Concurrent Health Research Articles

Associations Between Diabetes Knowledge, the Prevalence of Diet-Related Chronic Conditions, and Dietary Behavior Among Hispanic/Latino Farm Workers with Type 2 Diabetes in the Salinas Valley, California, USA.

Studies on diabetes prevalence among U.S. farmworkers indicate prevalence ranging from 9.3% in California to 16.1% in Arizona, with 39.9% of the California cases previously undiagnosed. Hispanic/Latino farmworkers in California face unique barriers that place them at high risk for undiagnosed and poorly controlled Type 2 diabetes (T2D). Despite this, limited research has been conducted to assess their T2D knowledge. This cross-sectional survey tests associations between diabetes knowledge, prevalence of concurrent chronic health conditions, and dietary behavior. Participants (n = 118) were recruited using unstructured and snowball sampling approaches. On average, diabetes knowledge among participants who use insulin was considered low with a score of 9.57/20 (48% correct) and 9.15/18 (51% correct) for participants who do not use insulin. It was found that health insurance status (p = 0.015) and general education level (p = 0.001) were predictors of diabetes knowledge. Hypertension was the most prevalent chronic health condition among study participants (n = 61) and no significant correlation was found between diabetes knowledge and prevalence of a chronic health condition or dietary behavior. Findings suggest that insurance status and general education attainment may influence diabetes knowledge among Hispanic/Latino farmworkers.

Abortion and contraception within prison health care: a qualitative study

BackgroundAlthough abortion was completely decriminalized in Canada 36 years ago, barriers to pregnancy prevention and termination persist across the country, such as travel and information gaps. Research demonstrates incarcerated people face barriers to family planning care, yet there is no systematic data collection of sexual and reproductive health experiences and outcomes among incarcerated people in Canada. The aim of this study was to explore family planning care experiences among women and gender diverse people who have experienced incarceration in Canada.MethodsWe conducted a qualitative community-based research study using focus groups for data collection and reflexive thematic analysis to generate key themes. Our study team included members with lived experience of incarceration. We conducted recruitment in partnership with community organizations. We asked about accessing abortion and contraception while incarcerated and on release.ResultsWe conducted six focus groups with 35 recently incarcerated participants. Five themes emerged: (1) Competing health needs; (2) Institutional barriers to care; (3) Mistreatment and unethical care; (4) Health knowledge gaps; and (5) Challenges to care-seeking in community.ConclusionPeople in prison experience concurrent unmet health needs that crowd out sexual and reproductive health. Prison procedures and perceived unethical professional behaviours impinge care-seeking. Information about abortion and contraception is not readily available in prison. Barriers to care persist upon release. Family planning professionals may improve care for people who experience incarceration by recognizing concurrent mental health needs; anticipating impact of prior negative experiences on care-seeking; challenging limitations to health education in prison; and addressing post-release challenges for patients.

Participatory research towards the control of snakebite envenoming and other illnesses in a riverine community of the Western Brazilian Amazon.

Riverine communities face various health problems, which involve geographical and cultural barriers to accessing care, in addition to a lack of financial investments in services aimed at these communities, resulting in a process of invisibility for the population living in these regions. In this scenario, the significant burden of snakebite envenoming (SBE) highlights the need for participatory research to address ways to minimize this situation. Thus, this study aimed to describe the priority health problems identified by this population and the ranking of SBEs in that context, mapping solutions according to the local reality. This study was conducted in Limeira, a riverine community located in Tabatinga, in the extreme Western Brazilian Amazonia, on the borders with Peru and Colombia. The research lasted approximately one year, from 2021 to 2022.It is a participatory study that followed three steps: baseline assessment of the community, community assembly, and final data analysis. The study included a total of 42 participants in the sociodemographic survey, which served as the basis for the subsequent stages of data collection. Of these 42 individuals, 32 participated in the qualitative interviews, and 20 took part in the community assembly. Participants emphasized snakebite envenoming as a significant health issue, though not the only one, and reported frequent encounters with snakes, underscoring its severity as a concern. The qualitative analysis identified three main themes: Snakebites in the Community, which focused on personal experiences with snakes; Common Health Problems, which addressed other health issues faced by community members; and Community Defining Solutions, which discussed strategies and solutions proposed by the community to address these challenges. Improvements in health care delivery to populations living in Amazonian communities are possible with the judicious use of tested integrated interventions, particularly when the community identifies various concurrent health problems. SBE control programs in remote areas of the Brazilian Amazon should be planned with a multidisciplinary and intercultural approach, preferably integrated with broader interventions that address the population's needs for a range of health issues.

