American journal of medicine open最新文献

Objective

Obesity affects 14.7 million children and adolescents in the United States. Children's health behaviors are affected by parental health practices. Therefore, pediatric obesity interventions should include parents. The objective of this study was to assess the changes in self-reported health behaviors in a diverse population attending the TEEEN program, with motivational interviewing of child-parent dyads as a key component, for 1 year.

Methods

Here we assessed the changes in Family and Nutrition and Physical Activity (FNPA) screening tool scores, a tool that assesses obesogenic behaviors, in the context of MI of child-parent dyads in a racially, ethnically, and socioeconomically diverse population who attended the TEEEN (Teens, Empowerment, Education, Exercise, Nutrition) program, a nonclinic and family-based behavior program in Massachusetts, for 1 year.

Results

Participation in the TEEEN program, which includes MI of child-parent dyads, was associated with a significant increase in the overall FNPA score (median change= 4 points, P = .007). We observed that 76.5% of children experienced a decrease in BMI% and BMI z-score. The change in BMI% (median= −0.9, P = .006) and change in BMI z-score (median= −0.2, P = .008) were statistically significant.

Conclusion

Participation in the TEEEN program seemed to be beneficial based on aspects of the FNPA screening tool and changes in weight parameters. The FNPA screening tool enhanced-motivational interviewing of child-parent dyads shows promise as an approach to address obesogenic behaviors. This study provides a detailed framework for medical providers to address pediatric obesity in a nonclinic setting with less time constraints.

Background

Dilated cardiomyopathy (DCM) contributes significantly to heart failure prevalence, yet supporting epidemiologic data is sparse. This study sought to estimate the period prevalence of DCM and the proportion of idiopathic DCM in the United States using a large, diverse electronic health records (EHR) database.

Methods

This retrospective, observational study included 56,812,806 deidentified patients in Optum EHR with visits between 2017 and 2019. Suspected DCM cases were identified using ICD-10 coding. Deidentified clinical notes from 1000 randomly selected cases were manually reviewed to determine the diagnosis of DCM and estimate the proportion of idiopathic DCM. The period prevalence and clinical burden of DCM and idiopathic DCM were estimated.

Results

Manual clinical review demonstrated that our definition had a positive predictive value of 92.5% for DCM, with 46.3% estimated as the idiopathic DCM proportion. The estimated period prevalence of DCM between 2017 and 2019 was 118.33 per 100,000. Prevalence increased for adults ≥65 years of age, males, and African Americans. Extrapolation to the 2019 US population led to an overall estimated burden of roughly 388,350 patients. Adjusting for the proportion of cases with idiopathic DCM yielded an idiopathic DCM prevalence of 59.23 per 100,000 and a burden of 194,385 patients. Evidence of clinical genetic testing in this population was scarce, with less than 0.43% of DCM cases reporting a testing code.

Conclusions

This study establishes a conservative period prevalence for DCM and idiopathic DCM and demonstrates very low molecular genetic testing for DCM. These findings suggest that the clinical burden of genetic DCM may be underestimated.

Introduction

Under-representation of women in high academic and medical positions is reported in many countries. This study aims to compare degrees and careers between men and women tenured as Full Professors of Medicine in recent years in France.

Methods

We identified all new tenured French Full Professors between 2017 and 2021 and collected the publicly available data (gender, year of birth, curriculum) from the Bibliographic Agency for Higher Education, a public institution under the aegis of the Ministry for Higher Education Research and Innovation. The primary outcome was the gender difference in age appointment of Full Professors. Secondary outcomes were gender differences in career development.

Results

Among 820 Full Professors, only 266 (32.4%) were women. They were tenured at a later age than men (43.7 vs 42.4 years, p<0.001), while they graduated for the MD (29.5 vs 29.9 years, p<0.005) or PhD (35.3 vs 36.0 years, p<0.05) several months earlier. Women were also more often Associate Professors than men before becoming Full Professors (67.3% vs 59.2%, p<0.05).  Before achieving Full professor tenure, the average delay is longer for women from MD graduation (14.6 vs 12.5 years), PhD graduation (8.7 vs 6.4 years), or Associate Professor nomination (7.5 vs 5.5 years), with a difference of 2.2, 2.4 and 2.0 years respectively (p<0.001 for all comparisons).

Conclusion

Gender inequalities remain in regards to access to Full Professor status, the highest position in the medical fields.

