Impact of United States 2017 Immigration Policy changes on missed appointments at two Massachusetts Safety-Net Hospitals

Introduction

Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants’ utilization of primary care.

Methods

We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English.

Results

After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000.

Conclusions

We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English.

     

Baseline Serum Prolactin in Drug-naive, First-episode Schizophrenia and Outcome at Five Years: Is it a Predictive Factor?

Objective: Serum prolactin is influenced by antipsychotic use but its relationships with psychopathology and general functioning are not clear. This study aimed to assess these relationships.Design: Serum prolactin levels were measured in patients with schizophrenia before being treated with antipsychotics and at various follow-up points.Setting: The study was conducted in a nongovernmental psychiatric treatment center in Mumbai, India.Participants: The participants included 30 male and 30 female drug-na?ve patients with schizophrenia and 31 control participants.Measurements: The severity of psychopathology at baseline, three weeks, six weeks, and five years following treatment was assessed using a modified Brief Psychiatric Rating Scale. The Global Assessment of Functioning questionnaire was used at baseline and five years follow up.Results: Contrary to our hypotheses, prolactin levels in male but not female patients at baseline were twice those of control volunteers. Correlations between prolactin, Brief Psychiatric Rating Scale, and Global Assessment of Functioning measurements were not significant for any time point up to six weeks, but were only significant at the five-year follow-up appointments, indicating that those patients with higher levels of serum prolactin had a better outcome at five years.Conclusion: Baseline serum prolactin levels in drug-naive patients with schizophrenia may be used for long-term prognosis, but are not reliable indicators of psychopathology and prognosis in the short term. Future research is needed to conclude with confidence whether or not prolactin can be used as a biomarker of psychopathological and overall functioning in schizophrenia.     

A panoramic view on phytochemical,nutritional, and therapeutic attributes of Ziziphus mauritiana Lam.: A comprehensive review

Ziziphus mauritiana (Rhamnaceae), commonly known as Indian jujube, is a pharmacologically diverse medicinal plant. A plethora of active phytochemical constituents of this plant has been revealed so far, namely, berberine, quercetin, kaempferol, sitosterol, stigmasterol, lanosterol, diosgenin, and so forth. Several studies demonstrated the exploration of pharmacological potential of various parts such as fruits, leaves, and stems of the plant as antioxidant, cytotoxic, antimicrobial, anti‐diarrhoeal, antidepressant, immunomodulator, and hepatoprotective. This review gives a unique summary including phytochemistry, nutritional value, and significant pharmacological importance of Z. mauritiana. The literature search was carried out via search engine PubMed, Science Direct, and so on. The data were heterogeneous in terms of leaves, stem, roots, and fruits which were used for different experimental findings, which made the comparison a lengthy task. Study findings suggested that the extracts from this plant may possess numerous types of pharmacological activities. As the search for novel drugs from botanical sources continues, there is need for future investigations to isolate and characterize pharmacologically active agents that confer medicinal properties on Z. mauritiana, as well as to elucidate the structures of these agents by which they exert their healing properties and to scientifically validate the existing traditional practices concerning its health benefits.     

Toxicological screening of traditional medicine Laghupatha (Cissampelos pareira) in experimental animals

Laghupatha (Cissampelos pareira) a important medicinal plant in Indian traditional system of medicine and is widely used in many countries by different tribal. Despite the wide use of Cissampelos pareira in folk medicine, no study has been published in the scientific literature about its toxicological profile. In present study 50% aqueous ethanolic extract of Cissampelos pareira (Menispermaceae) was evaluated for the acute and subacute toxicity. In the acute toxicity test, oral administration of 2g/kg of Cissampelos pareira produced neither mortality nor changes in behavior or any other physiological activities in mice. In subacute toxicity studies, no mortality was observed when the two doses of 1 or 2g/kg day of 50% aqueous ethanolic extract of Cissampelos pareira were administered p.o. for a period of 28 days in rats. There were no significant changes occurred in the blood chemistry analysis including glucose, sodium, potassium, calcium, phosphorus, chloride, total cholesterol, high density lipoprotein, triglycerides, total protein, blood urea nitrogen, creatinine, conjugated billirrubin, aspartate transaminase, alanine transaminase, total billirrubin, albumin, prothrombin time and thromboplastin partial time in both sexes of animals. Hematological analysis showed no marked differences in any of the parameters examined (WBC count, platelet and hemoglobin estimation) in either the control or treated group of both sexes. The urinalysis was negative for glucose, ketonic bodies, casts, red blood cells, and albumin in the control and treatment groups. There were no significant differences in the body and organ weights between controls and treated animals of both sexes. Pathologically, neither gross abnormalities nor histopathological changes were observed. Cissampelos pareira was found safe in acute and subacute toxicities while chronic toxicity studies are further required for the support of the safe and sound use of this traditional plant.     

Transtibial amputation with plantar flap for congenital deficiency of the tibia

Disarticulation of the knee has been the preferred treatment for the severe type (Type Ia and Type Ib classification of Jones et al) of congenital deficiency of the tibia because of marked flexion contracture of the knee and loss of quadriceps function. In such cases, the disarticulated stump is often small and poorly covered by soft tissues because of dysplastic femoral condyles and calf muscles. Therefore, stump complications after disarticulation may prevent early aggressive walking exercises and delay independent ambulation. To overcome this problem, a greater weightbearing surface was created by a transtibial amputation with a short stump of the fibula using the flexed knee. By this method, the distal femoral condyle and the anterior surface of the fibula were used for weightbearing. In addition, coverage of the new weightbearing area by a neurovascular pedicled sensate plantar flap provided a more tolerable weightbearing site. The purpose of the current study was to report a 5-year-old boy with bilateral congenital total deficiency of both tibias, who was treated using this technique. The patient was ambulating independently 15 weeks after surgery. A transtibial amputation with a plantar flap is an alternative procedure to knee disarticulation for the severe type of congenital deficiency of the tibia.     

Ethnomedical value of Cissampelos pareira extract in experimentally induced diarrhoea

The antidiarrhoeal activity of the ethanolic extract of Cissampelos pareira (Menispermaceae) roots was assessed on experimental animals. The hydroethanolic extract (25-100 mg dry extract kg(-1) body mass, p.o.) exhibited a dose dependent decrease in the total number of faecal droppings (control 65, reduced to 26-46) and 29.2-60.0% inhibition in castor oil-induced diarrhoea. Further, C. pareira produced a significant (p < 0.01) and dose dependent reduction in intestinal fluids accumulation (26.0-59.0%). The extract showed a greater inhibitory effect on the concentration of Na+ (20.0 and 34.5%) than on the concentration of K+ (6.7 and 9.4%). The extract also reduced dose dependently the gastrointestinal transit from 46.4 and 38.7%, equivalent to 53.6 and 61.3%. However, C. pareira significantly reduced the lipid peroxidation and inhibited the decrease in antioxidant enzyme levels (superoxide dismutase and catalase) on prior administration to castor oil-induced fluid accumulation. The extract of C. pareira had no effect on normal defecation at 25 mg kg(-1) in mice. However, 50 and 100 mg kg(-1) inhibited defecation by 100% in the initial 2 h and the activity was reduced to 40.0 and 73.0%, respectively, in the third hour.