Impact of Safety-Net Burden on In-Hospital Mortality and Hospitalization Costs Among Patients with Alcoholic Hepatitis and Alcoholic Cirrhosis

2020 ◽  
Author(s):  
Sanah Ladhani ◽  
Grishma Hirode ◽  
Ashwani K Singal ◽  
Robert J Wong
Keyword(s):  
African American ◽  
Hospital Mortality ◽  
Alcoholic Hepatitis ◽  
Alcoholic Cirrhosis ◽  
Safety Net ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Hospitalization Costs ◽  
The Usa ◽  
The Impact

Abstract Aims Alcoholic hepatitis (AH) and alcoholic cirrhosis disproportionately affect ethnic minority and safety-net populations. We evaluate the impact of a hospital’s safety net burden (SNB) on in-hospital mortality and costs among patients with AH and alcoholic cirrhosis. Methods We performed a cross-sectional analysis of 2012–2016 National Inpatient Sample. SNB was calculated as percentage of hospitalizations with Medicaid or uninsured payer status. Associations between hospital SNB and in-hospital mortality and costs were evaluated with adjusted multivariable logistic regression and linear regression models. Results Among 21,898 AH-related hospitalizations, compared to low SNB hospitals (LBH), patients hospitalized in high SNB hospitals (HBH) were younger (44.4 y vs. 47.4 y, P < 0.001) and more likely to be African American (11.3% vs. 7.7%, P < 0.001) or Hispanic (15.4% vs. 8.4%, P < 0.001). AH-related hospitalizations in HBH had a non-significant trend towards higher odds of mortality (OR 1.27, 95% CI 0.98–1.65, P = 0.07) and higher mean hospitalizations costs. Among 108,669 alcoholic cirrhosis-related hospitalizations, patients in HBH were younger (53.3 y vs. 55.8 y, P < 0.001) and more likely to be African American (8.2% vs. 7.3%, P < 0.001) or Hispanic (24.4% vs. 12.0%, P < 0.001) compared to LBH. Compared to alcoholic cirrhosis-related hospitalizations in LBH, mortality was higher among medium SNB (OR 1.10, 95% CI 1.03–1.17, P = 0.007) and HBH (OR 1.07, 95% CI 1.00–1.15, P = 0.05). Mean hospitalization costs were not different by SNB status. Conclusions HBH hospitals predominantly serve ethnic minorities and underinsured/uninsured populations. The higher in-hospital mortality associated HBH particularly for alcoholic cirrhosis patients is alarming given its increasing burden in the USA.

scholarly journals Total, insoluble and soluble dietary fibre intake in relation to blood pressure: the INTERMAP Study

2015 ◽  
Vol 114 (9) ◽  
pp. 1480-1486 ◽  
Author(s):  
Ghadeer S. Aljuraiban ◽  
Linda M. O. Griep ◽  
Queenie Chan ◽  
Martha L. Daviglus ◽  
Jeremiah Stamler ◽  
...  
Keyword(s):  
Blood Pressure ◽  
International Study ◽  
Linear Regression Models ◽  
Lower Systolic Blood Pressure ◽  
Cross Sectional ◽  
Soluble Fibre ◽  
Fibre Intake ◽  
Insoluble Fibre ◽  
The Usa ◽  
The Impact

AbstractProspective cohort studies have shown inverse associations between fibre intake and CVD, possibly mediated by blood pressure (BP). However, little is known about the impact of types of fibre on BP. We examined cross-sectional associations with BP of total, insoluble and soluble fibre intakes. Data were used from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) study, including 2195 men and women aged between 40 and 59 years from the USA. During four visits, eight BP, four 24 h dietary recalls and two 24 h urine samples were collected. Linear regression models adjusted for lifestyle and dietary confounders to estimate BP differences per 2 sd higher intakes of total and individual types of fibre were calculated. After multivariable adjustment, total fibre intake higher by 6·8 g/4184 kJ (6·8 g/1000 kcal) was associated with a 1·69 mmHg lower systolic blood pressure (SBP; 95 % CI −2·97, −0·41) and attenuated to −1·01 mmHg (95 % CI −2·35, 0·34) after adjustment for urinary K. Insoluble fibre intake higher by 4·6 g/4184 kJ (4·6 g/1000 kcal) was associated with a 1·81 mmHg lower SBP (95 % CI −3·65, 0·04), additionally adjusted for soluble fibre and urinary K excretion, whereas soluble fibre was not associated with BP. Raw fruit was the main source of total and insoluble fibre, followed by whole grains and vegetables. In conclusion, higher intakes of fibre, especially insoluble, may contribute to lower BP, independent of nutrients associated with higher intakes of fibre-rich foods.

