Healthcare costs and resource utilization of asthma in Germany: a claims data analysis

Introduction

Asthma is associated with a substantial economic burden on the German Statutory Health Insurance.

Aims and objectives

To determine costs and resource utilization associated with asthma and to analyze the impact of disease severity on subgroups based on age and gender.

Methods

A claims database analysis from the statutory health insurance perspective was conducted. Patients with an ICD-10-GM code of asthma were extracted from a 10 % sample of a large German sickness fund. Five controls for each asthma patient matched by age and gender were randomly selected from the same database. Costs and resource utilization were calculated for each individual in the asthma and control group. Incremental asthma-related costs were calculated as the mean cost difference. Based on prescribed asthma medication, patients were classified as intermittent or persistent. In addition, age groups of ≤5, 6–18, and >18 years were analyzed separately and gender differences were investigated.

Results

Overall, 49,668 individuals were included in the asthma group. On average, total annual costs per patient were €753 higher (p = 0.000) compared to the control group (€2,168 vs. €1,415). Asthma patients had significantly higher (p = 0.000) outpatient (€217), inpatient (€176), and pharmacy costs (€259). Incremental asthma-related total costs were higher for patients with persistent asthma compared to patients with intermittent asthma (€1,091 vs. €408). Women aged >18 years with persistent asthma had the highest difference in costs compared to their controls (€1,207; p < 0.0001). Corresponding healthcare resource utilization was significantly higher in the asthma group (p = 0.000).

Conclusions

The treatment of asthma is associated with an increased level of healthcare resource utilization and significantly higher healthcare costs. Asthma imposes a substantial economic burden on sickness funds.

     

Risk factors for non-atopic asthma/wheeze in children and adolescents: a systematic review

Background

The study of non-atopic asthma/wheeze in children separately from atopic asthma is relatively recent. Studies have focused on single risk factors and had inconsistent findings.

Objective

To review evidence on factors associated with non-atopic asthma/wheeze in children and adolescents.

Methods

A review of studies of risk factors for non-atopic asthma/wheeze which had a non-asthmatic comparison group, and assessed atopy by skin-prick test or allergen-specific IgE.

Results

Studies of non-atopic asthma/wheeze used a wide diversity of definitions of asthma/wheeze, comparison groups and methods to assess atopy. Among 30 risk factors evaluated in the 43 studies only 3 (family history of asthma/rhinitis/eczema, dampness/mold in the household, and lower respiratory tract infections in childhood) showed consistent associations with non-atopic asthma/wheeze. No or limited period of breastfeeding was less consistently associated with non-atopic asthma/wheeze. The few studies examining the effects of overweight/obesity and psychological/social factors showed consistent associations. We used a novel graphical presentation of different risk factors for non-atopic asthma/wheeze, allowing a more complete perception of the complex pattern of effects.

Conclusions

More research using standardized methodology is needed on the causes of non-atopic asthma.

     

Dietary quality is associated with abdominal aortic calcification: A mean of 18-year longitudinal study in community-dwelling older adults

Objective

This study aimed to examine the association between baseline and changes in dietary quality assessed by the Alternative Healthy Eating Index-2010 (AHEI-2010) and abdominal aortic calcification (AAC) among community-dwelling older adults.

Design

Population-based longitudinal study.

Setting

A subset of the Melbourne Collaborative Cohort Study (MCCS).

Participants

262 community-dwelling adults (60% female) aged 53 ± 5 years at baseline.

Measurements

Dietary intake was assessed using validated Food Frequency Questionnaires at baseline (1990-1994) and follow-up (2010-2011). AAC was evaluated by radiography and dual-energy x-ray absorptiometry (DXA) at follow-up.

Results

Higher baseline AHEI-2010 score was associated with lower AAC severity by radiography [OR (95% CI) for Tertile 3 VS Tertile 1: 0.53 (0.29-0.99)] after adjustment for gender, age, physical activity, smoking, BMI, systolic blood pressure, plasma total cholesterol, calcium and energy intake. The association between AHEI-2010 and AAC severity by DXA was also significant in the multivariate-adjusted model [OR (95% CI) for Tertile 3 VS Tertile 1: 0.38 (0.20-0.70)]. Changes in AHEI-2010 over 18 years were not associated with AAC severity.

