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Objective
To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores.Data Sources and Study Setting
This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015–2019.Study Design
This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables.Data Collection/Extraction Methods
We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file.Principal Findings
Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19–64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß = −12.79, p < 0.0001), followed by the percent of the population coded to “non-Hispanic, some other race” (ß = −2.59, p < 0.0023), and the percent of families in poverty (ß = −0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß = 0.35, p < 0.0001) and percent non-Hispanic Asian (ß = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores.Conclusions
The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent—that is, structural—association between market sociodemographics and HVBP scores. 相似文献3.
Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia
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Jade Hollingworth MBBS BSc Rachel Pietsch MBBS BSc Mathias Epee‐Bekima MD MRCOG FRANZCOG Elizabeth Nathan M.Biostat 《The Australian journal of rural health》2018,26(1):42-47
Objective
To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations.Design
A retrospective observational study of the 69 cases transferred to KEMH during 2015.Setting
Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth.Participants
Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation.Main outcome measures
The occurrence of delivery during the admission and time‐to‐delivery as well as length of admission and association between clinical factors and time‐to‐delivery.Results
The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty‐six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty‐three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001).Conclusion
The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge. 相似文献4.
S. Hirayama K. Terasawa R. Rabeler T. Hirayama T. Inoue Y. Tatsumi M. Purpura R. Jäger 《Journal of human nutrition and dietetics》2014,27(Z2):284-291
Background
Attention‐deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood, affecting 3–5% of school‐age children. The present study investigated whether the supplementation of soy‐derived phosphatidylserine (PS), a naturally occurring phospholipid, improves ADHD symptoms in children.Methods
Thirty six children, aged 4–14 years, who had not previously received any drug treatment related to ADHD, received placebo (n = 17) or 200 mg day–1 PS (n = 19) for 2 months in a randomised, double‐blind manner. Main outcome measures included: (i) ADHD symptoms based on DSM‐IV‐TR; (ii) short‐term auditory memory and working memory using the Digit Span Test of the Wechsler Intelligence Scale for Children; and (iii) mental performance to visual stimuli (GO/NO GO task).Results
PS supplementation resulted in significant improvements in: (i) ADHD (P < 0.01), AD (P < 0.01) and HD (P < 0.01); (ii) short‐term auditory memory (P < 0.05); and (iii) inattention (differentiation and reverse differentiation, P < 0.05) and inattention and impulsivity (P < 0.05). No significant differences were observed in other measurements and in the placebo group. PS was well‐tolerated and showed no adverse effects.Conclusions
PS significantly improved ADHD symptoms and short‐term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD. 相似文献5.
The use of haematopoietic stem cell transplantation in Fanconi anaemia patients: a survey of decision making among families in the US and Canada
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Sadie P. Hutson PhD RN WHNP BC Paul K. J. Han MD MA MPH Jada G. Hamilton PhD MPH Sean C. Rife MA Mohamad M. Al‐Rahawan MD MPH Richard P. Moser PhD Seth P. Duty RN BSN Sheeba Anand MPH Blanche P. Alter MD MPH 《Health expectations》2015,18(5):929-941
Background
Fanconi anaemia (FA) is a rare genetic disorder associated with bone marrow failure (BMF), congenital anomalies and cancer susceptibility. Stem cell transplantation (SCT) offers a potential cure for BMF or leukaemia, but incurs substantial risks. Little is known about factors influencing SCT decision making.Objective
The study objective was to explore factors influencing patients' with FA and family members' decision making about SCT.Design
Using a mixed‐methods exploratory design, we surveyed US and Canadian patients with FA and family members who were offered SCT.Main variables studied
Closed‐ended survey items measured respondents' beliefs about the necessity, risks and concerns regarding SCT; multivariable logistic regression was used to examine the association between these factors and the decision to undergo SCT. Open‐ended survey items measured respondents' perceptions of factors important to the SCT decision; qualitative analysis was used to identify emergent themes.Results
The decision to undergo SCT was significantly associated with greater perceived necessity (OR = 2.81, P = 0.004) and lower concern about harms of SCT (OR = 0.31, P = 0.03). Qualitative analysis revealed a perceived lack of choice among respondents regarding the use of SCT, which was related to physician influence and respondent concerns about patients' quality of life.Conclusions
Overall, study results emphasize the importance of the delicate interplay between provider recommendation of a medical procedure and patient/parental perceptions and decision making. Findings can help providers understand the need to acknowledge family members' perceptions of SCT decision making and offer a comprehensive discussion of the necessity, risks, benefits and potential outcomes. 相似文献6.
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Anu Ruusunen Jyrki K. Virtanen Soili M. Lehto Tommi Tolmunen Jussi Kauhanen Sari Voutilainen 《European journal of nutrition》2011,50(2):89-96
Purpose
The aim of this study is to investigate whether serum n − 3 polyunsaturated fatty acids (PUFAs) or n − 6 to n − 3 ratio is associated with risk of severe depression in middle-aged Finnish men. 相似文献8.
