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1.
Objective
To empirically assess the effect of adopting Affordable Care Act's Community First Choice (CFC) option on overall state home and community-based services (HCBS) expenditures as well as distribution of HCBS expenditures across different HCBS mechanisms. We also explore the heterogeneous effect of CFC across adopting states.Data Source
We used data from the Medicaid Long Term Services and Support (LTSS) expenditure reports prepared by Truven Analytics and Mathematica for the Centers for Medicare & Medicaid Services from 2008–2018 for all 48 states and the District of Columbia.Study Design
An event-study difference-in-differences model was used to estimate the effect of CFC on HCBS expenditures using Medicaid LTSS expenditure reports from 2008–2018. We also employ the synthetic control method to unmask heterogeneity across CFC adopting states using data from 2008–2018.Data Collection/Extraction Methods
Not applicable.Principal Findings
Overall, CFC was not associated with a change in HCBS expenditures per capita or HCBS expenditures as a proportion of LTSS expenditures. However, there appears to be an increase in HCBS expenditures among states that were institutionally-oriented prior to CFC adoption. Additionally, CFC adoption was associated with an overall decrease in expenditures in alternative HCBS mechanisms (Personal Care Services State Plan Option and 1915(c) waivers), suggesting potential substitution across overlapping programs.Conclusion
Results indicate heterogeneity across states adopting CFC. More institutionally-oriented states appear to use CFC to expand HCBS. In contrast, more HCBS-oriented states appear to employ CFC to strategically restructure their overall portfolio and processes. 相似文献2.
3.
Sumit Arora Jatin Talwar Vikramadittya Singh Vikas Gupta 《Indian Journal of Thoracic and Cardiovascular Surgery》2021,37(3):307
Tuberculosis in the tibial diaphysis following saphenous vein graft harvest for coronary artery bypass grafting has not been reported, to the best of authors’ knowledge. We report the first such clinical case in view of its clinical rarity and as a complication of the simple procedure like saphenous vein graft harvest. 相似文献
4.
Objective
To determine the association between provider training level and postplacental intrauterine device (IUD) outcomes following insertion instruction by email only.Study design
We conducted a single-center chart review of demographics, insertion and clinical outcomes within 6 months of delivery for 116 patients who underwent postplacental levonorgestrel 52?mg IUD placement from October 1, 2016, to March 31, 2017.Results
We confirmed IUD retention, removal or expulsion in 87 of 116 (75.0%) patients by 6 months after delivery. Complete expulsion or removal for malposition occurred in 20 (23.0%) patients and more frequently after vaginal than cesarean delivery (30.2% vs. 4.2%, OR 9.93 [95% CI 1.25–78.96]) and when a postgraduate year (PGY) 1 physician placed the IUD compared to a PGY 2–4 or attending physician (37.5% vs. 14.5%, OR 3.52 [95% CI 1.25–9.94]).Conclusion
Postplacental levonorgestrel 52?mg IUD expulsion rates are associated with provider training level as well as delivery route, though the individual association of each of these factors is difficult to ascertain given the high degree of collinearity between these two variables in our study. 相似文献5.
Background
Sewage management is hazardous due to chronic exposure to chemical gases, bioaerosols and micro-organisms through inhalation; accidental oral intake and penetration through skin or mucous membranes through injuries or breech in personal protective equipment. While there has been some research on isolated infections and multisystem symptom profiling of sewage workers, there is little research on the burden of chronic illnesses like Tuberculosis and Non Communicable Diseases (NCDs).Methods
A cross sectional observational study was conducted on chronic comorbidity profile of sewage workers with more than five years of occupational experience and employed in three contiguous districts of NCT of Delhi.Results
The study sample consisted of 104 sewage workers with mean age of 50.71 (±8.43) years, an average of 7.35 (±3.75) years of formal education and an average occupational exposure to sewage work of 21.28 (±10.54) years.21.15% sewage workers had Tuberculosis and 92.31% had at least one of the chronic respiratory diseases (COPD, Asthma or ACOS). 85.6% of participants were smokers. The most common NCD was Hypertension (67.3%) followed by Dyslipidaemia (50%) and Diabetes Mellitus (43.3%). There was clustering of NCDs with 53.85% subjects having three or more chronic disorders. Less than 5% of study participants were free from all the investigated chronic diseases.Conclusion
The sewage workers have an adverse chronic morbidity profile for both Tuberculosis and NCDs. There is an urgent need for epidemiological research and targeted screening and public health intervention for Tuberculosis and other NCDs in sewage workers as an occupational group. 相似文献6.
7.
Arora Iti Bellato Alessio Gliga Teodora Ropar Danielle Kochhar Puja Hollis Chris Groom Madeleine 《Journal of autism and developmental disorders》2022,52(2):600-616
Journal of Autism and Developmental Disorders - Slower habituation to repeating stimuli characterises Autism, but it is not known whether this is driven by difficulties with information processing... 相似文献
8.
9.
Sameer Arora Kamal Shemisa Muthiah Vaduganathan Arman Qamar Ankur Gupta Sushil K. Garg Dharam J. Kumbhani Helen Mayo Houman Khalili Ambarish Pandey Sandeep R. Das 《Journal of the American College of Cardiology》2019,73(19):2454-2464
Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor. 相似文献
10.