Aims

We aimed to determine what key resources, mechanisms, and contextual factors are necessary to integrate depression and diabetes treatment into low-resource settings.

Methods

A realist evaluation framework was employed to conduct a comparative case study. Data were collected through document review, key informant interviews (n=4), activity logs, and interviews with implementing health care providers (n=11) to test and refine program theories for collaborative care.

Results

Efforts to enhance patient care coordination (i.e., adapting clinics’ patient flow and resources, on-going trainings, and on-site support for care coordinators) improved implementation of depression treatment by usual care diabetes physicians. Clinician's avoidance of the term depression was identified as a barrier to mental health counseling and treatment.

Conclusions

The variations in organizational features and processes linked to implementation activities across two clinics provided an opportunity to examine how and why different contextual factors help or hinder the implementation process. Findings from this study demonstrate that successful implementation of an integrated depression and diabetes care model is feasible in a low-resource setting, while the revised program theories provide an explanatory framework of coordinated care implementation processes that can inform future efforts to disseminate and scale this care model.

Background

While international guidelines recommend low doses of systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) clinical practice patterns show significant heterogeneity. Increasing doses of corticosteroids have inconsistently been associated with a greater risk of hyperglycemia.

Methods

Patients admitted to inpatient services for AECOPD were retrospectively enrolled. Hospitalization corticosteroid doses, daily blood glucose levels, and other markers of corticosteroid excess were collected. Correlative and regression analyses were conducted to assess the relationship between corticosteroid dose and average hospitalization blood glucose.

Results

Daily corticosteroid dose significantly predicted a higher blood glucose (rs=0.179, p=0.0095; p<0.0028 respectively) and cumulative corticosteroid dose predicted a longer hospital length of stay in bivariate and multivariate analyses (rs=0.679, p<0.0001; p<0.0001 respectively). Patients that experienced hypernatremia, hypokalemia, acute hyperglycemia, and acute hypertension received larger corticosteroid doses than patients that did not experience these complicating events.

Conclusions

We identified that increasing amounts of corticosteroids administered to inpatients experiencing AECOPD experienced higher average hospitalization blood glucose values, protracted hospitalizations, and other untoward effects.

Objectives: Although femoral fractures can hit anyone, they carry an especially high burden in the elderly and are multifaceted in their injury pattern, related complications, and subsequent therapeutic strategies. An often underestimated posttraumatic risk is the development of trauma-related acute kidney injury (TRAKI). However, for TRAKI, no outcome study with a large data approach exists addressing fractures. Therefore, we analyzed the development of TRAKI in regard to different covariates and quantified the association of TRAKI with overall mortality.

Design: Retrospective cohort study with claims data.

Setting and participants: 119,000 patients from Germany with femur fracture.

Methods: We calculated cumulative mortality, mortality rates per 100 person-years (both occurring within 180 days after fracture), and adjusted hazard ratios with 95%-confidence intervals (CI).

Results: Patients with femur shaft fractures showed an incidence of 6.1% for TRAKI, followed by patients with femur neck fractures with an incidence of 5.7%, and by patients with distal fractures with an incidence of 4.5%, respectively. Overall, in patients with any femur fracture, we found a 3.17-times higher mortality rate (95%-CI: 3.02-3.26) during 180 days of observation in patients who developed TRAKI in comparison to patients without. The risk for development of TRAKI was significantly increased with increasing TRAKI stage, age, and time until surgical intervention.

Conclusions and implications: In conclusion, patients suffering from proximal-, shaft-, and distal femoral fracture face an over 3-times higher 180 day-mortality rate in case of posttraumatic TRAKI, which should be considered in peri-traumatic care to improve the long-term outcome of these patients.

Objective

This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments and to evaluate the effect of missed appointments on diabetes control.

Methods

All patients with diabetes mellitus (DM) managed at a major academic medical center between Jan 2015 and Dec 2020 were included in analysis. Association between insurance coverage and the proportion of missed appointments was evaluated with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated.

Results

The dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Proportion of missed appointments was 18.1 ± 18.1% among Medicaid covered patients,12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p < 0.001). Type of insurance was found to be a significant predictor of proportion of missed appointments after adjusting for age, race, language, marital status, smoking, BMI, HbA1c and type of diabetes (p < 0.001) in series regression analysis. Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.104 (p < 0.005) after adjusting for age, race, gender, type of insurance coverage, BMI and type of diabetes.

Conclusions

Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1c. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed.