Tag: pubmed

Health Serv Res. 2021 Oct 18. doi: 10.1111/1475-6773.13897. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the impacts of the Medicaid expansion on revenues, costs, assets and liabilities of federally funded community health centers.

DATA SOURCES: We combined data from the Uniform Data System, Internal Revenue Service non-profit tax returns, and county level characteristics from the Census Bureau. Our final dataset included 5841 center-year observations.

STUDY DESIGN: We used difference-in-differences model to estimate the fiscal impacts of the Medicaid expansion on community health centers. We employed event study models, state specific trend models, and placebo law tests as robustness checks.

DATA COLLECTION METHODS: Not applicable.

PRINCIPAL FINDINGS: On the revenue side, we found a $2.08 million relative increase (p = 0.002) in Medicaid revenues, offset by a $0.44 million decrease (p = 0.015) in total grants among community health centers in expansion states compared to centers in non-expansion states. On the expenditure side, we found a large but not statistically significant $0.98 million relative increase (p = 0.201) in total expenditures among centers in expansion states. Uncompensated care for health centers in expansion states decreased by $1.19 million (p < 0.001) relative to their counterparts in non-expansion states.

CONCLUSIONS: Community health centers in expansion states benefited from the increased, stable revenue stream from Medicaid expansions. While Medicaid revenue increased as a result of the policy, we find no major evidence of substitution away from other revenue lines, with one notable exception (i.e., substitution away from state and local government grants). From a policy perspective, these results are encouraging as the Biden Administration starts to implement the safety-net enhancements from the American Rescue Plan Act of 2021 and as more non-expansion states are considering opting into Medicaid expansions. It is anticipated that these added revenue streams will help to sustain health centers in the delivery of health care services to the underserved population. This article is protected by copyright. All rights reserved.

PMID:34658030 | DOI:10.1111/1475-6773.13897

J Anat. 2021 Oct 17. doi: 10.1111/joa.13550. Online ahead of print.

ABSTRACT

PURPOSE: The current standard in reconstructing defects of the orbital floor, by using the concept of mirroring, is time-consuming and ignores the natural asymmetry of the skull. By using a statistical shape model (SSM), the reconstruction can be automatized and improved in accuracy. The present study aims to show the possibilities of the virtual reconstruction of artificial defects of the orbital floor using an SSM and its potentials for clinical implementation.

METHODS: Based on 131 unaffected CT scans of the midface, an SSM was created which contained the shape variability of the orbital floor. Nineteen midface CT scans, that were not included in the SSM, were manually segmented to establish ground truth (control group). Then artificial defects of larger and smaller sizes were created and reconstructed using SSM (Group I) and the gold standard of mirroring (Group II). Eventually, a comparison to the surface of the manual segmentation (control group) was performed.

RESULTS: The proposed method of reconstruction using an SSM leads to more precise reconstruction results, compared with the conventional method of mirroring. Whereas mirroring led to the reconstruction errors of 0.7 mm for small defects and 0.73 mm for large defects, reconstruction using SSM led to deviations of 0.26 mm (small defect) and, respectively, 0.34 mm (large defect).

CONCLUSIONS: The presented approach is an effective and accurate method for reconstructing the orbital floor. In connection with modern computer-aided design and manufacturing, individual patient-specific implants could be produced according to SSM-based reconstructions and could replace current methods using manual bending techniques. By acknowledging the natural asymmetry of the human skull, the SSM-based approach achieves higher accuracy in reconstructing injured orbits.

PMID:34658032 | DOI:10.1111/joa.13550

Dermatol Ther (Heidelb). 2021 Oct 18. doi: 10.1007/s13555-021-00613-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Depression and anxiety are common among people with rosacea. However, the exact magnitude of the prevalence rate and odds ratios (ORs) for depression and anxiety, respectively, in rosacea patients is unclear, and no systematic review or meta-analysis of published data has yet been performed. We therefore performed as systematic review and meta-analysis to determine the prevalence rates and ORs for depression and anxiety in rosacea patients.

METHODS: We performed a systematic search of the PubMed, Embase and Medline databases for all observational studies published up to October 2020 that reported the prevalence rates and ORs for depression and anxiety in patients with rosacea. The primary outcome measures were prevalence rates and ORs for depression and anxiety in patients with rosacea. Heterogeneity across studies was assessed with the I² statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses.

RESULTS: A total of 14 studies involving 14,134,021 patients with rosacea were included in the systematic review and meta-analysis. The pooled prevalence of depression was 19.6% (95% confidence interval [CI] 15.0-24.3%) and that of anxiety was 15.6% (95% CI 11.8-19.3%). The prevalence of depression and anxiety was significantly lower in studies using clinical criteria to diagnose depression and anxiety (9.2 and 10.2%, respectively) than in those studies using screening tools (26.2% [P < 0.01] and 22.7% [P = 0.03], respectively). The methodological quality of the included studies greatly contributed to the heterogeneity. Patients with rosacea were more likely to experience depression (OR 2.21, 95% CI 1.79-2.72) and anxiety (OR 2.31, 95% CI 1.56-3.44) than healthy controls.