Conclusion

Baseline but not the changes in AHEI-2010 was inversely associated with the risk of AAC severity suggesting that a high quality diet might help prevent or delay the progression of AAC in community-dwelling older adults and the benefits might be manifested over the long-term.

     

Measuring Sarcopenia Severity in Older Adults and the Value of Effective Interventions

Objectives

Little is known about the severity and long-term health and economic consequences of sarcopenia. We developed a sarcopenia index to measure severity in older Americans and estimated the long-term societal benefits generated by effective interventions to mitigate severity.

Design

Using a micro-simulation model, we quantified the potential societal value generated in the US in 2010–2040 by reductions in sarcopenia severity in older adults. All analyses were performed in Stata and SAS. Setting & Participants: Secondary data from the National Health and Nutrition Examination Survey (NHANES) (N = 1634) and Health and Retirement Study (HRS) (N = 952) were used to develop a sarcopenia severity index in older adults.

Measurements

Multitrait multi-method and factor analyses were used to validate and calibrate the sarcopenia severity index, which was modeled as a function of gait speed, walking without an assistive device, and moderate physical activity.

Results

In representative elderly populations, reducing sarcopenia severity by improving gait speed by 0.1 m/s in those with gait speed under 0.8 m/s generated a cumulative benefit of $65B by 2040 (2015 dollars). Improving walking ability in those with walking difficulty generated cumulative social benefit of $787B by 2040.

Conclusions

Reducing sarcopenia severity would generate significant health and economic benefits to society— almost $800B in the most optimistic scenarios.

     

Correlates of employment status in individuals with asthma: a cross-sectional survey

Background

This study aims to elucidate factors that among adults with asthma are associated with working full-time.

Methods

This cross-sectional survey of 2613 working-age adults with asthma included questions on asthma history, symptoms and use of asthma medication, socioeconomic factors and health behavior. Full-time workers were compared to groups according to employment status: unemployed, work disability and retired due to age.

Results

Adults with asthma working full time were younger and more often nonmanual workers, experienced less asthma symptoms, used less asthma medication and smoked less than subjects with work disability. After adjusting for age, gender, smoking and professional status, having frequent symptoms of asthma during last month was associated with an increase in the risk of unemployment (OR 2.3, 95% CI 1.3–4.2) and with an increase in the risk of work disability (OR 4.4, 95% CI 2.3–8.2).

Conclusions

Among adults with asthma, full-time work was associated with younger age, less symptomatic asthma despite of less medication, nonmanual work and less smoking. Having more severe symptoms of asthma was associated with undesirable employment status such as unemployment or work disability. Possibilities to change from manual to nonmanual work may be important in preventing work disability and early exit from work.

     

Relationship between total fruit and vegetable intake and self-reported knee pain in older adults

Objectives

Knee pain is one of the most common symptoms of knee osteoarthritis (OA) that affects the quality of life in the older adults, and identifying the contributing factors of knee pain is important. We hypothesized that higher fruit and vegetable consumption might be associated with the severity of knee pain lower prevalence of severe knee pain by affecting pain perception in the knee joint. Therefore, we investigated the relationship between self-reported knee pain and the consumption of fruits vegetables, carotenoids and vitamin C and self-reported knee pain.

Design

Nationally representative cross sectional study.

Setting

2010-2011 rounds of the Korean National Health and Nutrition Examination Survey.

Participants

A total of 6588 subjects aged ≥50 years were participated.

Methods

Severity of knee pain was estimated using a 10-point numeric rating scale (NRS). Daily intake of fruits, vegetables, and vitamins were estimated using data from 24-hour recalls and food frequency questionnaires.

Results

The NRS scores of knee pain decreased significantly with increasing fruit and vegetable intake quartiles. A multivariate logistic regression analysis showed that the fourth quartile of vegetable and fruit consumption was associated with decreased prevalence of severe knee pain (OR 0.59, 95% CI 0.48-0.73) compared with first quartile of vegetable and fruit consumption; however, carotenoids and vitamin C consumption was not associated with the severity of knee pain.

Conclusions

In conclusion, severe knee pain was independently associated with fruit and vegetable consumption. Our findings suggest that intake of whole fruits and vegetables may help improve knee pain in older adults.

     

Risk modeling of non-communicable diseases using socio-demographic characteristics,lifestyle and family disease history among university students in Bangladesh

Aim

The objective of this study was to determine risk factors for non-communicable diseases (NCDs) on the basis of socio-demographic characteristics, lifestyle-related determinants, environmental and psychological characteristics, and individual and family disease history among university students in Bangladesh.