Insights into Maternal Health: Mentzer Index for Early Anemia Detection

The Mentzer Index is a widely used hematological tool for differentiating between iron deficiency anemia and thalassemia, especially in resource-limited settings where advanced diagnostic options may be unavailable. Calculated as the ratio of mean corpuscular volume (MCV) to red blood cell (RBC) count, it provides a quick and accessible method for anemia screening. For values over 13, iron deficiency anemia is more likely, while values below 13 typically indicate thalassemia. This simplicity makes the Mentzer Index advantageous in primary healthcare and community health settings, supporting early detection and intervention for at-risk populations, including pregnant women and children. Despite its usefulness, the Mentzer Index has limitations, including reduced specificity and accuracy in cases of coexisting anemia types, variations in age, and ethnic differences. Factors such as chronic inflammation, pregnancy-induced hemodilution, and concurrent health conditions can alter MCV and RBC values, potentially skewing the index and leading to misclassification. Additionally, the standard cut-off value may not universally apply to all populations, highlighting a need for localized studies to validate the index for diverse demographic and clinical groups. Moreover, the index is reliant on accurate laboratory results, which can be challenging in low-resource settings with limited access to quality-controlled equipment. Keywords: Mentzer Index, anemia detection, maternal health, iron deficiency anemia, thalassemia, early diagnosis, pregnancy complications

Exploring the Stability of Equilibria and Hopf-bifurcation in a Tuberculosis Model with Delayed Treatment

Abstract Tuberculosis poses a worldwide threat, particularly to low and middle-income nations. The timely screening, identification, and management of TB become problematic in these regions due to resource constraints, inadequate education and awareness, stigma and discrimination, weak healthcare infrastructure, and concurrent health conditions. This delay may lead to postponed diagnosis and treatment. This work presents and examines a mathematical model for tuberculosis that incorporates exogenous reinfection, slow-fast progression, and delay in detection and treatment. More precisely, we examine a scenario where a certain proportion of people with active tuberculosis receive prompt diagnosis and treatment, while the rest experience a delay in detection and appropriate treatment. First, we establish the non-negativity and boundedness of the solutions, and discuss the criteria for the existence of different equilibria. Then, the local stability of the equilibria is analyzed. The threshold value of the time delay which decides the local stability of the disease-free equilibrium (DFE) is obtained. We observe that the model exhibits a Hopf-bifurcation when the time delay crosses a certain threshold value, $\tau_0^*$. This reveals that the EEP is stable for $\tau<\tau_0^*$. However, as $\tau>\tau_0^*$, the EEP loses its stability via Hopf-bifurcation, leading to sustained periodic oscillations. Further, by applying center manifold theory, we analytically determine the direction and stability of the Hopf-bifurcation and validate the results numerically. It is observed that the Hopf-bifurcation is supercritical and the bifurcating periodic oscillations are stable. Global stability of the endemic equilibrium point (EEP) under certain conditions is established by choosing a suitable Lyapunov function. Additionally, the system also exhibits a Hopf-bifurcation in the absence of delay and numerical simulations are performed to determine the critical parameter values at which the bifurcation occurs. The impact of treatment delay is significant, as it not only contributes to the emergence of complex dynamical behavior but also significantly influences the stability properties of the system. This delay can lead to critical transitions, such as changes in equilibrium stability and the onset of oscillatory dynamics, depending on the interaction of system parameters.

Actor, partner, and similarity effects of attachment anxiety and avoidance on well-being and health in romantic couples

Romantic attachment orientations are important predictors of individuals’ and their partners’ well-being and health. However, less is known about whether similarity in attachment between partners predicts better well-being and health outcomes. In two studies (total N couples = 1,602), we tested with actor-partner interdependence and dyadic polynomial regression models if partners’ attachment and their similarity were linked to their well-being and health (i.e., life satisfaction, depressive symptoms, self-rated health, medical conditions). Results revealed significant actor effects between anxiety and life satisfaction (Study 1, male partners Study 2), depressive symptoms (both studies), self-rated health (both studies), and medical conditions (Study 2 only). For avoidance, significant actor effects were found for life satisfaction (Study 1, female partners Study 2), depressive symptoms (both studies), and self-rated health (both studies). Partner effects emerged for anxiety and life satisfaction (Study 1, male partners Study 2) and depressive symptoms (Study 1 only) and for avoidance and life satisfaction (Study 1, male partners Study 2), depressive symptoms (both studies), and self-rated health (both studies). The results of dyadic polynomial regression and response surface analyses, however, provided no evidence for any similarity effects of romantic attachment on well-being and health in both studies. In sum, the findings suggest that lower anxiety and avoidance in both partners is generally associated with higher well-being and health. However, similarity in partners’ attachment seem unimportant for concurrent well-being and health. Implications of the findings are discussed considering attachment theories and relationship processes.

