Tag: pubmed
Environ Health Perspect. 2023 Aug;131(8):87018. doi: 10.1289/EHP11344. Epub 2023 Aug 24.
ABSTRACT
BACKGROUND: Concentrated animal feeding operations (CAFOs) emit pollutants that can cause negative impacts on human health. The concentration of hog production in North Carolina raises concerns regarding the disproportionate exposure of vulnerable communities to air pollution from CAFOs.
OBJECTIVES: We investigated whether exposure to gaseous ammonia (NH3) and hydrogen sulfide (H2S) (in 2019) differs between subpopulations by examining demographics, including race/ethnicity, age, educational attainment, language proficiency, and socioeconomic status.
METHODS: We used an Air Monitoring Station (AMS)/Environmental Protection Agency (EPA) Regulatory Model (AERMOD)-based Human Exposure Model (version 3) to estimate ambient concentrations of NH3 and H2S from hog farms in Duplin County and its surrounding counties in North Carolina and estimate subsequent exposures of communities within 50km of Duplin County, North Carolina, or the Duplin County Region. We combined estimated exposures with 2016 American Community Summary Census data, at the block group level, using spatial analysis to investigate whether exposures to these pollutants differ by race and ethnicity, age, income, education, and language proficiency. Based on these estimations, we assessed associated exposure risks to the impacted communities and used multivariable regression modeling to evaluate the relationship between average ammonia exposures from Duplin regional hog farms and the presence of vulnerable populations.
RESULTS: The average [±standard deviation (SD)] annual estimated concentration of NH3 and H2S in the Duplin County Region is 1.75±2.81 μg/m3 and 0.0087±0.014 μg/m3, respectively. The maximum average annual ambient concentrations are estimated at 54.27±4.12 μg/m3 and 0.54±0.041 μg/m3 for NH3 and H2S, respectively. Our descriptive analysis reveals that people of low income, people of color, people with low educational attainment, and the linguistically isolated in the Duplin Region are disproportionately exposed to higher levels of pollutants than the average exposure for residents. Alternatively, our statistical results suggests that after adjusting for covariates, communities of color are associated with 1.70% (95% CI: –3.79, 0.44) lower NH3 concentrations per 1-SD increase. One-standard deviation increases in the adults with low educational attainment and children <19 years of age is associated with 1.26% (95% CI: –0.77, 3.33) and 1.20% (95% CI: –0.62, 3.05) higher NH3 exposure per 1-SD increase, respectively.
DISCUSSION: Exposures to NH3 and H2S differed by race and ethnicity, educational attainment, language proficiency, and socioeconomic status. The observed associations between exposure to CAFO-generated pollutants and sociodemographic indicators differed among demographics. The disproportionate distribution of hog facilities and resulting pollutant exposures among communities may have adverse environmental and human health impacts, raising environmental justice concerns. https://doi.org/10.1289/EHP11344.
PMID:37616159 | DOI:10.1289/EHP11344
Am J Manag Care. 2023 Aug 1;29(8):e229-e234. doi: 10.37765/ajmc.2023.89409.
ABSTRACT
OBJECTIVES: Readmission is common and costly for hospitalized Medicaid patients with diabetes. We aimed to develop a model predicting risk of 30-day readmission in Medicaid patients with diabetes hospitalized for any cause.
STUDY DESIGN: Using 2016-2019 Medicaid claims from 7 US states, we identified patients who (1) had a diagnosis of diabetes or were prescribed any diabetes drug, (2) were hospitalized for any cause, and (3) were discharged to home or to a nonhospice facility. For each encounter, we assessed whether the patient was readmitted within 30 days of discharge.
METHODS: Applying least absolute shrinkage and selection operator variable selection, we included demographic data and claims history in a logistic regression model to predict 30-day readmission. We evaluated model fit graphically and measured predictive accuracy by the area under the receiver operating characteristic curve (AUROC).
RESULTS: Among 69,640 eligible patients, there were 129,170 hospitalizations, of which 29,410 (22.8%) were 30-day readmissions. The final model included age, sex, age-sex interaction, past diagnoses, US state of admission, number of admissions in the preceding year, index admission type, index admission diagnosis, discharge status, length of stay, and length of stay-sex interaction. The observed vs predicted plot showed good fit. The estimated AUROC of 0.761 was robust in analyses that assessed sensitivity to a range of model assumptions.
CONCLUSIONS: Our model has moderate power for identifying hospitalized Medicaid patients with diabetes who are at high risk of readmission. It is a template for identifying patients at risk of readmission and for adjusting comparisons of 30-day readmission rates among sites or over time.
PMID:37616150 | DOI:10.37765/ajmc.2023.89409
Am J Manag Care. 2023 Aug;29(8):417-422. doi: 10.37765/ajmc.2023.89407.
ABSTRACT
OBJECTIVES: In 2015, CMS implemented reimbursement for non-face-to-face chronic care management (NFFCCM) for beneficiaries with multiple chronic conditions, including diabetes. This analysis estimated the association between NFFCCM and utilization of inpatient, outpatient, and emergency services.
STUDY DESIGN: We implemented a doubly robust estimator using propensity score matching in a regression context to compare eligible patients who used NFFCCM (n = 282) with eligible patients who did not use NFFCCM (n = 26,759).
METHODS: We tested 4 definitions of treatment: having any NFFCCM encounters and having 1 NFFCCM encounter per month, per 2 months, and per 3 months. Two-tailed statistical inference testing was conducted at the 5% level. We examined the utilization differences among patients with diabetes 65 years and older using merged electronic health records for 4 health systems in Louisiana from the Research Action for Health Network database in 2013 through 2018.
RESULTS: We found NFFCCM was associated with increased utilization of care in the outpatient setting by 0.056 visits per month (95% CI, 0.027-0.086) and with lower utilization in the inpatient setting (-0.024 visits per month; 95% CI, -0.038 to -0.010) and in the emergency department setting (-0.017 visits per month; 95% CI, -0.031 to -0.003). Alternative specifications of treatment showed similar associations.
CONCLUSIONS: CMS implementation of reimbursement codes for NFFCCM, and subsequent utilization of that reimbursement by health systems, was associated with a shift in patient utilization from high-cost settings (inpatient and emergency department) to a lower-cost setting (outpatient office).
PMID:37616148 | DOI:10.37765/ajmc.2023.89407
Am J Manag Care. 2023 Aug;29(8):395-401. doi: 10.37765/ajmc.2023.89405.
ABSTRACT
OBJECTIVES: Colorectal cancer (CRC) screening rates continue to be low among safety-net populations. We sought to elucidate the impact of social determinants of health (SDOH) on the noncompletion of fecal immunochemical tests (FITs) and colonoscopies at the Providence Community Health Centers (PCHC).
STUDY DESIGN: This was a retrospective cohort review of PCHC patients with associated SDOH profiles between December 1, 2018, and December 1, 2019.
METHODS: We analyzed fulfilled and unfulfilled CRC screening orders (FITs and colonoscopies) and examined associations and odds ratios between order noncompletion and the presence of SDOH variables. The study sample consisted of a total of 517 orders (fulfilled and unfulfilled; FIT, n = 348; colonoscopy, n = 169).
RESULTS: FITs were completed more often than colonoscopies (81.3% vs 65.7%, respectively; P < .001). Colonoscopy noncompletion was associated with patient-reported social determinants of “housing insecurity/homelessness” (P = .0083) and “living conditions” (P = .048) and staff-reported “behavioral health problem” (P = .048). The presence of housing insecurity/homelessness increased the likelihood of an unfulfilled colonoscopy order (odds ratio, 7.5; 95% CI, 1.3-75.0). Patients who reported any SDOH need had a statistically significant increase in colonoscopy noncompletion (P = .0022), whereas FIT noncompletion was not associated with the presence of SDOH needs (P = .81).
CONCLUSIONS: Providers should consider FITs as a strategic real-world modality for patients with SDOH needs.
PMID:37616146 | DOI:10.37765/ajmc.2023.89405
Euro Surveill. 2023 Aug;28(34). doi: 10.2807/1560-7917.ES.2023.28.34.2300442.
NO ABSTRACT
PMID:37616117 | DOI:10.2807/1560-7917.ES.2023.28.34.2300442
J Healthc Risk Manag. 2023 Aug 24. doi: 10.1002/jhrm.21555. Online ahead of print.
ABSTRACT
Creating adequate safeguards for physical and online locations (e.g., desktop computers, network servers) where protected health information (PHI) may be breached is critical for management within entities compliant with the Health Information Portability and Accountability Act (HIPAA). With the increasing complexity of cyber breaches and budgetary issues, prioritizing which locations require the most immediate attention by top management through a data-driven model is more important than ever. Using CORAS threat modeling and five methods for multi-criteria decision-making, these locations were ranked from greatest to least risk of data breaches. Statistical methods were subsequently used for consistency and robustness checks. The findings illustrate that each type of covered entity under HIPAA must prioritize a different set of locations to safeguard first: health care providers must focus on the security of network servers, other portable electronic devices, and category of others (i.e., miscellaneous locations); health plans must focus on the security of paper and films, network servers, and others; and business associates must focus on the security of category of others, network servers, and other portable electronic devices. Combined with data on the source of the breaches (external vs. internal) and type of threats (e.g., hacking, theft), these findings provide recommendations for risk identification for privacy officers across health care.
PMID:37616038 | DOI:10.1002/jhrm.21555
J Med Internet Res. 2023 Aug 24;25:e45836. doi: 10.2196/45836.
