Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.

An Expanded Survey of the Moth PBP/GOBP Clade in Bombyx mori: New Insight into Expression and Functional Roles

We studied the expression profile and ontogeny (from the egg stage through the larval stages and pupal stages, to the elderly adult age) of four OBPs from the silkworm moth Bombyx mori. We first showed that male responsiveness to female sex pheromone in the silkworm moth B. mori does not depend on age variation; whereas the expression of BmorPBP1, BmorPBP2, BmorGOBP1, and BmorGOBP2 varies with age. The expression profile analysis revealed that the studied OBPs are expressed in non-olfactory tissues at different developmental stages. In addition, we tested the effect of insecticide exposure on the expression of the four OBPs studied. Exposure to a toxic macrolide insecticide endectocide molecule (abamectin) led to the modulated expression of all four genes in different tissues. The higher expression of OBPs was detected in metabolic tissues, such as the thorax, gut, and fat body. All these data strongly suggest some alternative functions for these proteins other than olfaction. Finally, we carried out ligand docking studies and reported that PBP1 and GOBP2 have the capacity of binding vitamin K1 and multiple different vitamins.

Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access

Background: To compare healthcare expenditure, utilization and access between nonelderly adult cancer survivors enrolled in a high deductible health plan with a health savings account (“HDHP+HSA”), HDHP without HSA (“HDHP alone”) and low deductible health plan (“LDHP”). Methods: 1735 cancer survivors, aged 18–64 years, with continuous private coverage identified from the 2012–2017 Medical Expenditure Panel Survey: HDHP alone (n = 353), HDHP+HSA (n = 242) and LDHP (n = 1140). Healthcare expenditures, utilization and inability/delay obtaining medical care were analyzed using generalized linear regressions with inverse propensity score weighting and doubly robust estimation. Results: HDHP alone group (23,255 USD) had significantly higher total healthcare expenditure compared to HDHP+HSA (15,580 USD, p = 0.012) and LDHP (16,261 USD, p = 0.016). HDHP alone (6089 USD; p = 0.002) and HDHP+HSA (5743 USD; p = 0.012) groups had significantly higher out-of-pocket (OOP) expenditure compared to LDHP (4853 USD). HDHP alone (17,128 USD, p = 0.010) and LDHP (12,645 USD, p = 0.045) had significantly higher private insurer payments compared to HDHP+HSA (9216 USD). No differences were found in utilization or inability/delay obtaining medical care across groups. Conclusions: Non-elderly adult cancer survivors with continuous coverage and comparable sociodemographic characteristics enrolled in HDHP with HSA displayed the lowest healthcare costs compared to HDHP without HSA and LDHP. HDHP+HSA had a significantly higher OOP expenditure than LDHP. No significant differences were observed in utilization or access among groups.

Cognition and Functional Capacity in the Elderly Adult

Objetivo: determinar la relación entre la cognición y la capacidad funcional en la persona adulta mayor. Método: Investigación descriptiva transversal, correlacional realizada en 2015-2016 en la región La Libertad-Perú, con 1110 adultos mayores de 60 años y más, ambos sexos, aptos o no física y mentalmente. quienes cumplieron los criterios de inclusión y aceptaron voluntariamente participar en el estudio. Se midieron la variables cognición con el Minimental State Examination (MMSE) de Folstein y Cols., y la capacidad funcional con el indice de Katz modificado, para las actividades básicas de la vida diaria (ABVD) y la escala de Lawton y Brody para las actividades instrumentales de la vida diaria (AIVD), proporcionando un índice de autonomía-dependencia. Recolectada la información, se hizo un análisis bivariado para determinar la relación entre las variables utilizando la prueba chicuadrado. Resultados: El mayor porcentaje (22.7%) de los adultos mayores estuvieron en edades de (60-64 años), 58.8% mujeres, 47.4% con instrucción primaria, 93.6% cognitiva normal, y 83,4% y 60 % fueron independiente en las actividades básicas de la vida diaria (ABVD) y en las actividades instrumentales de la vida diaria (AIVD) respectivamente. Existe relación altamente significativa entre la cognición y la capacidad funcional de las actividades básicas de la vida diaria (ABVD) (x2=206.0 valor p= 0.000) y actividades instrumentales de la vida diaria (AIVD) (x2=289.0 valor p= 0.000). Conclusiones: El envejecimiento saludable implica la capacidad de conservar y mantener altos niveles de funcionalidad cognitiva y física, y son los principales determinantes de la calidad de vida y de bienestar en la vejez, y para enfermería son desafíos promover y/o mantener la autonomía e independencia al nivel más alto posible.