CONCLUSIONS: This systematic review and meta-analysis indicates that patients with rosacea are at a higher risk of experiencing depression and anxiety. More efforts are warranted to recognize and manage depression and anxiety in patients with rosacea.

PMID:34657997 | DOI:10.1007/s13555-021-00613-w

Br J Haematol. 2021 Oct 17. doi: 10.1111/bjh.17899. Online ahead of print.

ABSTRACT

It is unclear whether elderly patients established on direct oral anticoagulants (DOACs) have greater exposure to these drugs, which could subsequently increase their risk of bleeding. We assessed DOAC exposure and factors affecting it in a real-world elderly cohort of patients. For this, 151 medically stable hospital inpatients (76 established on apixaban, 61 on rivaroxaban, 14 on dabigatran) with a median [interquartile range (IQR)] age of 84 (78-89) years were recruited. Patients provided blood samples for measurement of peak and trough plasma DOAC concentrations. There was up to 48-fold and 13-fold variation in trough and peak plasma drug concentrations respectively. A significantly greater proportion of patients on apixaban had peak plasma drug concentrations within the reported ranges compared to those on either rivaroxaban or dabigatran (82·9% vs. 44·3% vs. 64·3% respectively; P < 0·001). A third of the variability in DOAC plasma concentrations was attributed to the influences of DOAC dosage, renal function and gender. To what extent the observed increases in DOAC exposure in the older patients is the cause of their increased risk of bleeding, which could potentially be ameliorated by dosing titration, requires further investigation.

PMID:34658009 | DOI:10.1111/bjh.17899

Eur Radiol. 2021 Oct 18. doi: 10.1007/s00330-021-08318-6. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI).

METHODS: CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality.

RESULTS: Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03).

DISCUSSION: In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.

KEY POINTS: • In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT. • Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor. • Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.

PMID:34657969 | DOI:10.1007/s00330-021-08318-6

Environ Monit Assess. 2021 Oct 17;193(11):728. doi: 10.1007/s10661-021-09524-x.

ABSTRACT

The research was carried out in the coppice-originated pure oak stands that are being converted to high forests in northwest Turkey. The main goal of the research was to determine the bark thickness (BT) based on tree variables, such as tree diameter at breast height (DBH), total tree height (H), crown diameter (CD), and age (AGE) of the stem sections taken from a total of 350 trees that were destructively sampled from different sites, different oak species (Quercus petraea, Quercus frainetto, Quercus cerris), and different development stages. Models were developed with stepwise multiple regression analysis to predict BT based on the variables. For all oak species, all models obtained by stepwise multiple regression analysis were found to be significant at p = 0.001 level. In Quercus petraea, only the DBH-dependent model explained the variation in BT at a rate of 73%, estimating with an absolute error rate of 21%. The fit statistics of the models (based on DBH and DBH-H explanatory variables) obtained for Quercus frainetto are very close to each other, and they explained the variation in BT at a rate of 69% and estimated with an error rate of 26%. Models (based on DBH and DBH-H explanatory variables) explain the variation in BT in Turkey oak at a rate of 91%, indicating species-specific results. The models based on only DBH can be used with high accuracy to estimate BT.

PMID:34657980 | DOI:10.1007/s10661-021-09524-x

Asian J Endosc Surg. 2021 Oct 17. doi: 10.1111/ases.12991. Online ahead of print.

ABSTRACT

INTRODUCTION: Tubal reanastamosis offers hope to conceive again. However, there are many factors that affect the success of this procedure. In our study we aimed to compare the pregnancy rates of the surgical methods used for tubal reanastamosis in pregnancy requested after tubal sterilization.

METHODS: In our study we compared the rates of pregnancies after reanastamosis retrospectively in female patients under the age of 40 who underwent reanastamosis between 2010 and 2019 with laparotomic, laparoscopic and robotic methods. A single layer of 4 quadrant 6/0 number polydioxanone absorbable sutures were used in all surgical methods. A similar surgical technique was used.

RESULTS: In surgical methods (laparotomy, laparoscopy, and robotics), there was a statistical difference between the three groups in terms of operation times of surgical methods used for tubal reanastamosis (p < 0.05). Laparotomy, laparoscopy, and robotics pregnancy rates were 52.6% (n = 41), 67.3% (n = 37), 61.2% (n = 63), respectively. There was no statistical difference between groups in terms of pregnancy rates. However, odds ratio (OR) values of the laparoscopy group and robotics group probability of conception were 1.536 (95% confidence interval [CI], 0.813-2.898), 1.111 (95% CI, 0.656-1.879) higher, respectively.

CONCLUSIONS: Although there is no statistical difference between the surgical methods used for tubal reanastamosis, we think that the laparoscopic surgical method may be preferable due to the shorter hospital stay. We think that the previous method of bilateral tubaligastion (BTL), the site of reanastasis, and the time between BTL and reanastomosis were effective in pregnancy success.

