We evaluated the effect of the Newborns' and Mothers' Health Protection Act on clinical and cost outcomes.
We conducted an observational study of 18,023 healthy, mother-infant dyads before (n = 8670) ...and after (n = 9353) implementation of the Newborns' and Mothers' Health Protection Act legislation. Logistic regression was used to calculate adjusted odds ratios (ORs) for the following outcome measures: length of stay at least 48 hours, satisfaction with maternal length of stay, 7- and 30-day hospital readmission utilization, and 7- and 30-day emergency room utilization. Analysis of covariance was used to evaluate adjusted mean hospitalization costs per delivery.
Mothers in the postlegislation period were more likely to have hospital stays at least 48 hours (OR 3.99; 95% confidence interval CI 3.57, 4.44) and rate their length of stay as "about right" (OR 5.54; 95% CI 4.76, 6.46) compared with mothers in the prelegislation period. Neonates in the postlegislation period were more likely to have hospital stays of at least 48 hours (OR 3.96; 95% CI 3.54, 4.43) and less likely to be rehospitalized within 7 days after hospitalization (OR 0.61; 95% CI 0.40, 0.95) compared with neonates in the prelegislation period. Adjusted mean hospitalization costs increased $116 per delivery in the postlegislation period.
After implementation of the Newborns' and Mothers' Health Protection Act legislation, maternal and newborn length of stay and maternal satisfaction with length of stay increased substantially, and hospitalization costs increased significantly. The strongest clinical benefit was observed among neonates who were at a lower risk for hospitalization within 1 week of discharge. With the exception of 30-day emergency room utilization, there was insufficient statistical power to test for differences among other maternal clinical outcomes.
Background:
Colorectal cancer (CRC) is the third most common cancer in the United States and is associated with significant morbidity and mortality. Although CRC has a good prognosis if diagnosed ...early, screening rates remain low. Innovative, low cost intervention, such as the use of automated reminder calls, may increase CRC screening rates. The objective of this prospective study was to determine the effect of an automated telephone reminder message on completion of a fecal occult blood test (FOBT), an evidence-based screening method for populations with average risk for CRC.
Methods:
A prospective randomized clinical trial of 5,993 patients (intervention group = 2,993, usual care group = 3,000), between ages 51–80, due for CRC screening with average risk for CRC. The patient population received care in a not for profit HMO in the Pacific Northwest. The intervention group received a 1-minute automated telephone call, which provided a general description and health benefits of FOBT. Patients could request that an FOBT kit be mailed to their home on the call. Up to three calls were attempted for non respondents over a five month period. Multiple logistic regressions was used to examine the independent effect of automated reminder calls on completion of an FOBT test, after adjusting for age, gender and prior CRC screening.
Results:
Compared to usual care, those in the intervention group were significantly more likely to complete an FOBT (OR = 1.60, 95% CI = 1.39–1.84), five months post randomization. Two characteristics were also associated with completion of FOBT:
older age age 61–70 (OR = 1.33, 95% CI = 1.14–1.56), age 71–80 (OR = 1.85, 95% CI = 1.52–2.25 vs. age 51–60, and
any prior CRC screening (OR = 3.13, 95% CI = 2.71–3.62) vs. no prior screening.
Conclusions:
Automated telephone calls increased completion of screening FOBT compared to usual care. Broad implementation may cost effectively increase community CRC screening rates. Further research is needed to better understand how the stage at CRC diagnosis and CRC related mortality are impacted and to evaluate cost effectiveness.
Abstract
Aims
To characterize serum metabolic signatures associated with atherosclerosis in the coronary or carotid arteries and subsequently their association with incident cardiovascular disease ...(CVD).
Methods and results
We used untargeted one-dimensional (1D) serum metabolic profiling by proton nuclear magnetic resonance spectroscopy (1H NMR) among 3867 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), with replication among 3569 participants from the Rotterdam and LOLIPOP studies. Atherosclerosis was assessed by coronary artery calcium (CAC) and carotid intima-media thickness (IMT). We used multivariable linear regression to evaluate associations between NMR features and atherosclerosis accounting for multiplicity of comparisons. We then examined associations between metabolites associated with atherosclerosis and incident CVD available in MESA and Rotterdam and explored molecular networks through bioinformatics analyses. Overall, 30 1H NMR measured metabolites were associated with CAC and/or IMT, P = 1.3 × 10−14 to 1.0 × 10−6 (discovery) and P = 5.6 × 10−10 to 1.1 × 10−2 (replication). These associations were substantially attenuated after adjustment for conventional cardiovascular risk factors. Metabolites associated with atherosclerosis revealed disturbances in lipid and carbohydrate metabolism, branched chain, and aromatic amino acid metabolism, as well as oxidative stress and inflammatory pathways. Analyses of incident CVD events showed inverse associations with creatine, creatinine, and phenylalanine, and direct associations with mannose, acetaminophen-glucuronide, and lactate as well as apolipoprotein B (P < 0.05).
Conclusion
Metabolites associated with atherosclerosis were largely consistent between the two vascular beds (coronary and carotid arteries) and predominantly tag pathways that overlap with the known cardiovascular risk factors. We present an integrated systems network that highlights a series of inter-connected pathways underlying atherosclerosis.
To evaluate the relationship of potential asthma quality-of-care markers to subsequent emergency hospital care.
Retrospective administrative database analysis.
Managed care organization.
Asthmatic ...patients aged 5 to 56 years of age.
None.
