共查询到20条相似文献，搜索用时 46 毫秒
1.
Paolo Dionigi Rossi Sarah Damanti Carolina Nani Mauro Pluderi Giulio Bertani Daniela Mari Matteo Cesari Dario Consonni Diego Spagnoli 《Journal of the American Medical Directors Association》2019,20(3):373-376.e3
Objectives
To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.Design
Prospective, monocentric, pilot study.Setting
University hospital.Participants
Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention.Intervention
Repeated CSF taps.Measurements
All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded.Results
No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption.Conclusions/Implications
Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients. 相似文献2.
3.
Masahiro Waza Keisuke Maeda Chihiro Katsuragawa Atsuko Sugita Ryotarou Tanaka Asako Ohtsuka Tomo Matsui Keiko Kitagawa Taiki Kishimoto Hiroko Fukui Katsuhisa Kawai Masahiko Yamamoto Michio Isono 《Journal of the American Medical Directors Association》2019,20(4):426-431
Objective
To determine the influence of the Kuchi-kara Taberu (KT) index on rehabilitation outcomes during hospitalized convalescent rehabilitation.Design
A historical controlled study.Setting and Participants
A rehabilitation hospital.Participants
Patients who were admitted to a convalescent rehabilitation ward from June 2014 to May 2017.Measures
Patients’ background characteristics included age, sex, nutritional status, activities of daily living (ADL) assessed using the Functional Impedance Measure (FIM), dysphagia assessed using the Functional Oral Intake Scale (FOIS), and reasons for rehabilitation. The following values before (control group) and after initiation of the KT index intervention period (intervention group) were compared: gain of FIM, length of stay, accumulated rehabilitation time, discharge destination, gain of FOIS, gain of body weight (BW), and nutritional intake (energy and protein).Results
Mean age was 76.4 ± 12.3 years (n = 233). There were no significant differences in the baseline characteristics of the patients at admission between the control and intervention groups, except for reason of rehabilitation. The intervention group demonstrated statistically higher values for the total (P = .004) and motor FIM gain (P = .003), total (P = .018) and motor FIM efficiency (P = .016), and FOIS gain (P < .001), compared with values in the control group. The proportion of patients returning home was statistically more frequent in the intervention group compared with that in the control group (73.4% vs 85.5%, odds ratio 2.135, 95% confidence interval [CI] 1.108-4.113, P = .022). Multivariate analyses indicated that intervention using the KT index was a significant independent factor for increased FIM gain (β coefficient = 0.163, 95% CI 1.379-8.329, P = .006) and returning home (adjusted odds ratio 2.570, 95% CI 1.154-5.724, P = .021).Conclusions/Implications
A rehabilitation program using the KT index may lead to improvement of inpatient outcomes in post-acute care. Further prospective research is warranted to confirm the efficacy of this program. 相似文献4.
Anupam Chandra Parvez A. Rahman Amelia Sneve Rozalina G. McCoy Bjorg Thorsteinsdottir Rajeev Chaudhry Curtis B. Storlie Dennis H. Murphree Gregory J. Hanson Paul Y. Takahashi 《Journal of the American Medical Directors Association》2019,20(4):444-450.e2
Objectives
Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF.Design
Retrospective cohort study.Setting
Ten independent SNFs affiliated with the post-acute care practice of an integrated health care delivery system.Participants
We evaluated 6032 patients who were discharged to SNFs for post-acute care after hospitalization.Measurements
The primary outcome was all-cause 30-day hospital readmission. Patient demographics, medical comorbidity, prior use of health care, and clinical parameters during the index hospitalization were analyzed by using gradient boosting machine multivariable analysis to build a predictive model for 30-day hospital readmission. Area under the receiver operating characteristic curve (AUC) was assessed on out-of-sample observations under 10-fold cross-validation.Results
Among 8616 discharges to SNFs from January 1, 2009, through June 30, 2014, a total of 1568 (18.2%) were readmitted to the hospital within 30 days. The 30-day hospital readmission prediction model had an AUC of 0.69, a 16% improvement over risk assessment using the Charlson Comorbidity Index alone. The final model included length of stay, abnormal laboratory parameters, and need for intensive care during the index hospitalization; comorbid status; and number of emergency department and hospital visits within the preceding 6 months.Conclusions and implications
We developed and validated a risk-prediction model for 30-day hospital readmission in patients discharged to a SNF for post-acute care. This prediction tool can be used to risk stratify the complex population of hospitalized patients who are discharged to SNFs to prioritize interventions and potentially improve the quality, safety, and cost-effectiveness of care. 相似文献5.
