Tag: pubmed

JAMA Health Forum. 2024 Jul 5;5(7):e242014. doi: 10.1001/jamahealthforum.2024.2014.

ABSTRACT

IMPORTANCE: Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD).

OBJECTIVE: To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study using data from the Massachusetts Public Health Data Warehouse. The cohort includes adults aged 18 to 63 years diagnosed with incident OUD between July 1, 2014, and December 31, 2014, who were enrolled in commercial insurance or Medicaid at diagnosis; individuals diagnosed after 2014 were excluded from the main analyses due to changes in the reporting of insurance claims. Data were analyzed from November 10, 2022, to May 6, 2024.

EXPOSURE: Insurance type at time of diagnosis (commercial and Medicaid).

MAIN OUTCOMES AND MEASURES: The primary outcome was the cumulative incidence of insurance transitions in the 12 months after diagnosis. Logistic regression models were used to generate estimated probabilities of insurance transitions by insurance type and diagnosis for several characteristics including age, race and ethnicity, and whether an individual started medication for OUD (MOUD) within 30 days after diagnosis.

RESULTS: There were 20 768 individuals with newly diagnosed OUD between July 1, 2014, and December 31, 2014. Most individuals with newly diagnosed OUD were covered by Medicaid (75.4%). Those with newly diagnosed OUD were primarily male (67% in commercial insurance, 61.8% in Medicaid). In the 12 months following OUD diagnosis, 30.4% of individuals experienced an insurance transition, with adjusted models demonstrating higher transition rates among those starting with Medicaid (31.3%; 95% CI, 30.5%-32.0%) compared with commercial insurance (27.9%; 95% CI, 26.6%-29.1%). The probability of insurance transitions was generally higher for younger individuals than older individuals irrespective of insurance type, although there were notable differences by race and ethnicity.

CONCLUSIONS AND RELEVANCE: This study found that nearly 1 in 3 individuals experience insurance transitions in the 12 months after OUD diagnosis. Insurance transitions may represent an important yet underrecognized factor in OUD treatment outcomes.

PMID:39058507 | DOI:10.1001/jamahealthforum.2024.2014

Transl Vis Sci Technol. 2024 Jul 1;13(7):19. doi: 10.1167/tvst.13.7.19.

ABSTRACT

PURPOSE: Compare choroidal changes in ranibizumab versus panretinal photocoagulation (PRP)-treated eyes with proliferative diabetic retinopathy (PDR).

METHODS: DRCR Retina Network Protocol S post hoc analysis evaluated optical coherence tomography change in choroidal thickness (subfoveal and 3mm superior and inferior to the fovea) through five years; choroidal vascularity index (CVI) was assessed at baseline and one year. Mixed linear models for choroidal change included adjustments for the baseline choroidal value and age.

RESULTS: This study included 328 eyes (158 ranibizumab and 170 PRP) from 256 participants (88 ranibizumab and 95 PRP eyes at five years). Mean change in choroidal thickness from baseline to five years at the fovea was -12 µm in ranibizumab versus -8 µm in PRP (difference [95% confidence interval]: -4 [-18 to 10], P = 0.57), superior was -14 µm versus -19 µm (difference: 5 [-8 to 17], P = 0.45) and inferior was -26 µm versus -32 µm [difference: 5 (-9 to 20), P = 0.45]; change at all three points within the ranibizumab group, and the superior and inferior points for PRP, were statistically significant (P < .05). Mean change in CVI at one year was -0.02% in ranibizumab versus -0.95% in PRP (difference: 0.93 [-0.35 to 2.21], P = 0.14).

CONCLUSIONS: In patients with PDR, treatment with ranibizumab versus PRP did not result in statistically significant differences in five-year choroidal thickness or one-year CVI change. Both groups had significant decreases in choroidal thickness at five years.

TRANSLATIONAL RELEVANCE: Ranibizumab treatment for PDR did not statistically significantly affect choroidal thickness or vascularity differently than PRP.

PMID:39058503 | DOI:10.1167/tvst.13.7.19

JAMA Netw Open. 2024 Jul 1;7(7):e2423336. doi: 10.1001/jamanetworkopen.2024.23336.

NO ABSTRACT

PMID:39058497 | DOI:10.1001/jamanetworkopen.2024.23336

JAMA Netw Open. 2024 Jul 1;7(7):e2423528. doi: 10.1001/jamanetworkopen.2024.23528.

NO ABSTRACT

PMID:39058495 | DOI:10.1001/jamanetworkopen.2024.23528

JAMA Netw Open. 2024 Jul 1;7(7):e2424732. doi: 10.1001/jamanetworkopen.2024.24732.

NO ABSTRACT

PMID:39058492 | DOI:10.1001/jamanetworkopen.2024.24732

JAMA Netw Open. 2024 Jul 1;7(7):e2423539. doi: 10.1001/jamanetworkopen.2024.23539.

ABSTRACT

IMPORTANCE: Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown.

OBJECTIVE: To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023.

MAIN OUTCOMES AND MEASURES: The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria.

RESULTS: A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD.

CONCLUSIONS AND RELEVANCE: In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.

PMID:39058488 | DOI:10.1001/jamanetworkopen.2024.23539

Technol Health Care. 2024 Jul 14. doi: 10.3233/THC-240518. Online ahead of print.

