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European Journal of Cardio-thoracic... Jun 2024To determine safety and survival outcomes associated with lobectomy, segmentectomy, and wedge resection for early-stage lung cancer by quiring the French...
OBJECTIVES
To determine safety and survival outcomes associated with lobectomy, segmentectomy, and wedge resection for early-stage lung cancer by quiring the French population-based registry EPITHOR.
METHODS
Retrospective analysis of 19,452 patients with stage c IA lung carcinoma who underwent lobectomy, segmentectomy, or wedge resection between 2016 and 2022 with curative-intent. Main outcomes measures were 90-day mortality and 5-year overall survival estimates. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patient, tumour, and practice environment factors.
RESULTS
The treatment distribution was 72.2% for lobectomy, 21.5% for segmentectomy, and 6.3% for wedge. Unadjusted 90-day mortality rates were 1.6%, 1.2% and 1.1%, respectively (P = 0.10). Unadjusted 5-year overall survival estimates were 80%, 78% and 70%, with significant inter-group survival curves differences (P < 0.0001). Multivariable proportional hazards regression showed that wedge was associated with worse overall survival (adjusted hazard ratio [AHR], 1.23 [95% CI, 1.03-1.47]; P = 0.021) compared with lobectomy, while no significant difference was disclosed when comparing segmentectomy to lobectomy (1.08 [0.97-1.20]; P = 0.162). The three-way propensity score analyses confirmed similar 90-day mortality rate for wedge resection and segmentectomy compared with lobectomy (HR: 0.43; 95% CI: 0.16-1.11; P = 0.081 and 0.99; 0.48-2.10; P = 0.998, respectively), but poorer overall survival (1.45; 1.13-1.86; P = 0.003 and 1.31; 1-1.71; P = 0.048, respectively).
CONCLUSIONS
Wedge resection was associated with comparable 90-day mortality but lower overall survival when compared to lobectomy. Overall, all types of sublobar resections may not offer equivalent oncologic effectiveness in real-world settings.
PubMed: 38917411
DOI: 10.1093/ejcts/ezae251 -
PloS One 2024Self-harm presents an important public health challenge. It imposes a notable burden on the utilization of emergency department (ED) services and medical expenses from...
BACKGROUND
Self-harm presents an important public health challenge. It imposes a notable burden on the utilization of emergency department (ED) services and medical expenses from patients and family. The Medicaid system is vital in providing financial support for individuals who struggle with medical expenses. This study explored the association of Medicaid coverage with ED visits following incidents of self-harm, utilizing nationwide ED surveillance data in Korea.
METHODS
Data of all patients older than 14 years who presented to EDs following incidents of self-harm irrespective of intention to end their life, including cases of self-poisoning, were gathered from the National ED Information System (NEDIS). The annual self-harm visit rate (SHVR) per 100,000 people was calculated for each province and a generalized linear model analysis was conducted, with SHVR as a dependent variable and factors related to Medicaid coverage as independent variables.
RESULTS
A 1% increase in Medicaid enrollment rate was linked to a significant decrease of 14% in SHVR. Each additional 1,000 Korean Won of Medicaid spending per enrollee was correlated with a 1% reduction in SHVR. However, an increase in Medicaid visits per enrollee and an extension of Medicaid coverage days were associated with an increase in SHVR. SHVR exhibited a stronger associated with parameters of Medicaid coverage in adolescents and young adults than in older adult population.
CONCLUSION
Expansion of Medicaid coverage coupled with careful monitoring of shifts in Medicaid utilization patterns can mitigate ED overloading by reducing visits related to self-harm.
Topics: Humans; Medicaid; Republic of Korea; Emergency Service, Hospital; Female; Male; Self-Injurious Behavior; Adult; Middle Aged; United States; Adolescent; Young Adult; Registries; Aged; Patient Acceptance of Health Care
PubMed: 38917201
DOI: 10.1371/journal.pone.0306047 -
Health Promotion and Chronic Disease... Jun 2024Food prescription programs are part of the broader social prescribing movement as an approach to address food insecurity and suboptimal diet in health care settings....
INTRODUCTION
Food prescription programs are part of the broader social prescribing movement as an approach to address food insecurity and suboptimal diet in health care settings. These programs exist amid other social services, including income-based supports and food assistance programs; however, evaluations of the interactions between these programs and pre-existing services and supports are limited. This study was embedded within a larger evaluation of the 52-week Fresh Food Prescription (FFRx) program (April 2021-October 2022); the objective of this study was to examine how program participation influenced individuals' interactions with existing income-based supports and food assistance programs.
METHODS
This study was conducted in Guelph, Ontario, Canada. One-to-one (n = 23) and follow-up (n = 10) interviews were conducted to explore participants' experiences with the program. Qualitative data were analyzed thematically using a constant comparative analysis.