Study design

Cross-sectional survey.

Methods

Using the WHO STEPwise approach for NCDs, a cross-sectional study was conducted among 1,140 students. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 22.

Results

In all, 29.2% of the respondents (BMI?≥?23.00 kg/m²) were overweight and/or obese, and almost two-thirds (65%) of them did not take part in any physical activity (PA). A third (33.3%, p?=?0.002) of male smokers reported health problems and it was found that environmental tobacco smoke (ETS) was significantly responsible for developing asthma (OR?=?0.55; CI?=?0.33–0.93). Individual and family history of NCDs was statistically significant for obesity and asthma and considerably increased the odds ratio for heart disease.

Conclusion

This study shows that the number of students suffering from different types of NCDs is not negligible. Their lifestyle and family history of NCDs are responsible for this to a significant extent. Urgent initiatives should be taken to rein in the spread of NCDs among the youth of Bangladesh.

     

Cost-Effectiveness Analysis of a Pharmacy Asthma Care Program in Australia

Objectives

A pharmacy asthma care program in Australia, which included specific education on asthma and asthma medication, trigger factors, use of inhalers, and medication adherence, as well as goal setting and patient review aspects, assessed the impact of a community pharmacy asthma service on the severity of patients’ asthma over 6 months. Data from this study were used to estimate the cost effectiveness of the program.

Methods

The intervention population was compared with a control population and results at 6 months were included in a Markov model in order to estimate the cost effectiveness over 5 years from the perspective of the Australian healthcare system. The model had a cycle length of 6 months and included transition probabilities for switching between classes of severity of asthma, the costs of asthma treatment and program delivery, and utility values for a patient’s quality of life with asthma. Costs were Australian dollars ($A), year 2006 values, and both costs and benefits were discounted at a rate of 5% per annum.

Results

Over the 5 years following an initial review, the program generated 0.131 additional quality-adjusted life-years (QALYs), at an additional net cost of $A623 if annual reviews were required to maintain asthma improvements (annual review scenario) or $A376 if annual reviews were not required (no annual review scenario), resulting in costs per QALY gained of $A4753 and $A2869, respectively.

Conclusions

The program appears to be cost effective compared with no program, whether or not annual reviews were required to maintain improvements and under a range of other assumptions. Current evidence suggests that the pharmacy asthma care program should be implemented and funded for the treatment of adults with asthma in Australia.

     

Factors associated with patient visits to the emergency department for asthma therapy in Pakistan

Background

Acute asthma is a chronic condition affecting people of all ages around the world and hence, is one of the leading causes of emergency department (ED) visits and hospital admissions globally. Most of them are related to poor patient practices and a weak healthcare system. The aim of our study was to assess the reasons for the increased usage of the ED by asthmatic patients in Pakistan.

Methods

A cross-sectional study was conducted on 600 asthmatic patients reporting to the ED of Civil Hospital Karachi over a 6-month period. The consenting patients were given a questionnaire to fill and the following data was collected: demographic information, duration of the disease, medications prescribed the, frequency of and reasons for outpatient clinic and ED visits for issues related to asthma.

Result

According to our results most of the participants visited the ED to obtain a nebulized bronchodilator (90 %) or oxygen (79.5 %). Moreover, 44.8 % of the people visited the ED to get treatment without any delay and 24.0 % considered that the severity of asthma does not allow the patient to wait for clinic visits. Strikingly, 92.8 % claimed that inhaled corticosteroid therapy treatment should be stopped when patients feel better. Irregular follow ups with clinics, low education about asthma and an education level higher than a Bachelors degree were the most important factors associated with three or more ED visits per year, p values = 0.0289, 0.0110 and 0.0150 respectively.

Conclusion

This study identifies several preventable risk factors responsible for recurrent visits to the ED by asthmatic patients in Pakistan.

     

Impact of Alzheimer’s disease on the family caregiver’s long-term quality of life: results from an ALSOVA follow-up study

Purpose

To examine caregivers’ health-related quality of life (HRQoL) and well-being during the first 3 years after their family member’s Alzheimer’s disease (AD) diagnosis and assessed the relationship between caregivers’ HRQoL, well-being, and the severity of AD. Further, to compare of caregivers’ HRQoL to general population.