Claudia Schulz Gisela Büchele Martin Rehm Dietrich Rothenbacher Patrick Roigk Kilian Rapp Christian Günster Hans-Helmut König Katrin Reber 《Journal of the American Medical Directors Association》2019,20(4):451-455.e3
Objectives
Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.Design
Retrospective cohort study.Setting and participants
Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011.Measures
The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome.Results
Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level.Conclusions/Implications
This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures. 相似文献6.
Matthew J. Landry Fiona M. Asigbee Sarvenaz Vandyousefi Erfan Khazaee Reem Ghaddar Jessica B. Boisseau Benjamin T. House Jaimie N. Davis 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):760-768
Background
No studies have assessed the relationship between diet quality, using the Healthy Eating Index (HEI), and adiposity, physical activity, and metabolic disease risk factors in a Hispanic college population.Objective
To assess associations between diet quality and adiposity, metabolic health, and physical activity levels in a Hispanic college freshman population.Design
This was a cross-sectional study. Measurements were obtained during a 4-hour in-person visit and included demographic information via questionnaire, height, weight, waist circumference, body mass index, body fat via BodPod, hepatic fat, visceral adipose tissue (VAT) and subcutaneous adipose tissue via magnetic resonance imaging, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and lipids via blood draw from fasting subjects, physical activity (ie, step counts per day and time spent in different intensity levels) via 7-day accelerometry, and dietary intake via three to four 24-hour dietary recalls. Dietary quality was calculated using the HEI-2015.Participants/setting
Hispanic college freshmen (n=92), 18 to 19 years, 49% male, who were enrolled at University of Texas at Austin from 2014 to 2015.Main outcome measures
Main outcome measures were diet quality and adiposity, metabolic health, and physical activity levels.Statistical analyses performed
Linear regressions determined if dietary quality is related to adiposity, metabolic, and physical activity outcomes. A priori covariates included sex, body fat, and body mass index percentile (for metabolic models), and moderate and vigorous physical activity (MVPA, for adiposity and metabolic models).Results
The average HEI-2015 total score was 54.9±13.4. A 1-point increase in HEI score was associated with 1.5 mL lower VAT (P=0.013); 8 minutes per day higher light activity (P=0.008), and 107 more step counts per day (P=0.002); and 0.10 μg/mL lower insulin (P=0.046) and 0.5 U lower HOMA-IR (P<0.001).Conclusion
Results suggest that small improvements in diet quality may be positively associated with a reduction in metabolic disease risk, during a critical time period in a young person’s life. 相似文献7.
Juliana P. Antonio Roberta A. Sarmento Jussara C. de Almeida 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):652-658
Background
The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control.Objective
To evaluate the relationship between diet quality and glycemic control.Design
Cross-sectional study with consecutive enrollment from 2013 to 2016.Participants
Outpatients with type 2 diabetes treated at a university hospital in southern Brazil.Main outcome measures
Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin.Statistical analyses
A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake.Results
A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group.Conclusions
Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes. 相似文献8.
Susan M.H. Gills Garry Auld Ann Hess Susan S. Baker 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):500-506
Background
The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls.Objective
To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN.Design
Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour.Participants and setting
The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states.Main outcome measures
The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups.Statistical analysis performed
Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement.Results
No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first.Conclusion
The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development. 相似文献9.
Teresa Botigué Olga Masot Jèssica Miranda Carmen Nuin Maria Viladrosa Ana Lavedán Sandra Zwakhalen 《Journal of the American Medical Directors Association》2019,20(3):317-322
Objective
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors.Design
This was a cross-sectional study.Setting and Participants
The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years.Measures
Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected.Results
Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio.Conclusions/Implications
The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes. 相似文献10.
