Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees

Background: Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. Hypothesis: The incidence of, and excess health care utilization for, stress fracture and non–stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Study Design: Cohort study; Level of evidence, 3. Methods: All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005–September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Results: Among the weight-qualified women, unfit participants had a higher non–stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non–stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1.19-2.21) and 1.22 (95% CI, 1.10-1.36), respectively. Among fit women exceeding body fat limits, the stress fracture incidence and related excess health care utilization rate ratios were 0.79 (95% CI, 0.49-1.28) and 1.44 (95% CI, 1.20-1.72), respectively, compared with those who were weight qualified. Conclusion: The results indicate a significantly increased risk of musculoskeletal injuries, including stress fractures, among unfit recruits and an increased risk of non–stress fracture musculoskeletal injuries among recruits who exceeded body fat limits. Once injured, female recruits who were weight qualified but unfit and those who were fit but exceeded body fat limits had increased health care utilization. These findings may have implications for military accession and training policies as downsizing of military services will make it more important than ever to optimize the health and performance of individual service members.

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General Health, Health Care Utilization, and Medical Comorbidity in Dysthymia

The International Journal of Psychiatry in Medicine ◽

10.2190/axcu-p704-23xq-cqtr ◽

1993 ◽

Vol 23 (3) ◽

pp. 211-238 ◽

Cited By ~ 56

Author(s):

Robert H. Howland

Keyword(s):

Health Care ◽

Major Depression ◽

Health Care Utilization ◽

General Health ◽

Public Health Problem ◽

Care Utilization ◽

Medical Comorbidity ◽

Medical Settings ◽

Poor General Health ◽

Increased Risk

Objective: This article reviews the literature on the general health, health care utilization, prevalence, medical comorbidity, and treatment of dysthymia in medical settings. Method: The literature was searched by using MEDLINE and by reviewing the bibliographies of recent publications. Studies were selected that included health data on patients with dysthymia or chronic depression according to DSM-III, DSM-III-R, ICD-9, or RDC criteria, or patients who were described as having persistent depressive symptoms. Results: This review shows that dysthymic patients are at increased risk for poor general health and frequently use medical services. Compared to the general population, dysthymia is more prevalent in primary care and among patients with various medical and neurological conditions, sleep disorders, chronic fatigue, hypothyroidism, and somatoform disorders. Pharmacotherapy is effective, but has not been well studied. Non-tricyclic antidepressants might be especially useful. Psychotherapy studies are virtually nonexistent. Conclusions: Although dysthymia is considered a minor depressive condition, these findings show that it is a significant public health problem, comparable to major depression. Recent efforts to improve the recognition and treatment of major depression in medical settings, therefore, should be extended to include the entire spectrum of depressive disorders. Future studies should investigate the type and pattern of medical comorbidity and health care utilization, different antidepressant and psychosocial therapies, and the clinical and biological correlates of treatment response in different chronic depressive subtypes in medical settings and compare them to major depressive and subsyndromal depressive conditions.

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Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

American Journal of Critical Care ◽

10.4037/ajcc2020498 ◽

2020 ◽

Vol 29 (4) ◽

pp. 311-317

Author(s):

Patricia S. Andrews ◽

Sophia Wang ◽

Anthony J. Perkins ◽

Sujuan Gao ◽

Sikandar Khan ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Health Care Utilization ◽

Mortality Risk ◽

Hazard Ratio ◽

Emergency Department Visits ◽

Care Utilization ◽

Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

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Specialist psychiatric health care utilization among older people with intellectual disability – predictors and comparisons with the general population: a national register study

BMC Psychiatry ◽

10.1186/s12888-020-02491-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

G. Ahlström ◽

A. Axmon ◽

M. Sandberg ◽

J. Hultqvist

Keyword(s):

Health Care ◽

Intellectual Disability ◽

General Population ◽

Health Care Utilization ◽

Older People ◽

Age Groups ◽

Care Utilization ◽

Increased Risk ◽

National Cohort ◽

Specialist Health Care

Abstract Background People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. Material and methods We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002–2012. Results After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. Conclusions Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers’ plans of resources to meet the needs of these people.