scholarly journals Impact of temperature and relative humidity on the transmission of COVID-19: a modelling study in China and the United States

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043863
Author(s):  
Jingyuan Wang ◽  
Ke Tang ◽  
Kai Feng ◽  
Xin Lin ◽  
Weifeng Lv ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Relative Humidity ◽  
Human Mobility ◽  
The United States ◽  
Reproductive Number ◽  
Cross Sectional ◽  
The Usa ◽  
Higher Temperature ◽  
Potential Impact ◽  
The Impact

ObjectivesWe aim to assess the impact of temperature and relative humidity on the transmission of COVID-19 across communities after accounting for community-level factors such as demographics, socioeconomic status and human mobility status.DesignA retrospective cross-sectional regression analysis via the Fama-MacBeth procedure is adopted.SettingWe use the data for COVID-19 daily symptom-onset cases for 100 Chinese cities and COVID-19 daily confirmed cases for 1005 US counties.ParticipantsA total of 69 498 cases in China and 740 843 cases in the USA are used for calculating the effective reproductive numbers.Primary outcome measuresRegression analysis of the impact of temperature and relative humidity on the effective reproductive number (R value).ResultsStatistically significant negative correlations are found between temperature/relative humidity and the effective reproductive number (R value) in both China and the USA.ConclusionsHigher temperature and higher relative humidity potentially suppress the transmission of COVID-19. Specifically, an increase in temperature by 1°C is associated with a reduction in the R value of COVID-19 by 0.026 (95% CI (−0.0395 to −0.0125)) in China and by 0.020 (95% CI (−0.0311 to −0.0096)) in the USA; an increase in relative humidity by 1% is associated with a reduction in the R value by 0.0076 (95% CI (−0.0108 to −0.0045)) in China and by 0.0080 (95% CI (−0.0150 to −0.0010)) in the USA. Therefore, the potential impact of temperature/relative humidity on the effective reproductive number alone is not strong enough to stop the pandemic.

scholarly journals Processes of care and outcomes for homeless patients hospitalised for cardiovascular conditions at safety-net versus non-safety-net hospitals: cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046959
Author(s):  
Atsushi Miyawaki ◽  
Dhruv Khullar ◽  
Yusuke Tsugawa
Keyword(s):  
Hospital Mortality ◽  
Health Outcomes ◽  
Care Delivery ◽  
Bypass Graft ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Homeless Adults ◽  
To Receive

ObjectivesEvidence suggests that homeless patients experience worse quality of care and poorer health outcomes across a range of medical conditions. It remains unclear, however, whether differences in care delivery at safety-net versus non-safety-net hospitals explain these disparities. We aimed to investigate whether homeless versus non-homeless adults hospitalised for cardiovascular conditions (acute myocardial infarction (AMI) and stroke) experience differences in care delivery and health outcomes at safety-net versus non-safety-net hospitals.DesignCross-sectional study.SettingData including all hospital admissions in four states (Florida, Massachusetts, Maryland, and New York) in 2014.ParticipantsWe analysed 167 105 adults aged 18 years or older hospitalised for cardiovascular conditions (age mean=64.5 years; 75 361 (45.1%) women; 2123 (1.3%) homeless hospitalisations) discharged from 348 hospitals.Outcome measuresRisk-adjusted diagnostic and therapeutic procedure and in-hospital mortality, after adjusting for patient characteristics and state and quarter fixed effects.ResultsAt safety-net hospitals, homeless adults hospitalised for AMI were less likely to receive coronary angiogram (adjusted OR (aOR), 0.42; 95% CI, 0.36 to 0.50; p<0.001), percutaneous coronary intervention (aOR, 0.52; 95% CI, 0.44 to 0.62; p<0.001) and coronary artery bypass graft (aOR, 0.43; 95% CI, 0.26 to 0.71; p<0.01) compared with non-homeless adults. Homeless patients treated for strokes at safety-net hospitals were less likely to receive cerebral arteriography (aOR, 0.23; 95% CI, 0.16 to 0.34; p<0.001), but were as likely to receive thrombolysis therapy. At non-safety-net hospitals, we found no evidence that the probability of receiving these procedures differed between homeless and non-homeless adults hospitalised for AMI or stroke. Finally, there were no differences in in-hospital mortality rates for homeless versus non-homeless patients at either safety-net or non-safety-net hospitals.ConclusionDisparities in receipt of diagnostic and therapeutic procedures for homeless patients with cardiovascular conditions were observed only at safety-net hospitals. However, we found no evidence that these differences influenced in-hospital mortality markedly.

