Kansas journal of medicine最新文献

Introduction: In 2022, the U.S. healthcare expenditure totaled $4.5 trillion, representing 17.3% of its gross domestic product. Despite this, 26 million Americans remain uninsured, often relying on out-of-pocket payments for essential services like cancer screenings. Kansas, with its high uninsured rate, faces unique challenges, emphasizing the need to analyze the cost burden of these critical yet repeatable interventions.

Methods: Authors of this cross-sectional study analyzed hospital pricing transparency data for breast, lung, and colon cancer screening costs across 124 Kansas hospitals. Data on self-pay costs were collected and compared between urban and rural regions, as well as geographic price variations. Statistical analyses included measures of central tendency, Kruskal-Wallis tests, and Mann-Whitney U tests to evaluate differences.

Results: Pricing disparities were evident across Kansas. Urban hospitals charged higher prices for chest computed tomography (CT) scans, while rural hospitals had elevated costs for colonoscopies and mammograms. Notable price variation included Northeast Kansas colonoscopy prices, which ranged from $595 to $11,684. Rural residents faced a greater financial burden, spending 7% of their income on screenings compared to 6% for urban residents. Median screening prices statewide were $2,247 for colonoscopies, $1,109 for chest CT scans, and $228 for mammograms.

Conclusions: These disparities call for targeted policy interventions, such as Medicaid expansion, standardized pricing regulations, and increased support for low-cost clinics. Enhanced hospital pricing transparency is critical for empowering patients and reducing financial burdens. This study highlights the urgent need for equitable access to cancer screenings in Kansas.

Introduction: Vaccines have been highly effective in reducing severe illness and death from COVID-19, yet vaccine hesitancy remains a significant barrier to further lowering the incidence of morbidity and mortality. This study aimed to identify the factors influencing parental decisions about COVID-19 vaccination for their children in Kansas, including demographic variables, trust in medical professionals, vaccine safety, and the impact of misinformation.

Methods: Data were analyzed from Phase 3.7, Week 53 of the United States Census Bureau's Household Pulse Survey (N = 68,504), collected between January 4 and January 16, 2023. The analysis focused on data specific to the state of Kansas (N = 1,231), using standard descriptive statistics to assess the findings.

Results: The respondents were predominantly middle-aged, female, and Caucasian, with a high level of educational attainment and health insurance coverage. Among respondents, 45.7% (n = 563) had children under 18 living in their household. Of these, 73.5% (n = 414) expressed concerns that led them to refrain from vaccinating their children against COVID-19. The primary reasons for hesitancy included concerns about potential side effects, distrust in the vaccine's safety for children, and the belief that their children were not part of a high-risk group for having severe illness with COVID-19.

Conclusions: These findings underscore persistent concerns about COVID-19 vaccine safety and efficacy among parents, even within a relatively well-educated and insured population. Addressing these concerns with targeted public health messaging and education could be essential in increasing vaccination rates among children in Kansas.

Introduction: Visualization of oral movements and facial expressions is essential for learning, development, and communication, especially among students receiving speech and language services. This study aimed to assess the effectiveness of cloth masks with transparent windows as an alternative to opaque masks in mitigating the risk of droplet-transmitted infectious diseases.

Methods: Researchers measured the filtration efficiency of various medical and non-medical masks, both with and without transparent windows. A testing pipe, fitted with the selected masks, was used to deliver particulate matter (PM) at an airflow velocity mimicking human breathing. Particle size and airflow were measured using three real-time particle monitors positioned upstream and downstream of the masks. Filtration efficiency was then calculated for each of the eight masks.

Results: Mask efficiency varied based on build quality and material. Filtration efficiency for the four face masks with transparent windows ranged from 28.6% to 90%, with the single-layer mask performing the worst. All multi-layer masks with windows achieved filtration efficiencies greater than 70% for all particle sizes tested (1, 2.5, and 10 microns), exceeding that of the opaque cotton masks and approaching the filtration levels of surgical masks.

Conclusions: Given the high filtration efficiency of cloth masks with transparent windows, the authors conclude that these masks can reduce the transmission of SARS-CoV-2 and other droplet-transmitted infectious diseases while also improving communication for individuals with speech, language, and/or hearing impairments.

Introduction: Suicide rates in the U.S. are higher than the global average, with rural areas experiencing even greater rates. This study investigated whether a single suicide prevention training could improve knowledge, awareness, and intention to act among various gatekeeper populations in Kansas, a rural state with elevated suicide rates.

Methods: Licensed clinical psychologists at a public university in Kansas developed an evidence-based suicide prevention training program, offered online to multiple subgroups: university faculty, staff, and students, health care workers, and community members (voluntarily), as well as high school staff and students (compulsorily). The study employed a reliable, validated instrument to assess participants' knowledge, awareness, and intention to act using a Likert-type scale. Participants also reported whether they had completed prior suicide prevention training. A total of 865 participants provided retrospective pre/post responses, and the data were analyzed using paired samples t-tests and one-way ANOVA/Kruskal-Wallis tests.

Results: Overall, participants in all subgroups, regardless of prior training, showed statistically significant pre/post increases across all measures. While no significant differences were found in learning between recruitment subgroups, variations were identified based on the number of previous trainings completed.

Conclusions: The findings support the effectiveness of a single suicide prevention training across diverse populations, suggesting important implications for targeting training efforts and optimizing resource allocation in high-need environments.

Introduction: An annual fasting lipid panel (FLP) is recommended for patients with diabetes, with more frequent testing advised during the escalation of cholesterol-lowering therapy. However, the calculated low-density lipoprotein cholesterol (LDL-C) using the Friedewald equation becomes unreliable when triglycerides are ≥400 mg/dL. In such cases, providers must order a separate direct LDL-C assay to obtain accurate results. Failing to do so may lead to missed opportunities for therapy intensification. This study examined an institution's current practices for following up on invalid LDL-C results, especially considering the stringent LDL-C targets outlined in recent guidelines and consensus statements.

Methods: The authors conducted a retrospective chart review across 13 outpatient clinics within a single health system over five years. The study included patients aged 40-75 with diabetes who had at least one invalid LDL-C result. They assessed the frequency of ordering a direct LDL-C assay within seven days of an invalid LDL-C result.

Results: Out of 1,364 unique invalid FLPs, 97 (7.1%) met the criteria for the primary outcome. The rate of therapy escalation was not numerically affected by whether a direct LDL-C was ordered or the provider type. However, patients without a direct LDL-C ordered within seven days showed a trend towards more frequent therapy escalation (16.2%, n = 25/154) compared to those with a direct LDL-C (14.9%, n = 23/154).

Conclusions: The current practice at this institution of manually ordering a direct LDL-C assay to verify invalid LDL-C results poses a risk of missing necessary guideline-directed therapeutic intensification. This process may be improved by implementing a reflex direct LDL-C assay.