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The American Journal of Managed Care Jun 2024To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to... (Observational Study)
Observational Study
OBJECTIVES
To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs).
STUDY DESIGN
Retrospective observational study using 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare.
METHODS
We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating).
RESULTS
We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95% CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02).
CONCLUSIONS
BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks.
Topics: Skilled Nursing Facilities; Humans; United States; Retrospective Studies; Medicare; Referral and Consultation; Quality Improvement; Female; Patient Care Bundles; Male; Arthroplasty, Replacement; Aged
PubMed: 38912933
DOI: 10.37765/ajmc.2024.89566 -
Folia Histochemica Et Cytobiologica Jun 2024Digital microscopy transformation, the basis for the virtual microscopy applications, is a challenge but also a requirement in modern Medical Education. This paper...
INTRODUCTION
Digital microscopy transformation, the basis for the virtual microscopy applications, is a challenge but also a requirement in modern Medical Education. This paper presents the scope, background, methods, and results of the project "Digital Transformation of Histology and Histopathology by Virtual Microscopy (VM) for an Innovative Medical School Curriculum", VM3.0, funded by the European Union under the Erasmus+ framework (ref.no.2022-1-RO01-KA220-HED-000089017). The project was initiated at Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania, with the support of Euroed Foundation, Iași, and cooperation of University partners from Gdansk (Poland), Plovdiv (Bulgaria), Alicante (Spain), and Patras (Greece) aimed to implement digital histology and histopathology teaching in a common network.
MATERIALS AND METHODS
The backbone of the project was the development of a Digital Slide Platform based on the scans of histological slides collected from all the partners of the participating universities and the creation of a simple and fast digital/internet communication tool that could be used to improve histology and histopathology teaching of medical and natural sciences students. The construction of a Virtual Microscopy Library (VML) has been based on the acquisition of whole scans of high-quality histological slides stained by hematoxylin and eosin (H&E) and other classical staining methods and description of the details in English as well as respective languages of the project's partners. The VML can be used for different approches, both for students' instruction in classes as well as for individual students' work and self-testing. Universities from other countries could use the modal structure of the developed VML system on the condition that more slides are provided and the implementation of national language(s) is implemented.
CONCLUSIONS
The combined efforts of all university partners allowed to establish the dynamic low-cost virtual microscopy educational system. The VM system could help unify the standards of cytology, histology, and histopathology teaching in a quest for the digital transformation of the European educational system.
PubMed: 38912571
DOI: 10.5603/fhc.100875 -
Heliyon Jun 2024Liver cancer is a heterogeneous disease characterized by poor responses to standard therapies and therefore unfavourable clinical outcomes. Understanding the...
Liver cancer is a heterogeneous disease characterized by poor responses to standard therapies and therefore unfavourable clinical outcomes. Understanding the characteristics of liver cancer and developing novel therapeutic strategies are imperative. Ferroptosis, a type of programmed cell death induced by lipid peroxidation, has emerged as a potential target for treatment. Naringenin, a natural compound that modulates lipid metabolism by targeting AMPK, shows promise in enhancing the efficacy of ferroptosis inducers. In this study, we utilized liver cancer cell lines and xenograft mice to explore the synergistic effects of naringenin in combination with ferroptosis inducers, examining both phenotypic outcomes and molecular mechanisms. Our study results indicate that the use of naringenin at non-toxic doses to hepatocytes can significantly enhance the anticancer effects of ferroptosis inducers (erastin, RSL3, and sorafenib). The combination index method confirmed a synergistic effect between naringenin and ferroptosis inducers. In comparison to naringenin or ferroptosis inducers alone, the combined therapy caused more robust lipid peroxidation and hence more severe ferroptotic damage to cancer cells. The inhibition of aerobic glycolysis mediated by the AMPK-PGC1α signalling axis is the key to naringenin's effect on reducing ferroptosis resistance in liver cancer, and the synergistic cytotoxic effect of naringenin and ferroptosis inducers on cancer cells was reversed after pretreatment with an AMPK inhibitor or a PGC1α inhibitor. Taken together, these findings suggest that naringenin could boost cancer cell sensitivity to ferroptosis inducers, which has potential clinical translational value.
PubMed: 38912485
DOI: 10.1016/j.heliyon.2024.e32288 -
Heliyon Jun 2024In low-income countries, social norms play a significant role in intrahousehold food allocation practices. These norms can sometimes lead to discrimination against...
BACKGROUND
In low-income countries, social norms play a significant role in intrahousehold food allocation practices. These norms can sometimes lead to discrimination against specific groups, posing a public health concern. This study focuses on the social norm surrounding food allocation within households and food taboos affecting adolescent girls in rural Ethiopia.
METHOD
A qualitative study was conducted using vignettes as prompts for 20 focus group discussions and 32 in-depth interviews. The vignettes were tailored to the local context. Participants were chosen purposefully, and data were collected in a comfortable setting. All sessions were recorded and transcribed verbatim. Data analysis was done using Open Code qualitative analysis software with a thematic framework approach.