Methods

Longitudinal design (36 months) after AD diagnosis of 236 caregiver–patient dyads. Linear regression was used to assess age- and gender-adjusted association between repeated measurements of caregivers’ HRQoL and the severity of AD. For comparison with general population, the National Health 2011 Health Examination Survey data was utilized.

Results

Caregivers had significantly lower HRQoL than age- and gender-standardized counterparts. Severity of AD was significantly (p < 0.05) associated with the mobility and depression dimensions of caregiver’s HRQoL but not with the total HRQoL index score.

Conclusions

Caregivers’ HRQoL seems to deteriorate earlier than previously noted. The severity of AD has not that great impact on caregiver’s HRQoL as assumed.

     

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity,Economic Adversity and Postpartum Depressive Symptoms

Objectives

This study examines the main and moderating effects of childhood abuse or neglect severity, income, and family social support on the presence of postpartum depressive symptoms (PDS).

Methods

Participants included 183 postpartum mothers who endorsed a history of childhood maltreatment (CM) and enrolled in a longitudinal study of mother and child outcomes. Participants completed questionnaires to assess CM severity, associated societal and maternal characteristics, and depressive symptom severity.

Results

The results confirm previously identified links between CM severity and PDS. Further, hierarchical linear regression analyses indicate the interaction of household income and interpersonal support from the family attenuates the relationship between CM severity and PDS. The final model accounted for 29% of the variance of PDS scores, a large effect size.

Conclusions

This study is the first to demonstrate interrelationships between income and social support on resilience to postpartum psychopathology in childhood trauma-surviving women. Social support appeared to protect against PDS for all mothers in this study while income only conferred a protective effect when accompanied by family support. For clinicians, this implies the need to focus on improving family and other relationships, especially for at-risk mothers.

     

Altered Eating Attitudes in Nursing Home Residents and Its Relationship with their Cognitive and Nutritional Status

Background

although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects.

Objectives

the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state.

Design and Setting

a observational experimental study was carried out at several nursing homes of Murcia, Spain.

Subjects

139 nursing home residents.

Methods

EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford’s scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated.

Results

33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment.

Conclusions

our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.

     

Age and IQ Explained Working Memory Performance in a RCT with Fatty Fish in a Group of Forensic Inpatients

Objectives

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.

Design

A randomized controlled trial.

Setting

A forensic facility.

Participants

Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.

Intervention

Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.

Measurement

Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.

Results

Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.

Conclusion

Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

     

Novel therapy of hyperhomocysteinemia in mild cognitive impairment,Alzheimer’s disease,and other dementing disorders

Objectives

Studies have produced conflicting results assessing hyperhomocysteinemia (HYH) treatment with B vitamins in patients with normal cognition, Alzheimer’s disease and related disorders (ADRD). This study examined the effect of HYH management with L-methylfolate (LMF), methylcobalamin (MeCbl; B12), and N-acetyl-cysteine (CFLN: Cerefolin®/Cerefolin-NAC®) on cognitive decline.

Design

Prospective, case-control study of subjects followed longitudinally.

Setting

Outpatient clinic for cognitive disorders.

Participants

116 ADRD patients (34 with HYH, 82 with No-HYH) met inclusion and exclusion criteria to participate. No study participant took B vitamins.

Intervention

HYH patients received CFLN, and No-HYH patients did not.

Measurements

Cognitive outcome measures included MCI Screen (memory), CERAD Drawings (constructional praxis), Ishihara Number Naming (object recognition), Trails A and B (executive function), and F-A-S test (verbal fluency). Dependent or predictor measures included demographics, functional severity, CFLN and no CFLN treatment duration, ADRD diagnosis, memantine and cholinesterase inhibitor treatment. Linear mixed effects models with covariate adjustment were used to evaluate rate of change on cognitive outcomes.

Results

The duration of CFLN treatment, compared to an equivalent duration without CFLN treatment, significantly slowed decline in learning and memory, constructional praxis, and visual-spatial executive function (Trails B). CFLN treatment slowed cognitive decline significantly more for patients with milder baseline severity. CFLN treatment effect increased as baseline functional severity decreased. The analytical model showed that treatment duration must exceed some minimum period of at least one year to slow the rate of cognitive decline.