A Rare Case Report Of Sigmoid Volvulus – An Important Differential To Consider In Acute Abdomen

Background: Sigmoid volvulus an uncommon source of bowel obstruction in middle-aged individuals.. This perilous condition pervades globally, with a pronounced predilection for elderly population burdened by concurrent health ailments. While both genders can fall victim, males (1) are more frequently affected. Case Report: A middle aged gentleman presented to emergency center reporting pain abdomen, vomiting , obstipation. On palpation generalized tenderness , guarding present, X – ray abdomen showed classic coffee bean (volvulus) immediately underwent emergency laparotomy - found sigmoid colon was distended and gangrenous. Sigmoidectomy with Hartmann’s performed. Conclusion: This case underscores the criticality of swift action in addressing this life-threatening ailment. Its evaluation should be of utmost importance among the potential diagnoses for individuals reporting with abdominal distention and pain, vomiting,obstipation. An abdominal X-ray (3) both erect and supine positions provides excellent diagnostic results

Health-related quality of life and supportive care needs in young adult cancer survivors—a longitudinal population-based study

PurposeTo examine health-related quality of life (HRQoL) and supportive care needs among young adult (YA) cancer survivors up to 3 years post-diagnosis.MethodsA national cohort of individuals diagnosed at 18–39 years with breast, cervical, ovarian, or testicular cancer, lymphoma or brain tumor was approached with surveys at 1.5 (n = 1010, response rate 67%) and 3 (n = 722) years post-diagnosis. HRQoL was measured using the EORTC QLQ-C30. Scores were dichotomized using cut-off scores to predict supportive care needs in the Supportive Care Needs Survey-Long Form 59 (SCNS-LF59). Swedish cancer quality registers provided clinical data. Factors predicting need of support at 1.5 and 3 years post-diagnosis were identified using logistic regression.ResultsHRQoL improvements over time were trivial to small. At both time points, a majority of respondents rated HRQoL levels indicating supportive care needs. At 1.5 years post-diagnosis, the risk of having support needs was lower among survivors with testicular cancer (compared to lymphoma) or university-level education, and higher among those on treatment (predominantly endocrine therapy). At 3 years post-diagnosis, when controlling for previous HRQoL scores, most correlations persisted, and poor self-rated household economy and chronic health conditions were additionally associated with supportive care needs.ConclusionA majority of YAs diagnosed with cancer rate HRQoL at levels indicating support needs up to 3 years post-diagnosis. Testicular cancer survivors are at lower risk of having support needs. Concurrent health conditions and poor finances are linked to lower HRQoL. More efforts are needed to provide adequate, age-appropriate support to YA cancer survivors.

Role of Homeopathy in Managing COVID-19 Symptoms in Elderly Patients: A Case Series Study

The global healthcare systems are facing a substantial challenge due to the COVID-19 pandemic, particularly concerning elderly patients with concurrent health conditions. This research study outlines the use of homeopathic remedies in managing COVID-19 symptoms among elderly patients. A comprehensive analysis of 116 elderly cases was conducted based on the severity of symptoms and associated health conditions. The study revealed that remedies such as Sulphur, Arsenicum Album, Lycopodium, and Phosphorus demonstrated notable efficacy in addressing severe cases, while Bryonia and Carbo Vegetabilis proved beneficial in alleviating cough and breathlessness, respectively.

