Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

ObjectiveTo provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.MethodsSystematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).ResultsOf the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.ConclusionAlthough HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.     

Variation in early neonatal mortality for different types of fetal growth retardation

Birth and first-48-hr death records were analyzed for 10,024 liveborn infants in Mexico City and 12,786 liveborn infants in Santa Cruz, Bolivia. The objective of the analysis was to characterize the early postnatal mortality rates for different types of fetal growth retardation and prematurity. Infants who were delivered prior to 37 weeks of gestation had 23-100 times the mortality risk of infants born at full term and normal weight. Light-for-gestational-age infants (birth weight less than 2,900 g) were further divided into proportionately growth-retarded with normal Rohrer's index (weight/height) and disproportionately growth-retarded with low Rohrer's index. The proportionately growth-retarded infant had nearly twice the mortality of the full-term, appropriate-weight infants, whereas the disproportionately growth-retarded infants had 2.9-5.7 times the mortality rate of the full-term, appropriate-weight infants. There were some differences between samples in mortality rates and prevalence of the different classes of small infants, but the pattern of mortality within samples was consistent between samples.     

On the interpretation of some planktonology equations

Summary The concept of the mean value of a function is used to interpret some population-dynamics equations. The well-known formula for the per capita growth rate r gives a precise mean value for any (not only exponentially growing) populations. This result is used to derive the birth and death rate equations of Paloheimo (1974) with minimal initial limitations.Abbreviations t time - N number of animals - E number of eggs - r specific (i.e. per capita) population growth rate - b specific birth rate - d specific death rate - D duration of embryonic development     

Treatment-resistant depression: definition,prevalence, detection,management, and investigational interventions

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.     

Analysis of dorsal pitting in the os publis in an extensive sample of modern American females

Pubic bones from 486 modern American females between the ages of 13 and 99 were studied in an attempt to explore the relationship between the degree of dorsal pitting and the following variables: (1) number of full term pregnancies, (2) inteval since last pregnancy, (3) age of decedent.A statistical association was found between the number of full term pregnancies and the degree of dorsal pitting. However, the correlation is not strong; 17 females reported as being nulliparous have "medium to large" dorsal changes whereas 22 females having from one to five full term pregnancies have an absence of dorsal changes. Females who had their last child 15 or more years prior to death are more apt to have "medium to large" dorsal changes than are females who have more recently given birth. This effect appears to be independent of the number of full term pregnancies, but is probably related to age. When the data are analyzed by multiple regression analaysis, it is found that age and number of pregnancies are most important in predicting the degree of pitting and the effect of the interval on pitting is not significant. Age is found to be an important variable independent of the number of full term pregnancies. In nulliparas, an absence of dorsal pitting is far more frequently found in females younger than 30 than in those over 30.     

Reproductive parameters of female Japanese macaques: Thirty years data from the arashiyama troops,Japan

Over a 30-year period from 1954 to 1983, 975 live births were recorded for Japanese macaque females at the Iwatayama Monkey Park, Arashiyama, Japan. Excluding unknown birth dates, primiparous mothers gave birth to 185 infants (182 cases with age of mother known) and multiparous mothers gave birth to 723 infants (603 cases with age of mother known). The peak month of birth was May with 52.3% of the total births occurring during the period. Multiparous females who had not given birth the previous year did so earlier than multiparous females who had given birth the previous year and also earlier than primiparous females. Among the females who had given birth the previous year, females whose infant had died gave birth earlier than females who had reared an infant the previous year. The offspring sex ratio (1:0.97) was not significantly different from 1:1, and revealed no consistent association with mother's age. Age-fecundity exhibited a humped curve. The annual birth rate was low at the age of 4 years but increased thereafter, ranging between 46.7% and 69.0%, at between 5 and 19 years of age, but again decreased for females between 20 and 25 years of age. Some old females displayed clear reproductive senescence. The infant mortality within the first year of age was quite low (10.3%) and the neonatal (less than 1 month old) mortality rate accounted for 49.0% of all infant deaths. There was no significant difference between the mortality rates of male and female infants. A female's rank-class had no apparent effect on the annual birth rate, infant mortality, and offspring sex ratio. These long-term data are compared with those from other primate populations.     