scholarly journals Association between egg intake and blood pressure in the USA: the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP)

2021 ◽  
pp. 1-9
Author(s):  
Thanh-Huyen T Vu ◽  
Linda Van Horn ◽  
Martha L Daviglus ◽  
Queenie Chan ◽  
Alan R Dyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dietary Cholesterol ◽  
International Study ◽  
Obese Women ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Men And Women ◽  
The Usa ◽  
Underlying Mechanisms

Abstract Objectives: To investigate associations of egg intake with blood pressure (BP) and the role of dietary variables and other macro- and micro-nutrients in the association. Design: We used cross-sectional data for the USA as part of the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). INTERMAP was surveyed between 1996 and 1999, including four 24-h dietary recalls, two 24-h urine collections and eight measurements of systolic BP and diastolic BP (SBP, DBP). Average egg intake (g/d) was calculated. Multivariable linear regression models were used to estimate the association between egg intake (per each 50 g/d or per quintile) and BP. The roles of dietary variables and other macro- and micro-nutrients in this association were also investigated. Setting: In the USA. Participants: In total, 2195 US INTERMAP men and women aged 40–59 years. Results: Participants were 50 % female, 54 % non-Hispanic White and 16 % non-Hispanic Black. Mean egg intake (sd) in men and women was 30·4(29·8) and 21·6(20·5) g/d, respectively. Adjusting for demographics, socio-economics, lifestyle and urinary Na:K excretion ratios, we found non-linear associations with BP in non-obese women (P-quadratic terms: 0·004 for SBP and 0·035 for DBP).The associations remained after adjusting for dietary variables, macro/micro nutrients or minerals. Dietary cholesterol was highly correlated with egg intake and may factor in the association. No association was found in obese women and in obese or non-obese men. Conclusion: Egg intake was non-linearly associated with SBP and DBP in non-obese women, but not in obese women or men. Underlying mechanisms require additional study regarding the role of obesity and sex.

Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population

2018 ◽  
Vol 103 (9) ◽  
pp. 1314-1319 ◽  
Author(s):  
Eva K Fenwick ◽  
Ryan E K Man ◽  
Alfred Tau Liang Gan ◽  
Neelam Kumari ◽  
Charlene Wong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Well Being ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Significant Difference ◽  
Related Quality ◽  
The Impact

Background/aimsTo assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population.MethodsThe Singapore Chinese Eye Study (n=3353; 2009–2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the ‘Reading’, ‘Mobility’ and ‘Emotional’ domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models.ResultsOf the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR.ConclusionsWe documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.

scholarly journals In-hospital mortality in COVID-19 vs. pre-COVID-19 era in the Split-Dalmatia County, Croatia

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
I Marasovic Šušnjara
Keyword(s):  
Hospital Mortality ◽  
Respiratory Diseases ◽  
Score Test ◽  
Additional Research ◽  
University Hospital ◽  
Complete Picture ◽  
Cross Sectional ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
The Impact

