder (PTSD) symptoms and hallucinations and delusions in a sample of patients (n = 63) seeking treatment for PTSD using the Dissociative Subtype of PTSD Scale; PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; and Diagnostic Interview for Anxiety, Mood, and Obsessive-Compulsive Disorder and Related Neuropsychiatric Disorders hallucinations and delusions screener in a sample of predominantly White women, the majority of whom met criteria for PTSD. Exploratory analyses were conducted to examine if the postpartum subsample endorsed our variables of interest more frequently than our overall sample.

RESULTS: As hypothesized, PTSD symptoms and dissociative symptoms exhibited a small, significant correlation with psychotic-like experiences. Furthermore, dissociative symptoms accounted for additional variance in our models in psychotic-like experiences; however, the additional variance accounted for did not reach the level of significance. However, this study was limited by cross-sectional data with a predominantly White, woman sample. Future studies should examine these associations longitudinally among marginalized groups.

CONCLUSIONS: Clinicians must provide thorough assessments to parse out PTSD symptoms, dissociative symptoms, and psychotic-like experiences, especially for clients seeking treatment for complex PTSD and/or a history of traumatic birth experience. Clinicians must conduct thorough assessments using validated tools like the Dissociative Experiences Scale and the Structured Interview for Psychosis-Risk Syndromes and could use interventions such as narrative exposure therapy that address maladaptive thoughts and dissociative experiences related to traumatic experiences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455532 | DOI:10.1037/tra0001926