The estimation of a bivariate fitness function from two samples taken from a population

Summary The fitness of animals subjected to natural selection can be defined as the probability of surviving selection for a given interval of time, or some convenient multiple of this. If the fitness is related to some measurable variablesX, Y, Z,… then the relationship is expressed mathematically in the fitness functionw(x, y, z,…) and this function can be estimated by comparing the joint distribution ofX, Y, Z,… in samples taken before and after selection. In an earlier paper (Manly, 1975) the problems involved in estimating a fitness function of one variable were discussed. In the present paper various methods for estimating a bivariate fitness function are proposed and compared on some semiartificial sample data. It is concluded that either a generalized version ofO’Donald’s (1968) method of moments or a weighted multiple regression method will be most satisfactory. Alternative methods involving assumptions of normality will need to be used with great care.     

妊娠晚期阴道B族链球菌的感染对肠道菌群和妊娠结局的影响

目的探究妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)的感染对肠道菌群和妊娠结局的影响。方法选取2018年3月至2019年11月大连市中心医院孕检并分娩的妊娠妇女744人为对象,调查并统计B族链球菌的感染率;筛选有和没有B族链球菌感染妊娠妇女各47人,调查不良妊娠结局的发生率;选取信息匹配的妊娠晚期阴道B族链球菌感染和未感染的妊娠妇女,采集粪便样本,提取菌群DNA,用16S rDNA方法分析菌群变化。结果744名妊娠妇女中B族链球菌检出49例,感染率为6.59%;B族链球菌感染组总的不良妊娠发生比例为76.6%,正常组发生比例为27.7%(χ^2=5.491,P<0.05)。B族链球菌感染组妊娠妇女胎膜早破(χ^2=16.177,P<0.01)、难产(χ^2=21.134,P<0.01)和羊水异常(χ^2=22.989,P<0.05)的发生率与未感染组比较显著增高。B族链球菌感染组妊娠妇女肠道菌群发生显著变化。结论妊娠晚期阴道B族链球菌的感染可能引起肠道菌群紊乱,增加不良妊娠结局。     

早产儿肠道微生态变化及其与胎龄、出生体质量的关系

目的探讨早产儿肠道微生态变化及其与胎龄、出生体质量的关系。方法选取2018年5月至2020年5月我院收治的80例早产儿作为早产组,同期收治的80例足月新生儿作为对照组。收集入组新生儿出生后3 d、3周的粪便,比较2组研究对象粪便标本中细菌丰富度和Shannon Wiener指数;根据早产组胎龄和出生体质量不同分组,分析胎龄、出生体质量与肠道微生态变化的关系。结果(1)出生3 d,早产组新生儿粪便标本的DGGE图谱条带数、Shannon Wiener指数均显著低于对照组(t=3.179、3.521,均P<0.05);(2)出生3 d,胎龄34⁺¹~36⁺⁶周组新生儿粪便标本的DGGE图谱条带数、Shannon Wiener指数显著高于28~30周组、30⁺¹~32周组和32⁺¹~34周组(q=9.653、6.476、4.848和8.796、8.008、6.277,均P<0.05);(3)出生3 d,体质量>2 000 g组新生儿粪便标本的的DGGE图谱条带数、Shannon Wiener指数显著高于≤1 500 g组(q=5.601和4.593,均P<0.05);(4)不同出生体质量、胎龄的早产儿,出生3周粪便标本的DGGE图谱条带数、Shannon Wiener指数相比差异无统计学意义(F=1.577和2.326,均P>0.05)。结论与足月新生儿相比,早产儿出生后细菌定植出现延迟且多样性差,胎龄越小、出生体质量越低的早产儿的肠道菌群的多样性更低、定植延迟的可能性更大,出生3周后其肠道微生态逐渐恢复正常。