RESULTS
Participants described their experience with FFRx in relation to existing income-based supports and food assistance programs. FFRx reportedly extended income support further to cover living expenses, allowed participants to divert income to other necessities, and reduced the sacrifices required to meet basic needs. FFRx lessened the frequency of accessing other food assistance programs. Aspects of FFRx's design (e.g. food delivery) shaped participant preferences in favour of FFRx over other food supports.
CONCLUSION
As food prescribing and other social prescribing programs continue to expand, there is a need to evaluate how these initiatives interact with pre-existing services and supports and shape the broader social service landscape.
Topics: Humans; Ontario; Female; Male; Qualitative Research; Social Work; Middle Aged; Adult; Food Insecurity; Food Assistance
PubMed: 38916554
DOI: 10.24095/hpcdp.44.6.03 -
Social Work in Public Health Jun 2024Thousands of youth are sexually trafficked each year in the United States. In order to address this concern, anti-trafficking advocates often emphasize the importance of...
Thousands of youth are sexually trafficked each year in the United States. In order to address this concern, anti-trafficking advocates often emphasize the importance of uniform screening protocols to assist with the identification of survivors. Unfortunately, an oft-overlooked component of sex trafficking identification is what to do once a victim has been identified, and how to best meet survivors' complex needs. In this article, the authors provide social work practitioners and other advocates with best practice guidelines for how to design and evaluate anti-sex trafficking advocacy programs for children and youth. These guidelines include considerations related to direct services with clients, community partnerships, and organizational capacity, as well as recommendations for how to begin and then evaluate programming. Regardless of the form selected for the program, all anti-sex trafficking programs should be designed to provide effective, client-centered follow-up and advocacy once a positive identification is made in the community. The recommendations included in this paper are based upon extant literature, the authors' practice experience with survivors, and insights from anti-sex trafficking program evaluations.
PubMed: 38916471
DOI: 10.1080/19371918.2024.2370782 -
Health Affairs Scholar Jun 2024Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global...
Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global Health Security (GHS) Tracking (tracking.ghscosting.org), we analyzed disbursements of direct financial assistance for GHS from 2016 to 2022 to compare pre-pandemic funding (2016-2019) to post-pandemic funding (2020-2022) for preparedness and response during each of the seven World Health Organization-declared public health emergencies of international concern (PHEICs) from 2009 to 2022. Over $165B was disbursed for capacity-building and preparedness activities between January 2016 and December 2022, and over $76B was provided for PHEIC response. Preparedness funding remained evenly distributed since 2016 across regions, with the African region receiving about 70% of total preparedness funding. Indeed, how capacity-building and preparedness funding is distributed has changed remarkably little since 2016, despite unprecedented changes to the funding environment-including markedly increased spending-in response to COVID-19. This suggests we now have a unique opportunity to restructure how funds are tracked for accountability and assessing return on investment moving forward.
PubMed: 38915813
DOI: 10.1093/haschl/qxae083 -
Journal of Nutrition in Gerontology and... Jun 2024Congregate Nutrition Services have long been a pillar of public health assistance, championing the independence and community engagement of older Americans. The advent...
Congregate Nutrition Services have long been a pillar of public health assistance, championing the independence and community engagement of older Americans. The advent of COVID-19, however, restricted access to these services due to the closure of physical locations. In response, Lanakila Meals on Wheels initiated a virtual congregate meal program, Kūpuna U, in collaboration with community partners in Honolulu County. The program combined grab-and-go or home-delivered meals with virtual and in-person classes to improve both nutrition and socialization for older adults. This study aimed to capture participant feedback to assess and enhance the Kūpuna U program, developing it as a flexible and scalable congregate meal solution applicable nationwide. Five focus group discussions were conducted with program participants ( = 34). The majority of participants were female (74%), Asian (73%), and living alone (56%). Participants found the program beneficial, enhancing their nutrition, social engagement, and learning experiences on various topics tailored for older adults. Supportive staff played a crucial role in motivating participants to stay engaged. Participants also identified potential enhancements to the program, including more activities and courses, expanded hours, additional in-person options at various locations, and culturally tailored meals.
PubMed: 38915295
DOI: 10.1080/21551197.2024.2367972 -
BMC Public Health Jun 2024Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and...
BACKGROUND
Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Though it occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to estimate the prevalence and design a screening tool to identify survivors of all forms of human trafficking among refugees in a German state registration and reception centre.
METHODS
In cooperation with the local authorities and the Ministry of Justice and for Migration Baden-Württemberg, we interviewed newly arrived refugees at an initial reception centre in Southern Germany to assess the prevalence of human trafficking. We used both a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to assess all forms of human trafficking.
RESULTS
In total, 13 of the 176 refugees had experienced trafficking, which corresponded to a prevalence of 7.3% (95%-CI = [3.5%, 11.3%]). Across all languages the questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a recommended cut-off of six positive responses. The recommended cut-off differed slightly for the Arabic, Farsi, Turkish, and English version. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%, 8 out of 24) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample.