FINDINGS
In the community, adolescent girls were expected to eat after serving the male family members. Those who did not follow this expectation faced sanctions such as being labeled as disrespectful and could even be insulted or beaten by their spouses and siblings. However, there were some exceptions to this rule, such as when girls were giving birth, breastfeeding, sick, or when male family members were traveling. Certain foods were also prohibited for adolescent girls, including spicy foods like chili, animal products such as meat and milk, and nuts. These foods were believed to increase girls' sexual desire, potentially leading them to engage in premarital or extramarital sex. Additionally, eating outside of the house was not considered appropriate behavior for adolescent girls in this community.
CONCLUSION
In many households, social norms dictate that adolescent girls are not given enough food or are denied essential nutrients for their health. It is important to challenge these norms to ensure fair food distribution within households and support the healthy development of adolescent girls.
PubMed: 38912476
DOI: 10.1016/j.heliyon.2024.e32295 -
Innovation in Aging 2024Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child...
BACKGROUND AND OBJECTIVES
Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child relationship and its health implications remains limited.
RESEARCH DESIGN AND METHODS
Data from the 2014 U.S. Health and Retirement Study and the 2015 Health and Retirement Longitudinal Study in China were used ( = 3,918; = 4,058). Relationship indicators included coresidence, living nearby, having weekly contact, receiving assistance with daily activities, providing grandchild care, and financial transfer to/from children. Latent class and regression analyses were conducted.
RESULTS
Four classes were identified for non-Hispanic White older Americans: (1) distant and uninvolved (6.58%), (2) geographically proximate with frequent contact and downward support (47.04%), (3) coresident with frequent contact and upward support (13.1%), and (4) geographically proximate with frequent contact (33.28%). Three classes were identified among older Chinese: (1) coresident with frequent contact and upward support (37.46%), (2) coresident/interdependent (25.65%), and (3) geographically proximate with frequent contact and upward financial support (36.89%). For non-Hispanic White older Americans, providing downward support was associated with fewer functional limitations and better cognition. Receiving instrumental support from children was associated with more depressive symptoms, more functional limitations, and poorer cognition among older Chinese.
DISCUSSION AND IMPLICATIONS
Cultural contrasts were evident in parent-child relationship typologies and their health implications. Compared to the U.S. non-Hispanic Whites, parent-child relationships in China tended to be closer and associated with poorer health status. The findings call for culturally relevant strategies to improve parent-child relationships and ultimately promote the health of older adults.
PubMed: 38912424
DOI: 10.1093/geroni/igae050 -
Frontiers in Medicine 2024Globally, the fastest growth in the number of older people combined with chronic and age-related medical conditions experienced by the older adult placed great demand on...
BACKGROUND
Globally, the fastest growth in the number of older people combined with chronic and age-related medical conditions experienced by the older adult placed great demand on geriatric care. Thus, nurses are required to be knowledgeable and have a desirable attitude toward geriatric nursing care. Therefore, this study aimed to assess knowledge and attitude toward geriatric nursing care and associated factors among nurses working at hospitals in Hawassa City, Ethiopia.
METHODS
Hospital-based cross-sectional study was conducted from June 30 to July 30, 2022, among 365 nurses. The hospitals and study participants were selected by using purposive and simple random sampling methods, respectively. Data were collected using self-administered questionnaires. Descriptive statistics were computed to generate descriptive results. Binary and multivariable logistic regressions were used to identify predictors at -value <0.05.
RESULTS
About 39.2% of nurses had good knowledge and 49.3% of the nurses showed a positive attitude toward geriatric nursing care. Nurses with BSc degree or above [AOR 2.5, 95% CI, (1.2-5.6)], having lived with older people [AOR 2.2, 95% CI, (1.4-3.6)], nurses with 6-10 years [AOR, 2.8, 95% CI, (1.4-5.57)] and >10 years of work experience [AOR 4.2, 95% CI, (1.6-10.8)] were more likely to have knowledge about geriatric nursing care. Having BSc degree or above [AOR 2.7, 95% C.I, (1.2-6)], 6-10 years [AOR 3, 95% CI, (1.48-6.3)], and >10 years [AOR 3.9, 95% CI, (1.4-10.99)] of work experience, living experience with older people [AOR 1.7, 95% C.I:1.05-2.7], knowledge about geriatric care [AOR 3, 95% CI,(1.85-4.92)], and having worked at adequate space [AOR 1.7, 95% CI: 1.009-2.8] increased odds of good attitude toward geriatric nursing care.
CONCLUSION
Less than half of nurses demonstrated good knowledge and positive attitude toward geriatric nursing care. Higher level of education, higher work experience, living with older people were significantly associated with knowledge and attitude toward geriatric nursing care. Additionally, working in an adequate space and having knowledge about geriatric care positively influenced attitude toward geriatric nursing care. Therefore, nursing schools and hospitals should conduct training and consider incorporating more content about geriatric care into nursing education to enhance nurses' knowledge and attitude.
PubMed: 38912339
DOI: 10.3389/fmed.2024.1284845 -
Frontiers in Public Health 2024Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying...
Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying the challenges these populations face in accessing healthcare. Bridging this digital divide is essential, as digital access and literacy are social determinants of health that can impact digital health use and access to care. This article discusses the potential of leveraging community Wi-Fi and spaces to improve digital access and digital health use, as well as the challenges and opportunities associated with this strategy. The existing limited evidence has shown the possibility of using community Wi-Fi and spaces, such as public libraries, to facilitate telehealth services. However, privacy and security issues from using public Wi-Fi and spaces remain a concern for librarians and healthcare professionals. To advance digital equity, efforts from multilevel stakeholders to improve users' digital access and literacy and offer tailored technology support in the community are required. Ultimately, leveraging community Wi-Fi and spaces offers a promising avenue to expand digital health accessibility and use, highlighting the critical role of collaborative efforts in overcoming digital health disparities.
Topics: Humans; Telemedicine; Health Services Accessibility; Healthcare Disparities; Digital Divide; Digital Health
PubMed: 38912273
DOI: 10.3389/fpubh.2024.1418627 -
Frontiers in Public Health 2024Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public...
BACKGROUND
Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia.
METHODS
A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization.
RESULTS
Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, -value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization.
CONCLUSION AND RECOMMENDATION
In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.
Topics: Ethiopia; Humans; Infant; Multilevel Analysis; Female; Male; Spatial Analysis; Immunization; Socioeconomic Factors; Health Surveys; Adult
PubMed: 38912271
DOI: 10.3389/fpubh.2024.1339539 -
Frontiers in Public Health 2024Pre-frailty represents an ideal window of opportunity to potentially prevent frailty and disability. Early and effective interventions to delay or reverse pre-frailty... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of a mHealth platform-based lifestyle integrated multicomponent exercise () program to reverse pre-frailty in community-dwelling older adults: a randomized controlled trial study protocol.
BACKGROUND
Pre-frailty represents an ideal window of opportunity to potentially prevent frailty and disability. Early and effective interventions to delay or reverse pre-frailty are public health imperative. The present trial aims to evaluate the effectiveness and underlying mechanisms of mobile health (mHealth) platform-supported lifestyle-integrated multicomponent exercise () to reverse pre-frailty in community-dwelling older adults.
METHODS
This is an open-label, prospective, two-arm parallel randomized controlled trial with allocation concealment and outcome assessment blinding. We aim to recruit 140 pre-frail community-dwelling older adults who will be randomized into two groups. The control group will receive a health education program, while the intervention group will receive training as planned for 1 year. The proportion of pre-frailty, functional performance (muscular strength, aerobic capacity, flexibility, and balance), body composition, and physical activity will be measured at pre-intervention, post-intervention, and 12-month follow-up. Inflammatory biomarkers will also be collected to explore the underlying mechanisms.
DISCUSSION
This is the first study to evaluate the effects of a novel digital lifestyle-integrated multicomponent exercise for pre-frail older people. The results of this trial will provide much-needed information on the short-and long-term effects of based on functional performance and body composition. Meanwhile, inflammatory biomarkers and physical activity levels will be used to elucidate the underlying mechanisms of . The findings from this trial will provide evidence for the effectiveness of lifestyle multicomponent exercise intervention supported by the mHealth platform that may reverse or even halt the onset of frailty.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showproj.html?proj=176477, identifier ChiCTR2200063431.
Topics: Humans; Aged; Independent Living; Male; Female; Telemedicine; Prospective Studies; Exercise; Frailty; Frail Elderly; Life Style; Exercise Therapy; Aged, 80 and over
PubMed: 38912262
DOI: 10.3389/fpubh.2024.1389297 -
International Journal of Women's Health 2024To explore the risk and protective factors for developing ovarian cancer and construct a risk prediction model.
PURPOSE
To explore the risk and protective factors for developing ovarian cancer and construct a risk prediction model.
METHODS
Information related to patients diagnosed with ovarian cancer on the electronic medical record data platform of three tertiary hospitals in Guangdong Province from May 2018 to September 2023 was collected as the case group. Patients with non-ovarian cancer who attended the clinic during the same period were included in the control group. Logistic regression analysis was used to screen the independent variables and explore the factors associated with the development of ovarian cancer. An ovarian cancer risk prediction model was constructed using a decision tree C4.5 algorithm. The ROC and calibration curves were plotted, and the model was validated.
RESULTS
Logistic regression analysis identified independent risk and protective factors for ovarian cancer. The sample size was divided into training and test sets in a ratio of 7:3 for model construction and validation. The AUC of the training and test sets of the decision tree model were 0.961 (95% CI:0.944-0.978) and 0.902 (95% CI:0.840-0.964), respectively, and the optimal cut-off values and their coordinates were 0.532 (0.091, 0.957), and 0.474 (0.159, 0.842) respectively. The accuracies of the training and test sets were 93.3% and 84.2%, respectively, and their sensitivities were 95.7% and 84.2%, respectively.
CONCLUSION
The constructed ovarian cancer risk prediction model has good predictive ability, which is conducive to improving the efficiency of early warning of ovarian cancer in high-risk groups.
PubMed: 38912202
DOI: 10.2147/IJWH.S462883