ABSTRACT

BACKGROUND: Thanks to modern methods of assisted reproduction (ART), parenthood has become an attainable goal for couples in which the male partner has experienced spinal cord injury (SCI).

OBJECTIVE: The aim of our study was to determine the success of the treatment of infertile patients with SCI with intracytoplasmic sperm injection (ICSI) of cryopreserved sperm obtained by the testicular sperm aspiration (TESA) procedure.

METHODS: In this retrospective study 156 infertile couples were included, in which the male partner is primarily infertile due to azoospermia. Infertile couples were divided into two groups. The first group (n= 82) includes men with SCI, and the second (n= 74) men with obstructive azoospermia (OA) as the cause of infertility. All infertile men were examined and processed in the diagnostic procedure, and based on the urological findings, surgical extraction of sperm from the testicles was indicated. Exclusion criteria were the age of women over 40 and men over 45.

RESULTS: We found that the quality of sperm was worse in the group with SCI, compared to the group with OA, but without statistical significance. Zenica and Johnsen score (p= 0.001; p= 0.000) showed worse semen characteristics in the group with SCI. There were no significant differences in the average number of embryos (p= 0.698), pregnancy rates per cycle (p= 0.979) and pregnancy rates per embrio transfer (ET), clinical pregnancy rates per ET (p= 0.987) and delivery rates per ET (p= 0.804) in couples with SCI, compared to couples with OA.

CONCLUSION: Based on the results of this research, the TESA and ICSI procedures can be recommended as a successful method in the treatment of male infertility caused by azoospermia due to SCI.

PMID:39058468 | DOI:10.3233/THC-240518

Technol Health Care. 2024 Jul 13. doi: 10.3233/THC-232037. Online ahead of print.

ABSTRACT

BACKGROUND: Renal failure is one of the most common chronic complications of diabetes. Simultaneous pancreas-kidney transplantation (SPK) is considered the preferred treatment for individuals with diabetes and chronic renal failure. This procedure has demonstrated efficacy in enhancing the quality of life for patients and minimizing the complications associated with diabetes.

OBJECTIVE: In this study, we analyzed the incidence and safety of complications in different thrombosis prevention techniques post simultaneous pancreas-kidney transplantation (SPK).

METHODS: Patients who underwent SPK between January 2019 and December 2022 were selectively categorized into two groups: the heparin group and the non-heparin group depending on the utilization of low molecular weight heparin. The occurrence of complications and clinical outcomes were subsequently calculated in each group.

RESULTS: In this study, we included a total of 58 recipients who underwent SPK, with 36 in the heparin group and 22 in the non-heparin group. Among the 58 participants, there were 3 cases of pancreatic thrombosis complications, with 2 cases (5.6%) in the heparin group and 1 case (4.6%) in the non-heparin group, and the differences were not statistically significant (P> 0.05). Regarding gastrointestinal bleeding, there were 17 cases out of the total 58 patients, with 14 cases (38.9%) in the heparin group and 3 cases (13.6%) in the non-heparin group, and the difference was statistically significant (P< 0.05).

CONCLUSION: After surgery, the use of low molecular weight heparin anticoagulation may increase the likelihood of experiencing gastrointestinal bleeding. Prior to the surgery, a comprehensive evaluation of the coagulation status and medical history of the patient should be performed, enabling stratification of risks involved. Based on this assessment, either low-molecular-weight heparin or aspirin should be selected as a preventive measure against thrombosis.

PMID:39058462 | DOI:10.3233/THC-232037

J Back Musculoskelet Rehabil. 2024 Jul 12. doi: 10.3233/BMR-230358. Online ahead of print.

ABSTRACT

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated.

OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP.

METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed.

RESULTS: There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group.

CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.

PMID:39058437 | DOI:10.3233/BMR-230358

Clin Cancer Res. 2024 Jul 26. doi: 10.1158/1078-0432.CCR-24-0461. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of nanvuranlat (a LAT1 inhibitor) monotherapy as a later-line treatment in advanced, metastatic, and refractory BTCs.

PATIENTS AND METHODS: The multicenter, randomized, double-blind, placebo-controlled, phase II study was conducted across 14 leading Japanese cancer centers and hospitals. Nanvuranlat 25 mg/m2/day or placebo was given intravenously in cycles of five consecutive days, followed by nine days off. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS) and disease control rate (DCR). Subgroup analysis was performed in patients with high LAT1 expression and BTC-subtypes.

RESULTS: A total of 211 patients were screened, 105 eligible patients were randomized, and then 70 received nanvuranlat and 35 received placebo. Nanvuranlat demonstrated an improvement in PFS when compared to placebo (Hazard Ratio (HR) 0.56; 95% CI, 0.34 – 0.90; P = 0.02). Grade 3 or higher adverse events were reported in 30.0% and 22.9% of those in the nanvuranlat and placebo groups, respectively. The overall survival (OS) was not statistically different between nanvuranlat- and placebo-treated patients. An exploratory analysis indicated that nanvuranlat is warranted to evaluate its long-term clinical benefit in patients with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder cancer.

CONCLUSION: Compared with placebo, nanvuranlat improved PFS in patients with advanced and refractory BTC with an acceptable safety profile. Further studies of this promising compound are warranted in the population of patients who are exhausted from treatment options.

PMID:39058429 | DOI:10.1158/1078-0432.CCR-24-0461