Conclusion

After covariate adjustment, HYH+CFLN significantly slowed cognitive decline compared to No-HYH+No-CFLN. Longer CFLN treatment duration, milder baseline severity, and magnitude of homocysteine reduction from baseline were all significant predictors. There are a number of factors that could account for disagreement with other clinical trials of B vitamin treatment of HYH. Moreover, CFLN is chemically distinct from commonly used B vitamins as both LMF and MeCbl are the fully reduced and bioactive functional forms; CLFN also contains the glutathione precursor, N-acetyl-cysteine. The findings of other B vitamin trials of HYH can, therefore, only partly account for treatment effects of CFLN. These findings warrant further evaluation with a randomized, placebo-controlled trial.

     

Interrelationship between Diet Quality and Depressive Symptoms in Elderly

Background

Several observational studies have shown association between diet quality and depression, but few studies have explored the interrelationship between these variables.

Objective

The aim of this study was to assess the interrelationship between diet quality and depressive symptoms in elderly.

Design

Cross-sectional study.

Setting

Population based.

Participants

1,378 elderly in the city of Pelotas, Brazil.

Measurements

The diet quality was assessed by a short food frequency questionnaire and the prevalence of depressive symptoms was estimated by the abbreviated Brazilian version of the Geriatric Depression Scale (GDS). The association between diet quality and depressive symptoms was assessed using logistic regression.

Results

The prevalence of depressive symptoms was 15.3%. Elderly with low-quality diet were more likely to experience depressive symptoms, and the association was almost twice higher in males than in females (men OR = 3.8, 95% CI 1.4, 10.6; women OR = 2.1, 95% CI: 1.4, 3.3). On the other hand, depressive elderly had higher odds of consuming a low-quality diet (OR 2.4, 95% CI: 1.7, 3.8). Limitations: Self-reported data and crosssectional design limit our conclusions.

Conclusions

The choice of a low-quality diet was associated to a higher risk of depressive symptoms in elderly, and vice-versa. These results highlight the importance of encouraging the choice of healthy food habits, especially in depressed elderly, in order to promote healthy aging.

     

Consumer understanding and nutritional communication: key issues in the context of the new EU legislation

Background

Nutrition communication by means of nutrition and health claims and otherwise, holds the potential to contribute to public health by stimulating informed healthier food choices and enhanced health-focussed competition in the market place, provided that the health messages are trustworthy (i.e. scientifically substantiated) and correctly used and interpreted by the consumer. Not surprisingly, these two considerations constitute the cornerstone of the new EU legislation on nutrition and health claims, in which evidence for consumer understanding of nutrition and health claims is a new requirement.

Aim of the study

To review some of the key issues in consumer understanding of nutritional communication as a basis for reflection on the consumer understanding element of the new EU legislation on nutrition and health claims.

Conclusions

There is a need for more methodologically advanced research in consumer understanding of nutrition and health claims as a basis for truly assessing the real-life use of such information and its actual effect on consumer food choices. Such approaches are pertinent in light of the evaluation and approval process of (new) nutrition and health claims as required under the new EU legislation on nutrition and health claims.

     

Soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not improve muscle functional property restoration

Objectives

Effect of 3 different dairy protein sources on the recovery of muscle function after limb immobilization in old rats.

Design

Longitudinal animal study.

Setting

Institut National de la Recherche Agronomique (INRA). The study took part in a laboratory setting.

Intervention

Old rats were subjected to unilateral hindlimb immobilization for 8 days and then allowed to recover with 3 different dietary proteins: casein, soluble milk proteins or whey proteins for 49 days.

Measurements

Body weight, muscle mass, muscle fibre size, isometric, isokinetic torque, muscle fatigability and muscle oxidative status were measured before and at the end of the immobilization period and during the recovery period i.e 7, 21, 35 and 49 days post immobilization.

Results

In contrast to the casein diet, soluble milk proteins and whey proteins were efficient to favor muscle mass recovery after cast immobilization during aging. By contrast, none of the 3 diary proteins was able to improve muscle strength, power and fatigability showing a discrepancy between the recovery of muscle mass and function. However, the soluble milk proteins allowed a better oxidative capacity in skeletal muscle during the rehabilitation period.

Conclusion

Whey proteins and soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not allow muscle functional property restoration.

     

Occlusal Support,Dysphagia, Malnutrition,and Activities of Daily Living in Aged Individuals Needing Long-Term Care: A Path Analysis

Objectives

This study aimed to examine the interrelationships among occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care.

Design

Cross-sectional study and path analysis.

Setting

Long-term health care facilities, acute care hospitals, and the community.

