Average Annual Days Research Articles

Psychotropic Polypharmacy Combinations and Duration of Polypharmacy Among Medicaid-Enrolled Youths.

This study evaluated psychotropic polypharmacy frequency and patterns of use among Medicaid-enrolled youths. A cross-sectional study of a state Medicaid claims database (2015-2020) focused on youths (≤17 years old) with at least one psychotropic medication claim and ≥90 continuous days of Medicaid enrollment. Psychotropic polypharmacy (claims for three or more therapeutic classes of psychotropics for ≥90 consecutive days) was analyzed as average annual days and annual prevalence of class combinations. Multivariable negative binomial regression models assessed changes in annual psychotropic polypharmacy days. A total of 126,972 unique youths were identified. Almost all youths with psychotropic polypharmacy had three-class combinations, the most common of which included attention-deficit hyperactivity disorder medications, antipsychotics, and antidepressants. The number of polypharmacy days increased from a mean±SD of 227.8±90.3 in 2015 to 235.7±97.5 in 2020. Polypharmacy days significantly increased year over year (rate ratio=1.01, 95% CI=1.00-1.01). Psychotropic polypharmacy regimens reflect chronic use that is increasing over time.

Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period.

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010-2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

Health and retirement age: Comparison of expectations and actual retirement

We examine the relationship between the subjective assessment of health status and retirement by using information on expected and actual retirement ages. Subjective data from cross-sectional surveys, conducted in Finland in 2003 and 2008, are linked to information on actual retirement age from register data from 2003 to 2013. Regression models are estimated for actual and expected retirement ages. While the health status is positively correlated with both actual and anticipated full-time retirement age, the actual age of retirement is less sensitive to health. On average, individuals tend to retire later than they had anticipated. We examine potential biases in the health-retirement relationship. Measurement error in regard to health status biases the results downwards. Using data on observed retirement ages, omitting those who do not retire during the data period, leads to a selection problem. Ignoring the selection also leads to a downwards bias in the health-retirement age connection. As a more exogenous health variable we use health shocks, which are measured by average annual days of absence due to sickness in the follow-up period. These shocks are negatively related to retirement age in a subsample of initially healthy individuals. When subjective assessment of health is used for explaining retirement behavior, the effects of health can often be underestimated rather than overestimated. To lengthen working careers, attention should be given to both the ability (health) and willingness (perceptions of proper retirement age) of people to continue longer at work.

Spatial analysis of annual runoff ratios and their variability across the contiguous U.S.

Summary This study examines the spatial patterns of annual runoff ratios and their variability and identifies the determinants of runoff indices for 238 reference basins with low levels of anthropogenic influence and 1352 non-reference basins with substantial levels of anthropogenic influence. Runoff ratios are high and runoff ratio coefficients of variation (CV) are low in coastal Pacific Northwest and Northeast basins, both humid temperate climates. The most significant variable that influences annual runoff ratio for both basin types is the average annual days of measurable precipitation. Snow percent of total precipitation and minimum watershed elevation are common predictors of runoff ratio for both types of basins. Slope percent and Horton overland flow are significant predictors for reference basin runoff ratio, while average annual precipitation, basin compactness, and dam storage are significant predictors for non-reference basin runoff ratio. The variables most significantly influencing runoff ratio CV in both types of basins are the average annual days of measurable precipitation, the precipitation seasonality index, and the base flow index. Horton overland flow is a significant predictor for reference basins, while minimum watershed elevation is a significant predictor for non-reference basins. Spatial autocorrelation of ordinary least squares estimated residuals are reduced by geographically weighted regression (GWR) for all models in both basin types. This study shows that GWR modeling, which takes into account spatial non-stationarity, can create more accurate representations of runoff ratio variability in both basin types. The spatially-varying coefficient values in GWR models also show local specific relationships between runoff indices and various climatic and landscape factors.

