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.

Examining Cannabis, Tobacco, and Vaping Discourse on Reddit: An Exploratory Approach Using Natural Language Processing

Background: Perceptions of tobacco, cannabis, and electronic nicotine delivery systems (ENDS) are continually evolving in the United States. Exploring these characteristics through user generated text sources may provide novel insights into product use behavior that are challenging to identify using survey-based methods. The objective of this study was to compare the topics frequently discussed among Reddit members in cannabis, tobacco, and ENDS-specific subreddits.Methods: We collected 643,070 posts on the social media site Reddit between January 2013 and December 2018. We developed and validated an annotation scheme, achieving a high level of agreement among annotators. We then manually coded a subset of 2,630 posts for their content with relation to experiences and use of the three products of interest, and further developed word cloud representations of the words contained in these posts. Finally, we applied Latent Dirichlet Allocation (LDA) topic modeling to the 643,070 posts to identify emerging themes related to cannabis, tobacco, and ENDS products being discussed on Reddit.Results: Our manual annotation process yielded 2,148 (81.6%) posts that contained a mention(s) of either cannabis, tobacco, or ENDS with 1,537 (71.5%) of these posts mentioning cannabis, 421 (19.5%) mentioning ENDS, and 264 (12.2%) mentioning tobacco. In cannabis-specific subreddits, personal experiences with cannabis, cannabis legislation, health effects of cannabis use, methods and forms of cannabis, and the cultivation of cannabis were commonly discussed topics. The discussion in tobacco-specific subreddits often focused on the discussion of brands and types of combustible tobacco, as well as smoking cessation experiences and advice. In ENDS-specific subreddits, topics often included ENDS accessories and parts, flavors and nicotine solutions, procurement of ENDS, and the use of ENDS for smoking cessation.Conclusion: Our findings highlight the posting and participation patterns of Reddit members in cannabis, tobacco, and ENDS-specific subreddits and provide novel insights into aspects of personal use regarding these products. These findings complement epidemiologic study designs and highlight the potential of using specific subreddits to explore personal experiences with cannabis, ENDS, and tobacco products.

Knowledge, Attitude and Practices of Osteoporosis Risk Factors among Jazan University Students, 2019

Osteoporosis is one of the non-communicable diseases that closely links to lifestyle and nutrition. This is a cross-sectional descriptive epidemiologic study, carried out on 440 Jazan university students (males& females). They are chosen by a stratified multistage cluster sampling technique to assess their knowledge, attitude, and practices (KAP) about osteoporosis risk factors. The data are collected using a validated semi structured Arabic questionnaires. The findings revealed that almost all survey participants agreed with the definition of osteoporosis, which is the decrease of bone density, with only 8.7% disagreeing. Furthermore, 80.0 percent of survey participants classified osteoporosis as a cause of bone fracture. The findings suggest that the study participants' good attitudes toward risk factor prevention of osteoporosis are linked to the daily consumption of an acceptable amount of milk. Another positive attitude toward osteoporosis prevention stemmed from a reduction in the amount of energy drinks consumed, which has been identified as an osteoporosis risk factor. The study recommends that university students of all grades participate in health education programs about osteoporosis risk factors and preventive treatment.

Opportunities to improve reporting of rapid response in health technology assessment

Introduction Mini health technology assessment (HTA) reports have been used to support policy makers and health systems by providing a timely summary of scientific evidence. The objective of this meta-epidemiologic study was to evaluate the quality of reporting of mini-HTA reports published in Brazil. Methods An electronic search for all mini-HTA reports published between 2014 and March 2019 was conducted in the SISREBRATS and CONITEC databases. The study selection and data extraction were performed by two independent assessors. The following data were extracted: bibliographic data; research question; characteristics of the population, health technologies and outcomes assessed; eligibility criteria; information about searches and study selection; risk of bias assessment; quality of evidence assessment; synthesis of results; and recommendation about the technology evaluated. A descriptive analysis was used to summarize the information retrieved from all the included mini-HTA reports. Results We included 103 mini-HTA reports, the great majority of which (92.3 percent) focused on the coverage of the technologies in the healthcare system, with more than 60 percent being about drugs. Only five mini-HTA reports (4.8 percent) gave reasons for the choice of outcomes, and fifteen (14.5 percent) discriminated between primary and secondary outcomes. All mini-HTAs reported the databases searched and 99 percent of them reported using Medline. Sixty percent of the mini-HTA reported assessing the risk of bias, and 52 percent reported assessing the quality of evidence. Conclusion The quality of reporting of the mini-HTA reports performed in Brazil is insufficient and needs to be improved to guarantee transparency and replicability.

Coronavirus (COVID-19) Spike in Georgia: An Epidemiologic Study of Data, Modelling, and Policy Implications to Understand the Gender-and Race-Specific Variations

ObjectiveThe purpose of this study was to investigate the gender-and race-specific predictive variations in COVID-19 cases and deaths in Georgia, USA.MethodsThe data were extracted from the Georgia Department of Public Health (GDPH). Statistical methods, such as descriptive statistics, Artificial neural networks (ANN), and Bayesian approach, were utilized to analyze the data.ResultsMore Whites died from COVID-19 than African-Americans/Blacks in Cobb, Hall, Gwinnett, and non-Georgia residents; however, more Blacks died in Dekalb and Fulton counties. The highest posterior mean for female deaths was obtained in Gwinnett County (77.17; 95% CI, 74.23–80.07) and for male deaths in Fulton County (73.48; 95% CI, 72.18–74.49). For overall race/ethnicity, Whites had the highest posterior mean for deaths (183.18; 95% CI, 128.29–238.27) compared with Blacks (162.48; 95% CI, 127.15– 197.42). Assessing the classification of the chronic medical conditions using ANN, Cobb and Hall Counties showed the highest mean AUC-ROC of the models (78% and 79%, respectively).ConclusionsThe predictive models of COVID-19 transmission will help public health practitioners and researchers to better understand the course of the COVID-19 pandemic. The study findings are generalizable to populations with geographic and racial/ethnic similarities and may be used to determine gender/race-specific future virus models for effective interventions or policy modifications.Human SubjectsNo personal identifiable information was obtained.