Gretchen A. Benson Abbey Sidebottom Joy Hayes Michael D. Miedema Jackie Boucher Marc Vacquier Arthur Sillah Safa Gamam Jeff J. VanWormer 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):585-598
Background
Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.Objective
To investigate the efficacy of a registered dietitian nutritionist–led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.Design
A randomized controlled trial in which participants were assigned to a control or intervention group.Participants/setting
One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.Intervention
For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.Main outcome measures
Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.Statistical analysis
Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.Results
A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.Conclusions
ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care. 相似文献11.
Jose M. Cancio Emili Vela Sebastià Santaeugènia Montse Clèries Marco Inzitari Domingo Ruiz 《Journal of the American Medical Directors Association》2019,20(4):456-461
Objectives
To assess the impact of hip fracture (HF) on health care expenditures and resource use.Design
Observational, retrospective study. An administrative registry was used to obtain sociodemographic, clinical, and expenditure data of patients treated in centers all over Catalonia (North-East Spain).Setting and participants
Male and female patients aged 65 years or older admitted to a Catalonian hospital due to hip fracture (HF) between January 1 2012, and December 31, 2016.Measures
The study data set included the expenditure and frequency of using nonemergency transport, rehabilitation, skilled nursing facility, specialist visits, admissions to the emergency department, hospitalization, pharmacy, and primary care. The patient status at each time point included living at home, staying in hospital, staying in a skilled nursing facility, institutionalized in a nursing home, and death.Results
The record included 38,628 patients (74.4% female) with a mean [standard deviation (SD)] age of 84.9 (7.07) years. The average expenditure per patient during the first year after hospital admission was €11,721.06, the index hospitalization being the leading expenditure (€4740.29). Expenditures related to hospitalization and skilled nursing facility remained higher than preinjury throughout the 3 years following HF. Three years after the index admission, 44.9% of patients had died, 39.7% were living in their homes, 14.2% were in a nursing home, 0.9% were in a skilled nursing facility, and 0.3% were in hospital. The expenditure of hospitalizations, primary care, and visits to the emergency department increased few months before the HF.Conclusions
In patients hospitalized for HF, the expenditure per patient decreases after hospital discharge but the use of healthcare resources is not restored to preinjury values. The increase of expenditures associated with primary care services, hospitalization, and emergency department services during the few months preceding hospital admission suggests a decline of health status in these patients. 相似文献12.
Christina Chauvenet Molly De Marco Carolyn Barnes Alice S. Ammerman 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):416-424.e2
Background
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.Objective
This article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.Design
The authors designed and conducted semistructured interviews and focus groups with WIC participants.Participants/setting
A convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).Statistical analysis conducted
Responses were analyzed qualitatively using principles of content analysis.Results
Challenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.Conclusions
Dissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma. 相似文献13.
Colleen M. Heflin Claire E. Altman Laura L. Rodriguez 《Disability and health journal》2019,12(2):220-226
Background
Households with a disabled adult are disproportionately food insecure, yet the mechanisms linking food insecurity to disability are under-specified.Objective
To develop and empirically examine a model of the potential pathways connecting specific types of disability with food insecurity.Methods
With pooled, repeated cross-sectional National Health and Nutrition Examination Survey data (1999–2014) including 38,354 participants, we ran probit models to estimate the probability of being food insecure as a function of different sets of disability measures and our control variables. We explored the extent to which these patterns differed for prime-aged individuals (19–59) from those age 60 and older.Results
Work-limiting disabilities, functional limitations, and trouble managing money were associated with an increased likelihood of food insecurity for both prime-aged and older individuals, net of other forms of disability. Mobility limitations, trouble seeing, and trouble hearing increased the likelihood of food insecurity for prime-aged individuals only.Conclusion
These findings suggest that disabilities are associated with food insecurity through multiple pathways. Revised public health and policy solutions are needed to address the high rates of food insecurity among those with disabilities. 相似文献14.
