Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia

TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.

Social Risk Factors for Asthma Exacerbations Among Pediatric Patients: A Scoping Review

Background: Asthma is the most common chronic illness among the pediatric patient population. While several studies have investigated the biological and environmental factors associated with asthma exacerbations, research on the relationship between asthma and social determinants of health is limited. This scoping review addresses this gap in knowledge by exploring social factors that are associated with the risk of asthma exacerbations among pediatric patients and mapping identified variables onto the SAVI database. Methods: The OVID Medline, Embase, and PsycInfo databases were systematically searched for studies published as of July 2, 2021. No restrictions on study design or publication type were made but search was limited to English manuscripts. Resulting studies were screened based on phased eligibility criteria on Covidence. In Phase 1, duplicates were removed. In Phase 2, studies unrelated to asthma and those with participants outside of 2-18 years of age were excluded based on title and abstract screening. In Phase 3, studies that investigated asthma exacerbations as well as its association with social factors were retained while studies solely looking at non-social factors or abstract-only studies were excluded based on the full text screening. In Phase 4, data on frequency of both inpatient and outpatient physician visits for asthma were extracted along with information on study characteristics and social factors. Results: Following the initial database search, 3312 studies were retrieved for the scoping review. 772 duplicates were removed during Phase 1. 1628 studies were excluded during the abstract and title screening in Phase 2. Upon resolving 384 conflicts, the remaining 912 studies proceeded to full text screening in Phase 3. Conclusion: The initial literature screening suggests an association between social risk factors and pediatric asthma exacerbations. Incorporating large scale change of these social factors with individual pharmacological treatment could help improve pediatric asthma outcomes.

Perinatal Mental Health Problems in Rural China: The Role of Social Factors

Background: Perinatal mental health is important for the well-being of the mother and child, so the relatively high prevalence of perinatal mental health problems in developing settings poses a pressing concern. However, most studies in these settings focus on the demographic factors associated with mental health problems, with very few examing social factors. Hence, this study examines the prevalence of the depressive, anxiety and stress symptoms among pregnant women and new mothers in rural China, and the associations between these mental health problems and social factors, including decision-making power, family conflicts, and social support.Methods: Cross-sectional data were collected from 1,027 women in their second trimester of pregnancy to 6 months postpartum in four low-income rural counties in Sichuan Province, China. Women were surveyed on symptoms of mental health problems using the Depression, Anxiety, and Stress Scale (DASS-21) and social risk factors. Multivariate logistic regression analyses were conducted to examine social risk factors associated with maternal mental health problems, with results reported as odds ratios (OR) and 95% confidence intervals (CI).Results: Among all respondents, 13% showed symptoms of depression, 18% showed symptoms of anxiety, 9% showed symptoms of stress, and 23% showed symptoms of any mental health problem. Decision-making power was negatively associated with showing symptoms of depression (OR = 0.71, CI: 0.60–0.83, p < 0.001) and stress (OR = 0.76, CI: 0.63–0.90, p = 0.002). Family conflict was positively associated with depression (OR = 1.53, CI: 1.30–1.81, p < 0.001), anxiety (OR = 1.34, CI: 1.15–1.56, p < 0.001), and stress (OR = 1.68, CI: 1.41–2.00, p < 0.001). In addition, social support was negatively associated with depression (OR = 0.56, CI: 0.46–0.69, p < 0.001), anxiety (OR = 0.76, CI: 0.63–0.91, p = 0.002), and stress (OR = 0.66, CI: 0.53–0.84, p < 0.001). Subgroup analyses revealed that more social risk factors were associated with symptoms of anxiety and stress among new mothers compared to pregnant women.Conclusion: Perinatal mental health problems are relatively prevalent among rural women in China and are strongly associated with social risk factors. Policies and programs should therefore promote individual coping methods, as well as target family and community members to improve the social conditions contributing to mental health problems among rural women.

Psychosocial, clinical, and organizational perspectives of the risks of remote work for employees` mental health

The objective of the study was to analyze the modern data on the risks of remote work influence on the employees` mental health from psychosocial, clinical, and organizational perspectives. Methods. The analysis of literary sources, policy documents, publications in the mass media with an emphasis on the period from the beginning of the spread of the new coronavirus infection 2019-nCoV to the present. Results. The current state of the problem of the impact of remote work on the employees` mental health in Russia and in and in other countries during the global COVID-19 pandemic is analyzed. The causal relationships of medical, social, and organizational perspectives of labor activity are considered, and strategies for prevention of negative effects are studied. The widespread using of remote work all over the world is due to the need to limit the direct interpersonal contacts of citizens to contain the spread of infection. It is established that employees of organizations that perform labor functions remotely can be recognized as a type of risk group for mental, behavioral, and addictive disorders due to medical and social perspectives. The development of self-employment and the provision of services on the principles of freelancing may contribute to reducing the number of employees covered by preventive maintenance medical examinations and complicate the early detection of mental and somatic deviations in freelance workers. Conclusion. The result of the growing popularity of remote work is the spread of a hybrid work regime, which requires a comparative assessment of the medical and social risk factors of remote workers, amendments to several regulatory documents as well as the development of evidence based psychohygienic methodological recommendations for employers and early detection of employees with contraindications to remote work.

Association between Apoϵ4 allele and cardiometabolic and social risk factors with cognitive impairment in elderly population from Bogota

ABSTRACT Being an ϵ4 carrier in the Apoϵ gene has been suggested as a modifying factor for the interaction between cardio-metabolic, social risk factors, and the development of cognitive impairment. Objective: The main objective of this study was to assess the existence of such interaction in a sample of Bogota’s elderly population. Methods: A cross-sectional study was conducted with 1,263 subjects older than 50 years. Each participant was diagnosed by consensus, after neuropsychological and neuropsychiatric evaluations, under a diagnosis of normal cognition, mild cognitive impairment (MCI) according to Petersen’s criteria, or dementia according to DSM-IV criteria. Apoϵ was typified and an analysis of MoCA test was performed in each group carrying or not ϵ4 allele. Results: Our study showed that 75% were women with a median age of 68 years (interquartile range 62–74 years) and a median schooling for 6 years (interquartile range 4–12 years). Dementia was related to low education level of ≤5 years OR=11.20 (95%CI 4.99–25.12), high blood pressure (HBP) OR=1.45 (95%CI 1.03–2.05), and age over 70 years OR=7.68 (95%CI 3.49–16.90), independently of being or not an ϵ4 allele carrier. Diabetic subjects with dementia carrying ϵ4 allele showed a tendency to exhibit lower scores on the MoCA test, when compared with noncarriers’ diabetic subjects with dementia. Conclusions: The presence of ϵ4 allele does not modify the relationship between cognitive impairment and the different cardio-metabolic and social risk factors, except in diabetic subjects ϵ4 carriers with dementia who showed a tendency to exhibit lower scores of the MoCA test, when compared with noncarriers’ diabetic subjects with dementia.