Alein Y. Haro-Ramos MPH Timothy T. Brown PhD Julianna Deardorff PhD Adrian Aguilera PhD Keshia M. Pollack Porter PhD MPH Hector P. Rodriguez PhD MPH 《Health services research》2023,58(Z2):186-197
Objective
To assess the magnitude of racial–ethnic disparities in pandemic-related social stressors and examine frontline work's moderating relationship on these stressors.Data Sources
Employed Californians' responses to the Institute for Governmental Studies (IGS) poll from April 16–20, 2020, were analyzed. The Pandemic Stressor Scale (PSS) assessed the extent to which respondents experienced or anticipated problems resulting from the inability to pay for basic necessities, job instability, lacking paid sick leave, unavailability of childcare, and reduced wages or work hours due to COVID-19.Study Design
Mixed-effects generalized linear models estimated (1) racial–ethnic disparities in pandemic stressors among workers during the first COVID-19 surge, adjusting for covariates, and (2) tested the interaction between race–ethnicity and frontline worker status, which includes a subset of essential workers who must perform their job on-site, to assess differential associations of frontline work by race–ethnicity.Data Collection
The IGS poll data from employed workers (n = 4795) were linked to the 2018 Centers for Disease Control and Prevention Social Vulnerability Index at the zip code level (N = 1068).Principal Findings
The average PSS score was 37.34 (SD = 30.49). Whites had the lowest PSS score (29.88, SD = 26.52), and Latinxs had the highest (50.74, SD = 32.61). In adjusted analyses, Black frontline workers reported more pandemic-related stressors than White frontline workers (PSS = 47.73 vs. 36.96, p < 0.001). Latinxs reported more pandemic stressors irrespective of frontline worker status. However, the 5.09-point difference between Latinx frontline and non-frontline workers was not statistically different from the 4.6-point disparity between White frontline and non-frontline workers.Conclusion
Latinx workers and Black frontline workers disproportionately reported pandemic-related stressors. To reduce stress on frontline workers during crises, worker protections like paid sick leave, universal access to childcare, and improved job security are needed, particularly for those disproportionately affected by structural inequities, such as racially minoritized populations. 相似文献9.
Cholesterol-lowering properties of Ganoderma lucidum in vitro, ex vivo, and in hamsters and minipigs
A Berger D Rein E Kratky I Monnard H Hajjaj I Meirim C Piguet-Welsch J Hauser K Mace P Niederberger 《Lipids in health and disease》2004,3(1):2
Introduction
There has been renewed interest in mushroom medicinal properties. We studied cholesterol lowering properties of Ganoderma lucidum (Gl), a renowned medicinal species. 相似文献10.
Diethelm K Remer T Jilani H Kunz C Buyken AE 《Clinical nutrition (Edinburgh, Scotland)》2011,30(5):640-646
Background & aims
Short sleep duration in early childhood may increase the risk for chronic diseases in later life. Strategies to improve sleep duration are thus of interest. We investigated whether the nutritional composition of the evening meal is associated with children’s sleep duration in the 2nd year of life.Methods
Multivariable regression models included 594 participants of the DONALD Study with 3-days weighed dietary records and average daily sleep duration at age 1.5 and 2 years.Results
Higher energy intakes with the evening meal were associated with a longer sleep duration (1 min/10 kcal, p = 0,01). With respect to absolute intakes, carbohydrates (0.8 min/g, p < 0.0001), especially from high GI foods (1.3 min/g, p < 0.01), and a higher GL (1.5 min/g GL, p < 0.01) were accompanied by longer sleeping time. A qualitative exchange of energy from protein by energy from carbohydrates from high GI foods was only associated with increased sleep duration in toddlers without (1.9 min/%E, p < 0.05), but not with nightly eating occasions (p > 0.4).Conclusions
The observed associations are in line with suggested sleep-improving effects of carbohydrates. Effect sizes suggest that the clinical relevance of nutritional composition for sleep duration is limited in healthy young toddlers. These observations and their possible importance for more vulnerable groups need to be confirmed in clinical trials. 相似文献11.
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K. Simpson D. Keen D. Adams C. Alston‐Knox J. Roberts 《Child: care, health and development》2018,44(1):99-107
Background
Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.Method
Caregivers of children on the spectrum aged 5 (n = 90) and 9–10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.Results
Item‐level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age‐appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).Conclusion
The possibility of autism‐specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers. 相似文献13.