Candidate quality measures included one or more or four or more controller medication canisters, a controller/total asthma medication ratio of ≥ 0.3 or ≥ 0.5, and the dispensing of fewer than six β-agonist canisters in 2002. Outcome was a 2003 asthma emergency department visit or hospitalization. Multivariable analyses adjusted for age, sex, and year 2002 severity (based on utilization). In the total sample (n = 109,774), one or more controllers (odds ratio, 1.35) and four or more controllers (odds ratio, 1.98) were associated with an increased risk of emergency hospital care, whereas a controller/total asthma medication ratio of ≥ 0.5 (odds ratio, 0.73) and the dispensing of fewer than six β-agonist canisters (odds ratio 0.30) were associated with a decreased risk. After adjustment for baseline severity in the total asthma sample, the controller/total asthma medication ratio (odds ratio, 0.62 to 0.78) and β-agonist measure (odds ratio, 0.42) were associated with decreased risk, whereas the dispensing of four or more canisters of controller medication was associated with increased risk (odds ratio, 1.33). After stratification by year 2002 β-agonist use, all of the measures were associated with decreased risk in those who received fewer than six β-agonist canisters, whereas all of the measures except the medication ratio of ≥ 0.5 were associated with increased risk in the cohort who received six or more β-agonist canisters.
Controller use and β-agonist use may function as severity indicators in large populations rather than as asthma quality-of-care markers. A medication ratio of ≥ 0.5 appeared to function as the best quality-of-care marker in this study.
Cancer cells can develop a strong addiction to discrete molecular regulators, which control the aberrant gene expression programs that drive and maintain the cancer phenotype. Here, we report the ...identification of the RNA-binding protein HuR/ELAVL1 as a central oncogenic driver for malignant peripheral nerve sheath tumors (MPNSTs), which are highly aggressive sarcomas that originate from cells of the Schwann cell lineage. HuR was found to be highly elevated and bound to a multitude of cancer-associated transcripts in human MPNST samples. Accordingly, genetic and pharmacological inhibition of HuR had potent cytostatic and cytotoxic effects on tumor growth, and strongly suppressed metastatic capacity in vivo. Importantly, we linked the profound tumorigenic function of HuR to its ability to simultaneously regulate multiple essential oncogenic pathways in MPNST cells, including the Wnt/β-catenin, YAP/TAZ, RB/E2F, and BET pathways, which converge on key transcriptional networks. Given the exceptional dependency of MPNST cells on HuR for survival, proliferation, and dissemination, we propose that HuR represents a promising therapeutic target for MPNST treatment.
Epigenetic mechanisms play a critical role during differentiation of T cells by contributing to the formation of stable and heritable transcriptional patterns. To better understand the mechanisms of ...memory maintenance in CD8
T cells, we performed genome-wide analysis of DNA methylation, histone marking (acetylated lysine 9 in histone H3 and trimethylated lysine 9 in histone), and gene-expression profiles in naive, effector memory (EM), and terminally differentiated EM (TEMRA) cells. Our results indicate that DNA demethylation and histone acetylation are coordinated to generate the transcriptional program associated with memory cells. Conversely, EM and TEMRA cells share a very similar epigenetic landscape. Nonetheless, the TEMRA transcriptional program predicts an innate immunity phenotype associated with genes never reported in these cells, including several mediators of NK cell activation (VAV3 and LYN) and a large array of NK receptors (e.g., KIR2DL3, KIR2DL4, KIR2DL1, KIR3DL1, KIR2DS5). In addition, we identified up to 161 genes that encode transcriptional regulators, some of unknown function in CD8
T cells, and that were differentially expressed in the course of differentiation. Overall, these results provide new insights into the regulatory networks involved in memory CD8
T cell maintenance and T cell terminal differentiation.
Determinants of future long-term asthma control Schatz, Michael; Zeiger, Robert S.; Vollmer, William M. ...
Journal of allergy and clinical immunology,
11/2006, Letnik:
118, Številka:
5
Journal Article
Recenzirano
Asthma control has been hypothesized to be inversely related to asthma severity, directly related to effective management, and also related to other definable factors, but empiric data to support ...this construct are few.
We sought to identify independent prospective determinants of future long-term asthma control among asthma severity, management, demographic, and comorbidity predictors.
Surveys were completed by a random sample of 2250 health maintenance organization members aged 18 to 56 years with persistent asthma. Linked computerized pharmacy data provided baseline and follow-up year medication dispensings. The outcome was follow-up year long-term asthma control, as assessed by using a previously validated 4-level scale based on the number of short-acting β-agonist canister dispensings.
Oral corticosteroids (odds ratio OR, 1.9) or unscheduled visits (OR, 1.2) in the prior year, any prior asthma hospitalizations (OR, 1.4), smoking (OR, 2.2), chronic obstructive pulmonary disease (OR, 1.9), male sex (OR, 1.5), black race (OR, 1.3), and lower educational level (OR, 1.1) were independently associated with poorer control in ordinal logistic regression analyses. Regular inhaled corticosteroids (OR, 0.7), long-acting β-agonists (OR, 0.7) and asthma specialist care (OR, 0.6) were independently associated with better control.
Markers of asthma severity and other patient characteristics are inversely related to future asthma control, but effective management strategies are associated with improved asthma control, even after accounting for these high-risk characteristics.
Inhaled corticosteroids, long-acting β-agonists, and asthma specialist care are associated with improved asthma control, even after accounting for markers of asthma severity.
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