Abstract Background The COVID-19 pandemic marked 2020 with numerous consequences for the health of the population. Therefore, this study aimed to explore whether the COVID-19 pandemic affected in-hospital mortality. Methods We employed a cross-sectional comparative study using two different time periods, pre-COVID-19 (2019 year) and COVID-19 era (2020 year) to explore possibilities of COVID-19 influences in-hospital mortality in Split-Dalmatia County, Croatia. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The indicators were statistically analyzed. The z-score test for two population proportions is used. Results In 2020, there was a significantly higher in-hospital mortality compared to 2019 (z = 9.0827; p &lt; 0.00001), which was supported by a significant increase in mortality from respiratory diseases according to the comparison of disease categories of International Statistical Classification of Diseases and Related Health Problems (ICD-10) (z = 9.0427; p &lt; 0.00001). Within hospital departments, significantly higher mortality was in the Intensive Care Unit (z = 5.2763; p &lt; 0.00001) and the Infectious Diseases Department (z = 9.6982; p &lt; 0.00001). Among deaths in 2020 with confirmed COVID-19, there were significantly more positive among deaths from respiratory diseases (z=-17.4462; p &lt; 0.00001). There was no difference in mortality rates between 2020 and 2019 by age. Conclusions The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality in Split-Dalmatia County, as well as in other regions and countries. Key messages The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality.

Estimating the environmental impact of disposable endoscopic equipment and endoscopes

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324729
Author(s):  
Sathvik Namburar ◽  
Daniel von Renteln ◽  
John Damianos ◽  
Lisa Bradish ◽  
Jeanne Barrett ◽  
...  
Keyword(s):  
Environmental Impact ◽  
Cross Sectional Study ◽  
Healthcare Sector ◽  
Passenger Cars ◽  
Cross Sectional ◽  
Endoscopic Procedures ◽  
The Usa ◽  
Single Use ◽  
Soccer Fields ◽  
The Impact

ObjectiveProcedure-intense specialties, such as surgery or endoscopy, are a major contributor to the impact of the healthcare sector on the environment. We aimed to measure the amount of waste generated during endoscopic procedures and to understand the impact on waste of changing from reusable to single use endoscopes in the USA.DesignWe conducted a 5-day audit (cross-sectional study) of all endoscopies performed at two US academic medical centres with low and a high endoscopy volume (2000 and 13 000 procedures annually, respectively). We calculated the average disposable waste (excluding waste from reprocessing) generated during one endoscopic procedure to estimate waste of all endoscopic procedures generated in the USA annually (18 million). We further estimated the impact of changing from reusable to single-use endoscopes taking reprocessing waste into account.Results278 endoscopies were performed for 243 patients. Each endoscopy generated 2.1 kg of disposable waste (46 L volume). 64% of waste was going to the landfill, 28% represented biohazard waste and 9% was recycled. The estimated total waste generated during all endoscopic procedures performed in the USA annually would weigh 38 000 metric tons (equivalent of 25 000 passenger cars) and cover 117 soccer fields to 1 m depth. If all endoscopic procedures were performed with single-use endoscopes and accounting for reprocessing, the net waste mass would increase by 40%. Excluding waste from ancillary supplies, net waste generated from reprocessing and endoscope disposal would quadruple with only using single-use endoscopes.ConclusionThis quantitative assessment of the environmental impact of endoscopic procedures highlights that a large amount of waste is generated from disposable instruments. Transitioning to single-use endoscopes may reduce reprocessing waste but would increase net waste.

scholarly journals Comparison of food and beverage products’ availability, variety, price and quality in German and US supermarkets

2020 ◽  
Vol 23 (18) ◽  
pp. 3387-3393
Author(s):  
Nanette Stroebele-Benschop ◽  
Kerstin Wolf ◽  
Katharine Palmer ◽  
Casey J Kelley ◽  
Stephanie B Jilcott Pitts
Keyword(s):  
Fruits And Vegetables ◽  
Food Products ◽  
High Energy ◽  
Cross Sectional Study ◽  
Food Prices ◽  
General Tendency ◽  
Cross Sectional ◽  
Convenience Sample ◽  
The Usa ◽  
The Impact

AbstractObjective:To assess availability, variety, price and quality of different food products in a convenience sample of supermarkets in Germany and the USA.Design:Cross-sectional study using an adapted version of the Bridging the Gap Food Store Observation Form.Setting:Information on availability, quality, price and variety of selected food products in eight German and seven US supermarkets (discount and full service) was obtained and compared by country.Results:A general tendency for lower prices of fruits and vegetables in Germany was observed, while produce quality and variety did not seem to differ between countries, with the exception of the variety of some vegetables such as tomatoes. Chips and cereals did not differ significantly in variety nor price. In both countries, high energy-dense foods were lower in energy costs than lower energy-dense foods.Conclusions:The influence of food prices and availability on consumption should be further explored, including the impact of country differences.

