Hospitalization of medicaid children: analysis of small area variations in admission rates.

Population-based hospitalization rates were computed and analyzed for AFDC children among 14 small area subdivisions of the State of Washington. Medical-surgical admission rates ranged from 65.3 to 161.7 per 1,000 person-years among the 14 areas. Surgical admission rates were significantly higher in urban areas; medical admission rates were significantly higher in rural areas. The majority of variance in overall rates was accounted for by admissions for four diagnostic categories: gastroenteritis (18-fold differences), lower respiratory infections (15-fold differences), upper respiratory infections (8-fold differences), and ear, nose, and throat (ENT) surgery (6-fold differences). Secondary analysis indicates that these differences in admission rates were not associated with: medical need or demographic factors, epidemic patterns of disease, physician supply, hospital bed supply or occupancy rates, or severity of disease or delay in seeking medical care as reflected by average length of stay. It is possible that the observed variations may reflect either differences in the propensity of local physicians to hospitalize or differences in the use or adequacy of community, ambulatory, and preventive care.     

Oxidative stress treatment for clinical trials in neurodegenerative diseases

Oxidative stress is a metabolic condition arising from imbalance between the production of potentially reactive oxygen species and the scavenging activities. Mitochondria are the main providers but also the main scavengers of cell oxidative stress. The role of mitochondrial dysfunction and oxidative stress in the pathogenesis of neurodegenerative diseases is well documented. Therefore, therapeutic approaches targeting mitochondrial dysfunction and oxidative damage hold great promise in neurodegenerative diseases. Despite this evidence, human experience with antioxidant neuroprotectants has generally been negative with regards to the clinical progress of disease, with unclear results in biochemical assays. Here we review the antioxidant approaches performed so far in neurodegenerative diseases and the future challenges in modern medicine.     

Community exercise program use and changes in healthcare costs for older adults

BACKGROUND: Regular exercise is associated with many health benefits. Community-based exercise programs may increase exercise participation, but little is known about cost implications. METHOD: A retrospective, matched cohort study was conducted to determine if changes in healthcare costs for Medicare-eligible adults who choose to participate in a community-based exercise program were different from similar individuals who did not participate. Exercise program participants included 1114 adults aged > or = 65 years, who were continuously enrolled in Group Health Cooperative of Puget Sound (GHC) between October 1, 1997 and December 31, 2000 and who participated in the Lifetime Fitness (exercise) Program Copyright (LFP) at least once; three GHC enrollees who never attended LFP were randomly selected as controls for each participant by matching on age and gender. Cost and utilization estimates from GHC administrative data for the time from LFP enrollment to December 31, 2000 were compared using multivariable regression models. RESULTS: The average increase in annual total healthcare costs was less in participants compared to controls (+642 dollars vs +1175 dollars; p=0.05). After adjusting for differences in age, gender, enrollment date, comorbidity index, and pre-exposure cost and utilization levels, total healthcare costs for participants were 94.1% (95% confidence interval [CI], 85.6%-103.5%) of control costs. However, for participants who attended the exercise program at an average rate of > or = 1 visit weekly, total adjusted follow-up costs were 79.3% (95% CI, 71.3%-88.2%) of controls. CONCLUSIONS: Including a community exercise program as a health insurance benefit shows promise as a strategy for helping some Medicare-eligible adults to improve their health through exercise.     

A randomized controlled trial testing the effectiveness of a universal school-based depression prevention program 'Op Volle Kracht' in the Netherlands

Background  

The incidence of depressive symptoms increases during adolescence, from 10.0% to 24.5% at age 11 to 15, respectively. Experiencing elevated levels of depressive symptoms increases the risk of a depressive disorder in adulthood. A universal school-based depression prevention program Op Volle Kracht (OVK) was developed, based on the Penn Resiliency Program, aimed at preventing the increase of depressive symptoms during adolescence and enhancing positive development. In this study the effectiveness of OVK will be tested and possible mediators of program effects will be focus of study as well.     

An essential review of Singapore’s response to out-of-hospital cardiac arrests: improvements over a ten-year period

Care for patients who experience out-of-hospital cardiac arrest (OHCA) has rapidly evolved in the past decade. Increased sophistication of care in the community, emergency medical services (EMS) and hospital setting is associated with improved patient-centred outcomes. Notably, Utstein survival doubled from 11.6% to 23.1% between 2011 and 2016. These achievements involved collaboration between policymakers, clinicians and researchers, and were made possible by a strategic interplay of policy, research and implementation. We review the development and current state of OHCA in Singapore using primary population-based data from the Pan-Asian Resuscitation Outcomes Study and an unstructured search of research databases. We discuss the roles of important milestones in policy, community, dispatch, EMS and hospital interventions. Finally, we relate these interventions to relevant processes and outcomes, such as the relationship between the strategic implementation of bystander cardiopulmonary resuscitation and placement of automated external defibrillator with return of spontaneous circulation, survival to discharge and survival with favourable neurological outcomes.     

MR vascular imaging with a fast gradient refocusing pulse sequence and reformatted images from transaxial sections

The authors present a method for obtaining magnetic resonance (MR) images of intra- and extracranial vessels from thin contiguous transaxial sections. A section-selective gradient refocusing pulse sequence with a short repetition time caused flow-related enhancement from spins that flowed perpendicular to the transaxial sections. The signal was further enhanced by means of flow compensation gradients to rephase any phase shifts resulting from moving spins in the presence of the imaging gradients. Coronal and sagittal sections, reformatted from multiple transaxial sections, are shown to have excellent vessel contrast without the use of contrast material. These images were obtained in 12 minutes of acquisition time from as many as 60 sections of 3-mm thickness. Such a technique shows significant promise for MR angiography.