398. DYSPHAGIA OR REGURGITATION AND ITS CORRELATES AMONG UP TO 10-YEAR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURVIVORS

Abstract Background Dysphagia and regurgitation significantly impair the quality of life among survivors of esophageal squamous cell carcinoma (ESCC). Notably, the prevalence and associated factors of these symptoms in long-term survivors, particularly within Asian populations, remain underexplored. This study endeavors to bridge these critical knowledge gaps. Methods We evaluated the severity of dysphagia and regurgitation (mild, moderate, and severe), and their associations with clinical features and lifestyle factors among 512 10-year ESCC survivors who underwent ESCC radical surgery. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-surgery, and dysphagia and regurgitation was assessed at the 10-year post-surgery follow-up survey. Results In this study, 13.3% and 27.0% of participants reported dysphagia and regurgitation, respectively. Multivariable polytomous regression analysis revealed a significant association of dysphagia with upper thoracic esophageal carcinoma (mild dysphagia OR: 2.371, 95% CI: 1.051, 5.347) and postoperative radiotherapy and chemotherapy (mild dysphagia OR: 4.352, 95% CI: 2.168, 8.732; moderate/severe dysphagia OR: 3.651, 95% CI: 1.046, 12.745). An inverse relationship was observed between dysphagia and dietary quality as measured by the CHFP-2007 score (mild dysphagia OR: 0.458, 95% CI: 0.341, 0.615; moderate/severe dysphagia OR: 0.168, 95% CI: 0.089, 0.316). For regurgitation, positive associations were found with higher income level (mild regurgitation OR: 2.074, 95% CI: 1.020, 4.216), insomnia (moderate/severe regurgitation OR: 3.523, 95% CI: 1.127, 11.010), and use of Chinese patent medicine (mild regurgitation OR: 2.264, 95% CI: 1.279, 4.007). Conversely, age at surgery (moderate/severe dysphagia OR: 0.907, 95% CI: 0.848, 0.970) and higher dietary quality (mild dysphagia OR: 0.744, 95% CI: 0.606, 0.914; moderate/severe dysphagia OR: 0.406, 95% CI: 0.259, 0.634) showed protective effects against regurgitation. Conclusions The prevalence of dysphagia and regurgitation among long-term survivors of ESCC in China is high, underscoring a significant health concern. This study identifies critical correlates such as the tumor's anatomical site, the nature of postoperative interventions, dietary quality, socioeconomic standing, and concurrent health issues. These findings advocate for the integration of postoperative management approaches, including tailored dietary and lifestyle adjustments, aimed at mitigating these symptoms in long-term ESCC survivors.

Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior.

Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.

Evolution of an epidemic: Understanding the opioid epidemic in the United States and the impact of the COVID-19 pandemic on opioid-related mortality.

We conduct this research with a two-fold aim: providing a quantitative analysis of the opioid epidemic in the United States (U.S.), and exploring the impact of the COVID-19 pandemic on opioid-related mortality. The duration and persistence of the opioid epidemic lends itself to the need for an overarching analysis with extensive scope. Additionally, studying the ramifications of these concurrent severe public health crises is vital for informing policies to avoid preventable mortality. Using data from CDC WONDER, we consider opioid-related deaths grouped by Census Region spanning January 1999 to October 2022 inclusive, and later add on a demographic component with gender-stratification. Through the lens of key events in the opioid epidemic, we build an interrupted time series model to reveal statistically significant drivers of opioid-related mortality. We then employ a counterfactual to approximate trends in the absence of COVID-19, and estimate excess opioid-related deaths (defined as observed opioid-related deaths minus projected opioid-related deaths) associated with the pandemic. According to our model, the proliferation of fentanyl contributed to sustained increases in opioid-related death rates across three of the four U.S. census regions, corroborating existing knowledge in the field. Critically, each region has an immediate increase to its opioid-related monthly death rate of at least 0.31 deaths per 100,000 persons at the start of the pandemic, highlighting the nationwide knock-on effects of COVID-19. There are consistent positive deviations from the expected monthly opioid-related death rate and a sizable burden from cumulative excess opioid-related deaths, surpassing 60,000 additional deaths nationally from March 2020 to October 2022, ∼70% of which were male. These results suggest that robust, multi-faceted measures are even more important in light of the COVID-19 pandemic to prevent overdoses and educate users on the risks associated with potent synthetic opioids such as fentanyl.

Malnutrition among the older adult: an additional challenge for the rehabilitation team-insights of a small population of Switzerland.