scholarly journals A longitudinal study investigating change in BMI z-score in primary school-aged children and the association of child BMI z-score with parent BMI

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
R. Mears ◽  
R. Salway ◽  
D. Sharp ◽  
J. P. H. Shield ◽  
R. Jago
Keyword(s):  
Strong Association ◽  
Z Score ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
School Aged Children ◽  
Key Indicator ◽  
Unit Increase ◽  
Obesity Interventions ◽  
Child Bmi ◽  
The Impact

Abstract Background This paper aims to explore change in BMI z-score through childhood and the association between parent BMI and child BMI z-score. This is important to understand for the development of effective obesity interventions. Methods Data from the longitudinal B-ProAct1v study (1837 participants) were analysed. A paired sample t-test examined changes in child BMI z-score between Year 1 and 4. Multivariable linear regression models examined the cross-sectional associations between child BMI z-score and parent BMI in Year 1 and 4. The influence of change in parental BMI between Year 1 and Year 4 on child BMI z-score in Year 4 was explored through regression analyses, adjusted for baseline BMI z-score. Results There was a strong association between child BMI z-score at Year 1 and 4. Child mean BMI z-score score increased from 0.198 to 0.330 (p = < 0.005) between these timepoints. For every unit increase in parent BMI, there was an increase in child BMI z-score of 0.047 in Year 1 (p = < 0.005) and of 0.059 in Year 4 (p = < 0.005). Parental BMI change was not significantly associated with Year 4 child BMI z-score. Conclusion The key indicator of higher child BMI at Year 4 is high BMI at Year 1. Further studies are needed to explore the impact of parental weight change on child BMI z-score and whether interventions targeted at overweight or obese parents, can improve their child’s BMI z-score.

scholarly journals 008 Associations between comorbidities and adverse events of antiepileptic drugs and quality of life: a survey of epilepsy patients in australia

2019 ◽  
Vol 90 (e7) ◽  
pp. A3.2-A3
Author(s):  
Jeremy M Welton ◽  
Christine Walker ◽  
Kate Riney ◽  
Alvin Ng ◽  
Lisa M Todd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Antiepileptic Drugs ◽  
List Type ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Stepwise Selection ◽  
Memory Problems ◽  
The Impact

IntroductionThis study explored the impact of specific types of comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs) on quality of life (QoL) among adult patients with epilepsy (PwE) in Australia.MethodsCross-sectional surveys were completed by PwE, or caregiver proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May–August 2018 Data were collected on demographics, epilepsy severity and management, AEs, comorbidities, and QoL (using QOLIE-10-P total score).1 Multiple linear regression models were constructed to explore associations between AEs or comorbidities and QOLIE-10-P, with possible confounders determined using stepwise selection.Results978 responses were included (mean age 44.5 years, 64% female, 52% employed). 97% reported recent AED use, 47% on AED monotherapy, 35% exposed to ≤2 lifetime AEDs, and 55% seizure-free for >1 year. After stepwise selection, control variables included in both models were: time since diagnosis, employment status, seizure frequency, number of currently prescribed AEDs, and number of general practitioner visits per year. In the model for comorbidities, ‘psychiatric disorders’ was associated with the largest QOLIE-10-P decrease (-23.30, p<0.001). In the model for AEs, which additionally controlled for depression and anxiety disorder, ‘memory problems’ was associated with the largest decrease in QOLIE-10-P (-14.27, p<0.001).ConclusionsIn this survey of Australian PwE, of which many had relatively well-controlled epilepsy, psychiatric and memory problems were common and associated with the greatest detrimental impact on QoL. Further research is needed to understand causality, relationships between possibly interrelated or overlapping symptoms, and management strategies. UCB Pharma-sponsored.ReferenceCramer JA, Perrine K, Devinsky O, Meador K. A brief questionnaire to screen for quality of life in epilepsy: The QOLIE-10. Epilepsia 1996;37:577–582.

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