Patient related outcomes in a real life prospective follow up study: Allergen immunotherapy increase quality of life and reduce sick days

Background One fourth of the adult population in Europe suffer from respiratory allergy. Subcutaneous-allergen-specific-immunotherapy (SCIT) has long-term disease modifying effect on disease specific Health-Related Quality of Life (HRQoL). The purpose of this study was to assess the effect of SCIT on alternative disease outcomes in patients with grass-pollen and/or house dust mite induced allergic rhino-conjunctivitis and/or an asthma diagnosis. Focus was on expressing outcomes in terms of generic quality of life (Quality-Adjusted-Life-Years (QALY)) and reductions in sick days.Methods The study was a multi-centre study with prospective follow-up. 248 patients were initiated on SCIT. The disease specific Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ) and two generic (HRQoL) instruments 15D and EQ-5D were used at baseline and at follow-up. The outcome measures included change in; disease severity, RQLQ-scores, number of days with symptoms- and number of sick days per year and finally changes in generic HRQoL and thus, QALY. Disease severity was assessed by specialist doctors; severity of rhino-conjunctivitis was classified according to the Allergic Rhinitis and its Impact on Asthma (ARIA) and asthma severity according to the Global Initiative for Asthma (GINA guideline). The remaining outcome measures were assessed by the patients in questionnaires at baseline and at follow-up. An intension to treat approach was applied. For missing items imputation of sample mean base-line values or follow-up values were used after specified criteria. The effect of SCIT on rhino-conjunctivitis and/or asthma diagnoses was analysed at follow-up using three logistic regression models.Results The disease severity showed significantly improved disease control. Mean RQLQ-score was reduced from 3.02 at baseline to 2.00 at follow-up. Average annual days with symptoms were reduced from 189 to 145 days whilst annual sick days were reduced from 3.7 to 1.2 days. The 15D-score increased from 0.83 to 0.86 and the EQ-5D-score from 0.70 to 0.77, which indicated an annual gain per patient of 0.03-0.06 QALY.Conclusions Allergic patients suffering from rhino-conjunctivitis alone or rhino-conjunctivitis and asthma experience significantly increased HRQoL and they gain 0.03-0.06 QALY, when treated with SCIT for one year.Trial registration The study was registered at ClinicalTrials.gov with the identifier:NCT01486498.

Developing a Longitudinal Perspective on the Human Dimensions of Recreational Fisheries

ABSTRACT Tseng, Y.-P.; Huang, Y.-C., and Ditton, R., 2012. Developing a longitudinal perspective on the human dimensions of recreational fisheries. The purpose of this study is to demonstrate a longitudinal perspective on state-level recreational fisheries that could be used anywhere systematic angler surveys are conducted over time. With six angler surveys from Texas conducted over a 16-year time period, selected human dimension indicators of recreational fishing were analyzed with the index of qualitative variation (IQV) and Spearman rank-order correlation coefficient. Saltwater anglers demonstrated significant upward trends in household income, self-reported skill, preference for catching one particular species, and satisfaction with their fishing experiences. No significant downward trends were found. Although expected in some cases for various reasons, no significant trends were found in gender, baby boomer participation, racial/ethnic differences, years of fishing experience, and average annual days...

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Drug disorders and cardiovascular disease: the impact on annual hospital length of stay for the Medicare population.

We studied 3,942,868 Medicare patients (comprised of elderly and disabled) discharged with cardiovascular disease (CVD) during 1987, of which 41,095 (1%) had a drug disorder. Among this small subgroup, the percent of those overlapping with an alcohol and/or mental disorder is 33% for the elderly and 47% for the disabled. The presence of a drug disorder discharge diagnosis is associated with an excess of 329,650 days of hospital care and +174,498,071 in hospital charges as illustrated by a 51% increase in average annual days in the hospital for the elderly, and a similar 61% increase for the disabled. The concomitant increase in average annual discharges offers an explanation. Clinical progression in drug disorder severity (six categories were defined) is associated with increasing lengths of stay; for example, drug dependence comorbidities present longer lengths of stay than drug abuse comorbidities. Among the 12 categories of CVD defined, patients with rheumatic heart disease, hypertensive heart disease, hypertension, and other venous disorders were those whose length of stay experienced the largest percent increase when a drug disorder was present. When drug disorders compete with alcohol and/or mental disorders in a general linear model predicting average annual length of stay, they remain significant at the p < .001 level.