PMID:34657383 | DOI:10.1111/ases.12991

Ideggyogy Sz. 2021 Sep 30;74(9-10):323-328. doi: 10.18071/isz.74.0323.

ABSTRACT

BACKGROUND AND PURPOSE: The detoxification process in medication overuse headache is the most difficult process for the patient. We aimed to investigate the effectiveness of the combination of low dose IV lidocaine and magnesium (100 mg lidocaine and 1.25 mg magnesium) in patients with medication overuse headache during the detoxification process.

METHODS: A total of 30 patients were included in the study; 15 received 24 hours of IV hydration, 15 received 1-hour lidocaine-magnesium infusion at the onset of pain in addition to the 24 hours of IV hydration. Headache severity (numeric rating scale, NRS), attack durations, onset of headache, monthly analgesic/triptan intakes, numbers of monthly headache days data were documented. We evaluated the severity of headache before and after daily treatment of two groups for one week.

RESULTS: When both groups were compared, there was no significant difference in the pre-treatment NRS values, whe-reas, in the group receiving IV lidocaine-magnesium combination, there was a statistically significant decrease in the post-treatment NRS values in the first five days (p <0.05).

CONCLUSION: An 1-hour combined infusion of lidocaine-magnesium may be considered as an alternative option for the patient to have a more quality detoxification process during the hospital stay, so that in parallel to the reduction in the use of multiple treatments (such as neuroleptics, benzodiazepines, antiemetics and opioids) and duration length of stay, the economic costs can also be reduced. The administration of combination will bring fewer side effects compared to their administration separately.

PMID:34657403 | DOI:10.18071/isz.74.0323

Pharmacoepidemiol Drug Saf. 2021 Oct 17. doi: 10.1002/pds.5372. Online ahead of print.

ABSTRACT

PURPOSE: In drug safety and effectiveness studies based on secondary data, the choice of an appropriate exposure measure for a given outcome can be challenging. Different measures of exposure can yield different estimates of treatment effect and safety. There is a knowledge gap with respect to developing and refining measures of drug exposure, to ensure that the exposure measure addresses the study question and is suitable for statistical analysis.

METHODS: We present a transparent, step-by-step approach to the development of drug exposure measures involving secondary data. This approach would be of interest to students and investigators with initial training in pharmacoepidemiology. We illustrate the approach using a study about Parkinson’s disease.

RESULTS: We described the exposure specifications according to the study question. Next, we refined the exposure measure by linking it to knowledge about four major concepts in drug safety and effectiveness studies: drug use patterns, duration, timing, and dose. We then used this knowledge to guide the ultimate choice of exposure measure: time-varying, cumulative 6-month exposure to tamsulosin (a drug used to treat prostate hyperplasia).

CONCLUSIONS: The proposed approach links exposure specifications to four major concepts in drug safety and effectiveness studies. Formulating subject-matter knowledge about these major concepts provides an avenue to develop the rationale and specifications for the exposure measure. This article is protected by copyright. All rights reserved.

PMID:34657356 | DOI:10.1002/pds.5372

ESC Heart Fail. 2021 Oct 17. doi: 10.1002/ehf2.13631. Online ahead of print.

ABSTRACT

AIMS: Sleep apnoea and congestive heart failure (CHF) commonly co-exist, but their interaction is unclear. Metabolomics may clarify their interaction and relationships to outcome.

METHODS AND RESULTS: We assayed 372 circulating metabolites and lipids in 1919 and 1524 participants of the Framingham Heart Study (FHS) (mean age 54 ± 10 years, 53% women) and Women’s Health Initiative (WHI) (mean age 67 ± 7 years), respectively. We used linear and Cox regression to relate plasma concentrations of metabolites and lipids to echocardiographic parameters; CHF and its subtypes heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF); and sleep indices. Adenine dinucleotide phosphate (ADP) associated with left ventricular (LV) fractional shortening; phosphocreatine with LV wall thickness; lysosomal storage molecule sphingomyelin 18:2 with LV mass; and nicotine metabolite cotinine with time spent with an oxygen saturation less than 90% (β = 2.3 min, P = 2.3 × 10^-5 ). Pro-hypertrophic metabolite hydroxyglutarate partly mediated the association between LV wall thickness and HFpEF. Central sleep apnoea was significantly associated with HFpEF (P = 0.03) but not HFrEF (P = 0.5). There were three significant metabolite canonical variates, one of which conferred protection from cardiovascular death [hazard ratio = 0.3 (0.11, 0.81), P = 0.02].

CONCLUSIONS: Energetic metabolites were associated with cardiac function; energy- and lipid-storage metabolites with LV wall thickness and mass; plasma levels of nicotine metabolite cotinine were associated with increased time spent with a sleep oxygen saturation less than 90%, a clinically significant marker of outcome, indicating a significant hazard for smokers who have sleep apnoea.

PMID:34657379 | DOI:10.1002/ehf2.13631