Angela R. Fertig Katie A. Loth Amanda C. Trofholz Allan D. Tate Michael Miner Dianne Neumark-Sztainer Jerica M. Berge 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):818-830
Background
Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families.Objective
The present study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients than pre-prepared meals.Design
Data for the study came from the National Institutes of Health–funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an 8-day observation window.Participants/setting
In this study, investigators followed 150 families with children aged 5 to 7 years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota.Main outcome measures
The main outcomes were participants’ self-reports of whether they served fruits, vegetables, and whole grains at a meal, and reports were made within hours of the meal.Statistical analyses performed
Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner, or a snack and whether it was a weekend meal.Results
For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (P<0.001). Meals that were partly home-cooked were the most likely to contain whole grains (P<0.001). Restaurant meals were more likely to contain vegetables than pre-prepared meals (P<0.001) but were equally likely to contain fruits and/or whole grains as pre-prepared meals.Conclusions
Interventions or initiatives that encourage fully or partly home-cooked meals may help families incorporate nutritious foods into their diets. In addition, evaluations of potential strategies to increase the likelihood of supplementing pre-prepared and restaurant meals with nutritious meal ingredients warrants further investigation. 相似文献15.
16.
Buyun Liu Yangbo Sun Guifeng Xu Linda G. Snetselaar Gabriele Ludewig Robert B. Wallace Wei Bao 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):617-625
Background
Excess iron levels can induce oxidative stress and could therefore affect telomere attrition. However, little is known about the impact of body iron status on telomere length.Objective
Our aim was to examine the association between serum ferritin concentrations, an indicator of body iron status, and leukocyte telomere length in US adults.Design
We conducted a nationwide, population-based, cross-sectional study.Participants/setting
We used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. We included 7,336 adults aged 20 years or older who had available data on serum ferritin levels and telomere length. High ferritin levels were defined as a serum ferritin level >200 ng/mL (449.4 pmol/L) in women and >300 ng/mL (674.1 pmol/L) in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL (67.4 pmol/L).Main outcome measures
Leukocyte telomere length was assayed using the quantitative polymerase chain reaction method.Statistical analyses
Linear regression with survey weights was performed to estimate the association between serum ferritin levels and telomere length.Results
The prevalence of adults with high and low serum ferritin levels was 10.9% and 17.6%, respectively. High ferritin levels were inversely associated with telomere length compared to normal ferritin levels. After adjustment for demographic, socioeconomic and lifestyle factors, body mass index, C-reactive protein, and leukocyte cell type composition, the β coefficient for log-transformed telomere length was –0.020 (standard error [SE]=0.009; P=0.047). The association was stronger in adults aged 65 years or older (β coefficient –0.081, SE=0.017; P<0.001) than in adults 20 to 44 years old (β coefficient –0.023, SE=0.019; P=0.24) or adults aged 45 to 64 years old (β coefficient 0.024, SE=0.015; P=0.10) (P for interaction 0.003). Low ferritin levels were not significantly associated with telomere length compared with normal ferritin levels.Conclusions
In a US nationally representative population, high body iron status was associated with shorter telomeres, especially in adults aged 65 years or older. 相似文献17.
Julia Thornton Snider Jesse Sussell Mahlet Gizaw Tebeka Alicia Gonzalez Joshua T. Cohen Peter Neumann 《Value in health》2019,22(3):332-339
Background
Payers frequently rely on budget impact model (BIM) results to help determine drug coverage policy and its effect on their bottom line. It is unclear whether BIMs typically overestimate or underestimate real-world budget impact.Objective
We examined how different modeling assumptions influenced the results of 6 BIMs from the Institute for Clinical and Economic Review (ICER).Study Design
Retrospective analysis of pharmaceutical sales data.Methods
From ICER reports issued before 2016, we collected estimates of 3 BIM outputs: aggregate therapy cost (ie, cost to treat the patient population with a particular therapy), therapy uptake, and price. We compared these against real-world estimates that we generated using drug sales data. We considered 2 classes of BIM estimates: those forecasting future uptake of new agents, which assumed “unmanaged uptake,” and those describing the contemporaneous market state (ie, estimates of current, managed uptake and budget impact for compounds already on the market).Results
Differences between ICER's estimates and our own were largest for forecasted studies. Here, ICER's uptake estimates exceeded real-world estimates by factors ranging from 7.4 (sacubitril/valsartan) to 54 (hepatitis C treatments). The “unmanaged uptake” assumption (removed from ICER's approach in 2017) yields large deviations between BIM estimates and real-world consumption. Nevertheless, in some cases, ICER's BIMs that relied on current market estimates also deviated substantially from real-world sales data.Conclusions
This study highlights challenges with forecasting budget impact. In particular, assumptions about uptake and data source selection can greatly influence the accuracy of results. 相似文献18.