CONCLUSIONS
The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons. The designed screening tool seems to be a promising tool to detect an especially vulnerable group of refugees and provides assistance in identifying survivors of human trafficking.
Topics: Humans; Refugees; Human Trafficking; Female; Male; Adult; Prevalence; Germany; Surveys and Questionnaires; Young Adult; Middle Aged; Mass Screening; Adolescent
PubMed: 38914998
DOI: 10.1186/s12889-024-18997-7 -
Australian Health Review : a... Jun 2024ObjectivesMental health triage services are the first contact for people wanting support for their mental health and provide access to public mental health services in...
ObjectivesMental health triage services are the first contact for people wanting support for their mental health and provide access to public mental health services in Victoria, Australia. People living with young-onset dementia and their families may contact triage services seeking assistance for behaviour changes and pathways to care as there are few alternative services available.MethodsThe authors reviewed the minimum triage dataset from one of the largest mental health services in Victoria, Australia from 2018 to 2021 investigating reasons for referral for people with young-onset dementia.ResultsOf the 1766 referrals for 'dementia', 145 were for young-onset dementia. Of these, 69% were referred for behaviour changes. About half of the referrals for behaviour changes were triaged as 'advice only'. One-third of referrals were from general practitioners.ConclusionsThe availability of dementia-specific support services that could provide advice on dementia as well as advice for behaviour changes related to the disease could potentially ease the burden of phone calls received by mental health triage services.
PubMed: 38914423
DOI: 10.1071/AH24117 -
IEEE Journal of Biomedical and Health... Jun 2024Nuclei segmentation is a crucial pre-task for pathological microenvironment quantification. However, the acquisition of manually precise nuclei annotations for improving...
OBJECTIVE
Nuclei segmentation is a crucial pre-task for pathological microenvironment quantification. However, the acquisition of manually precise nuclei annotations for improving the performance of deep learning models is time-consuming and expensive.
METHODS
In this paper, an efficient nuclear annotation tool called NuSEA is proposed to achieve accurate nucleus segmentation, where a simple but effective ellipse annotation is applied. Specifically, the core network U-Light of NuSEA is lightweight with only 0.86 M parameters, which is suitable for real-time nuclei segmentation. In addition, an Elliptical Field Loss and a Texture Loss are proposed to enhance the edge segmentation and constrain the smoothness simultaneously.
RESULTS
Extensive experiments on three public datasets (MoNuSeg, CPM-17, and CoNSeP) demonstrate that NuSEA is superior to the state-of-the-art (SOTA) methods and better than existing algorithms based on point, rectangle, and text annotations.
CONCLUSIONS
With the assistance of NuSEA, a new dataset called NuSEA-dataset v1.0, encompassing 118,857 annotated nuclei from the whole-slide images of 12 organs is released. The codes and the new dataset are publicly available at https://github.com/dreambamboo/NuSEA/.
SIGNIFICANCE
NuSEA provides a rapid and effective annotation tool for nuclei in histopathological images, benefiting future explorations in deep learning algorithms.
PubMed: 38913516
DOI: 10.1109/JBHI.2024.3418106 -
The American Journal of Managed Care Jun 2024Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare...
OBJECTIVES
Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare (TM). We examined changes in Medicare supplemental insurance coverage in the context of MA growth.
STUDY DESIGN
Repeated cross-sectional analysis of the Medicare Current Beneficiary Survey from 2005 to 2019.
METHODS
We determined whether Medicare beneficiaries 65 years and older were enrolled in MA (without Medicaid), TM without supplemental coverage, TM with employer-sponsored supplemental coverage, TM with Medigap, or Medicaid (in TM or MA).
RESULTS
From 2005 to 2019, beneficiaries with TM and supplemental insurance provided by their former (or current) employer declined by approximately half (31.8% to 15.5%) while the share in MA (without Medicaid) more than doubled (13.4% to 35.1%). The decline in supplemental employer-sponsored insurance use was greater for White and for higher-income beneficiaries. Over the same period, beneficiaries in TM without supplemental coverage declined by more than a quarter (13.9% to 10.1%). This decline was largest for Black, Hispanic, and lower-income beneficiaries.
CONCLUSIONS
The rapid rise in MA enrollment from 2005 to 2019 was accompanied by substantial changes in supplemental insurance with TM. Our results emphasize the interconnectedness of different insurance choices made by Medicare beneficiaries.
Topics: Humans; United States; Aged; Male; Female; Cross-Sectional Studies; Primary Health Care; Medicare; Medicare Part C; Aged, 80 and over; Hospitalization; Insurance Coverage; Medicaid; Cost Sharing
PubMed: 38912952
DOI: 10.37765/ajmc.2024.89509