Participants

Three hundred and fifty-four individuals aged ≥ 65 years with dysphagia or potential dysphagia in need of long-term care.

Measurements

The modified Eichner Index, Dysphagia Severity Scale, Mini Nutritional Assessment Short Form, and Barthel index.

Results

The participants included 118 males and 236 females with a mean (standard deviation) age of 83 (8) years. A total of 216 participants had functional occlusal support with or without dentures. Of the total participants, 73 were within normal limits regarding the severity of dysphagia, 119 exhibited dysphagia without aspiration, and 162 exhibited dysphagia with aspiration. Only 34 had a normal nutritional status, while 166 participants were malnourished, and 154 were at risk of malnutrition. The median Barthel index score was 30. Path analysis indicated two important findings: occlusal support had a direct effect on dysphagia (standard coefficient = 0.33), and dysphagia was associated directly with malnutrition (standard coefficient = 0.50). Dysphagia and malnutrition were associated directly with impaired activities of daily living (standard coefficient = 0.57, 0.22).

Conclusion

In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.

     

Clinical and Utilization Outcomes for a Pediatric and Adolescent Telephonic Asthma Care Support Program

Objective

To investigate the effect of an asthma care support program for patients under the age of 18 years.

Study design

A 1:1 matched cohort study design was used. The purpose of matching is to find a similar comparison group in terms of observable variables. The propensity score method of matching was used to find a suitable comparison cohort, which is similar at baseline to the treatment cohort. For each treatment cohort member, a comparison cohort member was selected on the basis of having the closest estimated propensity score. Once a comparison cohort was defined, variables were compared at baseline year to ensure the similarity of the two groups. The Kruskal-Wallis test was used for comparison of variables between the treatment and comparison cohorts due to the non-Gaussian distribution of variables. Finally, variables were compared during the program year to estimate the treatment effects of the disease management program.

Patient groups

318 asthma care support program participants and 318 matched non-participants.

Main outcome measures

The rates of medical service utilization including rates of hospitalization, emergency department (ED) visits, and selected clinical indicators including allergen immunotherapy, chest x-rays, influenza vaccinations, and pneumococcal vaccinations.

Results

Baseline matching resulted in no statistically significant difference between the treatment and matched cohorts. However, during the program period the treatment cohort had 35.6% fewer inpatient admissions (p = 0.045), 32.5% fewer ED visits (p = 0.007), 56.7% fewer asthma-related inpatient admissions (p = 0.008), 50.8% fewer asthma-related ED visits (p < 0.0001), 26.8% fewer chest x-rays (p = 0.036), and 51.6% more influenza immunizations (p = 0.046).

Conclusions

Where controlled randomized clinical trials cannot be performed, the use of propensity scores provides an alternative for the purpose of estimating a treatment effect using observational data. The current study employed a propensity score-matching methodology to select a subset of comparison units most comparable to treatment units. It documented the beneficial clinical outcomes of pediatric and adolescent participation in an asthma care support program which suggested a beneficial impact of monitoring, education, and more rigorous adherence to action plans for program participants.

     

Handgrip strength predicts longitudinal changes in clock drawing test performance. An observational study in a sample of older non-demented adults

Objective

Impairment of physical performance might identify older people at higher risk of dementia over time. The present study evaluated handgrip strength as independent predictor of cognitive decline.

Design

Observational, prospective. Follow-up duration: 11.2 ± 0.8 months.

Setting and participants

Geriatric outpatients center. 104 consecutive stroke- and dementia-free older adults (44% men, ages 80.2±5.4 years).

Methods

The Clinical Dementia Rating scale and the Clock Drawing Test (CDT) were administered. Handgrip strength was assessed using a Jamar hand dynamometer. Brain magnetic resonance imaging studies at 1.5 T were performed. White matter damage was expressed as severity of white matter hyperintensities (WMHs). Longitudinal changes in cognitive function were expressed as 1-year decline in CDT performance.

Results

A robust association was observed between baseline handgrip strength and 1-year cognitive decline after multiple adjustment. Of note, the strength of such association was only minimally attenuated after adjusting for deep WMHs extent (β coefficient for handgrip strength = 0.183, SE= 0.038, p= 0.007, R2= 0.58).

Conclusions

Handgrip strength predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older adults. Future studies are needed to elucidate the causal mechanisms linking limitations in physical function with dementia risk.