Lauren E. Au Courtney Paolicelli Klara Gurzo Lorrene D. Ritchie Nancy S. Weinfield Kaela R. Plank Shannon E. Whaley 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):435-448
Background
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy.Objective
Our aims were to examine commonly consumed foods and estimate the proportion of dietary intake contributed by WIC-eligible foods among 13- and 24-month-old children, and to assess differences by WIC participation status at 24-months.Design
This was a national observational study.Participants/setting
Children participating in the WIC Infant and Toddler Feeding Practices Study-2 were included (13 months old [n=2,777] and 24 months old [n=2,450]) from 2013 to 2016.Main outcome measures
Dietary intakes were assessed using 24-hour dietary recalls at 13 and 24 months. The 10 most commonly consumed foods were described using the What We Eat in America food category classification system. WIC-eligible foods were defined as meeting the WIC nutrient criteria set forth in the Federal regulation.Statistical analyses performed
The estimated proportion (mean±standard error) of WIC-eligible foods to total daily intake was calculated for energy, macronutrients, and select micronutrients. Multiple linear regression, adjusted for confounders, was conducted to compare the estimated proportion of nutrient intake from WIC-eligible foods by WIC participation at 24 months.Results
At 13 and 24 months, most (60% and 63%, respectively) of the commonly consumed foods were eligible for purchase as part of the child WIC food package. WIC-eligible foods provided >40% of calories and close to 50% or more of other nutrients, and the contribution of WIC-eligible foods to overall micronutrient intake increased between 13 and 24 months. Children still on WIC at 24 months obtained a larger proportion of calories and most other nutrients from WIC-eligible foods than children no longer on WIC.Conclusions
WIC-eligible foods could contribute to the overall diet of toddlers who were enrolled in WIC prenatally or in early infancy. Further, there may be additional nutritional benefits of staying on the program through 24 months. 相似文献19.
Thierry Bautrant Michel Grino Corinne Peloso Frédéric Schiettecatte Magali Planelles Charles Oliver Caroline Franqui 《Journal of the American Medical Directors Association》2019,20(3):377-381
Objectives
To determine whether environmental rearrangements of the long-term care nursing home can affect disruptive behavioral and psychological symptoms of dementia (BPSD) in residents with dementia.Design
Prospective 6-month study.Setting
The study was conducted before (phase 1) and after (phase 2) environmental rearrangements [skylike ceiling tiles in part of the shared premises, progressive decrease of the illuminance at night together with soothing streaming music, reinforcement of the illuminance during the day, walls painted in light beige, oversized clocks in corridors, and night team clothes color (dark blue) different from that of the day team (sky blue)].Participants
All of the patients (n = 19) of the protected unit were included in the study. They were aged 65 years or older and had an estimated life expectancy above 3 months.Measures
Number and duration of disruptive BPSD were systematically collected and analyzed over 24 hours or during late hours (6:00-12:00 pm) during each 3-month period.Results
There was no significant change in the patients' dependency, risk of fall, cognitive or depression indexes, or treatment between phase 1 and 2. Agitation/aggression and screaming were observed mainly outside the late hours as opposed to wandering episodes that were noticed essentially within the late hours. The number of patients showing wandering was significantly lower over 24 hours during phase 2. The number of agitation/physical aggression, wandering, and screaming and the mean duration of wandering episodes were significantly (P = .039, .002, .025, and .026 respectively) decreased over 24 hours following environmental rearrangements. Similarly, a significant reduction in the number and mean duration of wandering was noticed during the late hours (P = .031 and .007, respectively).Conclusions
Our study demonstrates that BPSD prevalence can be reduced following plain environmental rearrangements aimed at improving spatial and temporal orientation. 相似文献20.
Shubing Cai Susan C. Miller Ira B. Wilson 《Journal of the American Medical Directors Association》2019,20(4):497-502