ABSTRACT
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause difficulty with communication and social interactions as well as complicated family dynamics. Digital health interventions can reduce treatment costs and promote healthy lifestyle changes. These therapies can be adjunctive or replace traditional treatments. However, issues with cooperation and compliance prevent preschool patients with ASD from applying these tools. In this open-label, randomized controlled trial, we developed a nonwearable digital therapy called virtual reality-incorporated cognitive behavioral therapy (VR-CBT).
OBJECTIVE: The aim of this study was to assess the adjunctive function of VR-CBT by comparing the effects of VR-CBT plus learning style profile (LSP) intervention with those of LSP-only intervention in preschool children with ASD.
METHODS: This trial was performed in China on 78 preschool children (age 3-6 years, IQ>70) diagnosed with ASD who were randomized to receive a 20-week VR-CBT plus LSP intervention (intervention group, 39/78, 50%) or LSP intervention only (control group, 39/78, 50%). The primary outcome was the change of scores from baseline to week 20, assessed by using the parent-rated Autism Behavior Checklist (ABC). Secondary outcomes included the Childhood Autism Rating Scale (CARS), Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and behavioral performance data (accuracy and reaction time) in go/no-go tasks. All primary and secondary outcomes were analyzed in the intention-to-treat population.
RESULTS: After the intervention, there was an intervention effect on total ABC (β=-5.528; P<.001) and CARS scores (β=-1.365; P=.02). A similar trend was observed in the ABC subscales: sensory (β=-1.133; P=.047), relating (β=-1.512; P=.03), body and object use (β=-1.211; P=.03), and social and self-help (β=-1.593; P=.03). The intervention also showed statistically significant effects in improving behavioral performance (go/no-go task, accuracy, β=2.923; P=.04). Moreover, a significant improvement of ADHD hyperactivity-impulsivity symptoms was observed in 53 children with comorbid ADHD based on ADHD-RS-IV (β=-1.269; P=.02). No statistically significant intervention effect was detected in the language subscale of ABC (β=-.080; P=.83). Intervention group girls had larger improvements in ABC subscales, that is, sensory and body and object use and in the CARS score and accuracy of go/no-go task (all P<.05) than the control group girls. Statistically significant intervention effects could be observed in hyperactivity-impulsivity symptoms in the intervention group boys with comorbid ADHD compared with those in the control group boys (β=-1.333; P=.03).
CONCLUSIONS: We found potentially positive effects of nonwearable digital therapy plus LSP on core symptoms associated with ASD, leading to a modest improvement in the function of sensory, motor, and response inhibition, while reducing impulsivity and hyperactivity in preschoolers with both ASD and ADHD. VR-CBT was found to be an effective and feasible adjunctive digital tool.
TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100053165; http://www.chictr.org.cn/showproj.aspx?proj=137016.
PMID:37616029 | DOI:10.2196/45836
JMIR Form Res. 2023 Aug 24;7:e49439. doi: 10.2196/49439.
ABSTRACT
BACKGROUND: The health information system (HIS) functions are getting wider with more diverse users. Information security in the health industry is crucial because it involves comprehensive and strategic information that might harm human life. The human factor is one of the biggest security threats to HIS.
OBJECTIVE: This study aims to investigate the information security behavior (ISB) of HIS users using a comprehensive assessment scale suited to the information security concerns in health care. Patients are increasingly being asked to submit their own data into HIS systems. As a result, this study examines the security behavior of health workers and patients, as well as their demographic variables.
METHODS: We used a quantitative approach using surveys of health workers and patients. We created a research instrument from 4 existing measurement scales to measure prosecurity and antisecurity behavior. We analyzed statistical differences to test the hypotheses, that is, the Kruskal-Wallis test and the Mann-Whitney test. The descriptive analysis was used to determine whether the group exhibited exemplary behavior when processing the survey results. A correlational test using the Spearman correlation coefficient was performed to establish the significance of the relationship between ISB and age as well as level of education.
RESULTS: We analyzed 421 responses from the survey. According to demographic factors, the hypotheses tested for full and partial security behavior reveal substantial differences. Education levels most significantly affect security behavior differences, followed by user type, gender, and age. The health workers’ ISB is higher than that of the patients. Women are more likely than men to engage in prosecurity actions while avoiding antisecurity behaviors. The older the HIS user, the more likely it is that they will participate in prosecurity behavior and the less probable it is that they will engage in antisecurity behavior. According to this study, differences in prosecurity behavior are mostly impacted by education level. Higher education, on the other hand, does not guarantee improved ISB for HIS users. All demographic characteristics, particularly concerning user type, show discrepancies that are caused mainly by antisecurity behavior rather than prosecurity behavior.
CONCLUSIONS: Since patients engage in antisecurity behavior more frequently than health workers and may pose security risks, health care facilities should start to consider information security education for patients. More comprehensive research on ISB in health care facilities is required to better understand the patient’s perspective, which is currently understudied.
PMID:37616025 | DOI:10.2196/49439