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Trends in health care utilization and costs attributable to hepatocellular carcinoma, 2002–2009: a population-based cohort study

Current Oncology ◽

10.3747/co.23.2956 ◽

2016 ◽

Vol 23 (3) ◽

pp. 196 ◽

Cited By ~ 7

Author(s):

H.H. Thein ◽

Y. Qiao ◽

S.K. Young ◽

W. Zarin ◽

E.M. Yoshida ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

End Of Life ◽

Population Based ◽

Care Utilization ◽

Short Term ◽

Control Subjects ◽

Costs Of Care ◽

Life Phase ◽

Rate Ratios

Background The incidence of hepatocellular carcinoma (HCC) and the complexity of its diagnosis and treatment are increasing. We estimated trends in net health care utilization, costs of care attributable to hcc in Ontario, and rate ratios of resource use at various stages of care.Methods This population-based retrospective cohort study identified HCC patients and non-cancer control subjects, and health care resource utilization between 2002 and 2009. Generalized estimating equations were then used to estimate net health care utilization (HCC patients vs. the matched control subjects) and net costs of care attributable to HCC. Generalized linear models were used to analyze rate ratios of resource use.Results We identified 2832 HCC patients and 2808 matched control subjects. In comparison with the control subjects, HCC patients generally used a greater number of health care services. Overall, the mean net cost of care per 30 patient–days (2013 Canadian dollars) attributable to outpatient visits and hospitalizations was highest in the pre-diagnosis (1 year before diagnosis), initial (1st year after diagnosis), and end-of-life (last 6 months before death, short-term survivors) phases. Mean net homecare costs were highest in the end-of-life phase (long-term survivors). In the end-of-life phase (short-term survivors), mean net costs attributable to outpatient visits and total services significantly increased to $14,220 from $1,547 and to $33,121 from $14,450 (2008–2009 and 2002–2003 respectively).Conclusions In HCC, our study found increasing resource use and net costs of care, particularly in the end-of-life phase among short-term survivors. Our findings offer a basis for resource allocation decisions in the area of cancer prevention and control.

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Increasing Age Has Limited Impact on Risk of Clostridium difficile Infection in an Elderly Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy160 ◽

2018 ◽

Vol 5 (7) ◽

Cited By ~ 8

Author(s):

Margaret A Olsen ◽

Dustin Stwalley ◽

Clarisse Demont ◽

Erik R Dubberke

Keyword(s):

Risk Factors ◽

Health Care ◽

Clostridium Difficile ◽

Health Care Utilization ◽

Clostridium Difficile Infection ◽

Elderly Population ◽

Univariate Analysis ◽

Model Performance ◽

Care Utilization ◽

Increased Risk

Abstract Background Numerous studies have found increased risk of Clostridium difficile infection (CDI) with increasing age. We hypothesized that increased CDI risk in an elderly population is due to poorer overall health status with older age. Methods A total of 174 903 persons aged 66 years and older coded for CDI in 2011 were identified using Medicare claims data. The comparison population consisted of 1 453 867 uninfected persons. Potential risk factors for CDI were identified in the prior 12 months and organized into categories, including infections, acute noninfectious conditions, chronic comorbidities, frailty indicators, and health care utilization. Multivariable logistic regression models with CDI as the dependent variable were used to determine the categories with the biggest impact on model performance. Results Increasing age was associated with progressively increasing risk of CDI in univariate analysis, with 5-fold increased risk of CDI in 94–95-year-old persons compared with those aged 66–67 years. Independent risk factors for CDI with the highest effect sizes included septicemia (odds ratio [OR], 4.1), emergency hospitalization(s) (OR, 3.9), short-term skilled nursing facility stay(s) (OR, 2.7), diverticulitis (OR, 2.2), and pneumonia (OR, 2.1). Exclusion of age from the full model had no impact on model performance. Exclusion of acute noninfectious conditions followed by frailty indicators resulted in lower c-statistics and poor model fit. Further exclusion of health care utilization variables resulted in a large drop in the c-statistic. Conclusions Age did not improve CDI risk prediction after controlling for a wide variety of infections, other acute conditions, frailty indicators, and prior health care utilization.

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Are Inflammatory Bowel Disease Patients With Diabetes Mellitus at Increased Risk for Poor Outcomes Including Greater Health Care Utilization?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz306 ◽

2020 ◽

Vol 26 (9) ◽

pp. 1443-1444

Author(s):

Uni Wong ◽

Raymond K Cross

Keyword(s):

Diabetes Mellitus ◽

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

Care Utilization ◽

Increased Risk ◽

Patients With Diabetes ◽

Inflammatory Bowel ◽

Active Disease

Inflammatory bowel disease patients with diabetes mellitus are more likely to have active disease, report worse quality of life, and have higher health care utilization. This high-risk subgroup of patients with confirmed active disease should be treated with appropriate medical therapy including biologic therapy with or without an immunosuppressant.

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