An investigation into the nutritional composition and cost of gluten‐free versus regular food products in the UK
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Background
The gluten‐free (GF) food market has expanded considerably, although there is limited comparative evidence for the nutritional quality and cost of GF food products. The present study aims to compare the nutrient composition and cost of GF and gluten‐containing (regular) foods across 10 food categories in the UK.Methods
Nutritional information and the cost of GF foods available in the UK (n = 679) and comparable regular foods (n = 1045) were systematically collected from manufacturer and supermarket websites. Foods were classified using UK front‐of‐pack labelling for content of fat, saturated fat, sugar and salt and nutrient content, and cost per 100 g were identified and compared between GF and regular foods.Results
Overall, more GF foods were classified as containing high and medium fat, saturated fat, sugar and salt than regular foods, although this was not universally consistent. More GF bread and flour products contained high fat and sugar, whereas fewer GF crackers contained high fat and sugar compared to regular foods. High salt content was found more frequently in GF than regular products. On average, GF products were 159% more expensive than regular (£0.44/100 g versus £1.14/100 g). GF items were also more likely to be lower in fibre and protein content than regular foods.Conclusions
Differences exist in the nutritional composition of GF and regular food. GF food is unlikely to offer healthier alternatives to regular foods, except for those who require a GF diet for medically diagnosed conditions, and it is associated with higher costs. 相似文献14.
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Jinjiao Wang PhD RN Jenny Y. Shen MD Yeates Conwell MD Eric J. Podsiadly BA Thomas V. Caprio MD MPH MS Kobi Nathan PharmD Fang Yu PhD RN GNP-BC FGSA FAAN Erika E. Ramsdale MD Donna M. Fick PhD FAAN Amanda S. Mixon MD MS MSPH Sandra F. Simmons PhD 《Health services research》2023,58(Z1):123-138
Objective
To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—“Medication”, “Mentation”, “Mobility”, and “What Matters Most” to the person—can be used to guide assessment of age-friendliness of deprescribing trials.Data Source
Published literature.Study Design
Scoping review.Data Extraction Methods
The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms.Principal Findings
Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: “Medication” was considered in the intervention design of all trials; “Mentation” was considered in eight trials; “Mobility” (n = 2) and “What Matters Most” (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: “Medication” was the most commonly assessed outcome (n = 33), followed by “Mobility” (n = 13) and “Mentation” (n = 10) outcomes, with no study examining “What Matters Most” outcomes.Conclusions
“Mentation” and “Mobility”, and “What Matters Most” have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system. 相似文献16.
Jakob H. Hansen Ingunn H. Geving Randi E. Reinertsen 《International archives of occupational and environmental health》2010,83(6):607-615
Purpose
To determine the total phase delay and adaptation rate of 6-sulfatoxymelatonin (aMT6s) on subjective and objective sleep quality and cognitive performance after 7 days of working night shifts (1800–0600 hours). The subjects studied were offshore fleet workers (N = 7). 相似文献17.
No difference in self‐reported frequency of choking between infants introduced to solid foods using a baby‐led weaning or traditional spoon‐feeding approach
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A. Brown 《Journal of human nutrition and dietetics》2018,31(4):496-504
Background
Baby‐led weaning (BLW) where infants self‐feed family foods during the period that they are introduced to solid foods is growing in popularity. The method may promote healthier eating patterns, although concerns have been raised regarding its safety. The present study therefore explored choking frequency amongst babies who were being introduced to solid foods using a baby‐led or traditional spoon‐fed approach.Methods
In total, 1151 mothers with an infant aged 4–12 months reported how they introduced solid foods to their infant (following a strict BLW, loose BLW or traditional weaning style) and frequency of spoon‐feeding and puree use (percentage of mealtimes). Mothers recalled if their infant had ever choked and, if so, how many times and on what type of food (smooth puree, lumpy puree, finger food and specific food examples).Results
In total, 13.6% of infants (n = 155) had ever choked. No significant association was found between weaning style and ever choking, or the frequency of spoon or puree use and ever choking. For infants who had ever choked, infants following a traditional weaning approach experience significantly more choking episodes for finger foods (F2,147 = 4.417, P = 0.014) and lumpy purees (F2,131 = 6.46, P = 0.002) than infants following a strict or loose baby‐led approach.Conclusions
Baby‐led weaning was not associated with increased risk of choking and the highest frequency of choking on finger foods occurred in those who were given finger foods the least often. However, the limitations of noncausal results, a self‐selecting sample and reliability of recall must be emphasised. 相似文献18.
The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer
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A. Fisher A. M. Craigie M. Macleod R. J. C. Steele A. S. Anderson 《Journal of human nutrition and dietetics》2018,31(3):306-313
Background
Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status.Methods
The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into ‘more deprived’ (SIMD 1–2, n = 58) and ‘less deprived’ (SIMD 3–5, n = 105). Socio‐economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status.Results
At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes.Conclusions
Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio‐economic groups. 相似文献19.
Martín-González C González-Reimers E Santolaria-Fernández F Fernández-Rodríguez C García-Valdecasas-Campelo E González Díaz A Alvisa-Negrín J Martínez Riera A 《Clinical nutrition (Edinburgh, Scotland)》2011,(6):822-830
Background & aims
The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes.Methods
From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25–53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment).Results
Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ2 = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ2 = 4.68; p = 0.03) and right leg lean mass (χ2 = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan–Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality.Conclusions
Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass. 相似文献20.
Davor Rimac Jelena Macan Veda M. Varnai Marija Vučemilo Kristina Matković Ljerka Prester Tatjana Orct Ivančica Trošić Ivan Pavičić 《International archives of occupational and environmental health》2010,83(1):9-19