Nutritional deficiency among the older adult is a widespread concern, significantly affecting their health. The prevalence of malnutrition increases with age, concurrent health conditions, and the level of care provided. Hospital stays can affect as 90% of the older adult. Malnutrition can hinder efforts to improve health and regain function in individuals undergoing rehabilitation. This study aims to assess the frequency of malnutrition among geriatric rehabilitation patients. A retrospective quantitative analysis was conducted on 357 patients admitted to the geriatric unit at Lucerne Cantonal Hospital Wolhusen in Switzerland. The patients' nutritional status was evaluated using the standardized Mini Nutritional Assessment Long Form questionnaire. The initial analysis indicated a considerable prevalence of malnutrition among the geriatric population: 31.1% were identified as malnourished (MNA < 17), while an additional 35.8% were at risk of malnutrition (MNA 17-23.5), totaling 66.9% of patients. The Kruskal-Wallis ANOVA test revealed a statistically significant difference in MNA scores among different age groups (p = 0.035). Statistical analysis also suggested a slightly higher prevalence of malnutrition among female patients. The duration of rehabilitation varied from 20.07 ± 6.93 to 22.20 ± 7.50 days, with longer durations associated with lower MNA scores. A correlation analysis between MNA values and body mass index (BMI) showed a positive correlation coefficient (r = 0.56), indicating that lower MNA scores were associated with lower BMI and vice versa. Malnutrition is prevalent among individuals over 65 years old, highlighting the importance of regular and timely nutritional assessments for geriatric patients to mitigate the complications and enhance prognoses in both acute care and rehabilitation settings. Such assessments can also improve the efficacy of rehabilitation programs and potentially reduce the duration of rehabilitation, thus carrying significant economic implications.

The effects of occupational disruption during COVID-19 lockdowns on health: a cross-sectional study.

The disruption in daily activity performance during COVID-19 lockdowns is widely understood to have impacted health, but a better understanding of how restricted performance of specific activities are associated with health is needed. This cross-sectional study answers the following question: How were changes in the performance of 16 daily activities associated with health during COVID-19 lockdowns? A total of 116 participants completed an online survey rating their health before and during COVID-19 lockdowns and comparing their recollection of the performance of 16 activities before COVID-19 with their performance during lockdowns. Multiple stepwise linear regression analysis was used to estimate the relationship between self-reported changes in activities during lockdowns and concurrent (during-lockdown) health status, while controlling for pre-COVID-19 health status. Only changes in activities that were uniquely and significantly associated with lockdown health status were retained in the final model. Health before COVID-19 accounted for 3.7% (P=0.039) of the variance in health during COVID-19 lockdowns. After controlling for health before COVID-19, five types of activity were significantly and uniquely predictive of health during lockdowns, together accounting for 48.3% of the variance. These activities and the variances they accounted for were rest and sleep (29.5%, P<0.001), play and recreational activities (8%, P<0.001), work (4.8%, P=0.002), personal hygiene (3.2%, P=0.01), and healthy eating (2.8%, P=0.013). The study suggests that these five types of activity should be prioritized in policy or interventions when participation in activity is constrained by lockdowns or comparable factors.

Determinants of mortality in hypertensive patients admitted with COVID-19: a single-centre retrospective study at a tertiary hospital in South Africa

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted global health, with successive outbreaks leading to substantial morbidity and mortality. Hypertension, a leading cause of cardiovascular disease globally, has been identified as a critical comorbidity in patients with severe COVID-19, exacerbating the risk of adverse outcomes. This study aimed to elucidate the impact of hypertension on COVID-19 outcomes within the South African context.MethodsA retrospective analysis was conducted at King Edward VIII Hospital, KwaZulu-Natal, South Africa, encompassing patients aged 13 years and above admitted with laboratory-confirmed SARS-CoV-2 infection between June 2020 and December 2021. The study investigated the association between hypertension and COVID-19 outcomes, analysing demographic, clinical, and laboratory data. Statistical analysis involved univariate and multivariate logistic regression to identify predictors of mortality among the hypertensive cohort.ResultsThe study included 420 participants—encompassing 205 with hypertension. Hypertensive patients demonstrated significantly greater requirements for oxygen and steroid therapy (p < 0.001), as well as higher mortality rates (44.88%, p < 0.001)) compared to their non-hypertensive counterparts. Key findings demonstrated that a lower oxygen saturation (adjusted odds ratio (aOR) 0.934, p = 0.006), higher pulse pressure (aOR 1.046, p = 0.021), elevated CRP (aOR 1.007, p = 0.004) and the necessity for mechanical ventilation (aOR 5.165, p = 0.004) were independent risk factors for mortality in hypertensive COVID-19 patients. Notably, the study highlighted the pronounced impact of hypertension-mediated organ damage (HMOD) on patient outcomes, with ischemic heart disease being significantly associated with increased mortality (aOR 8.712, p = 0.033).ConclusionHypertension significantly exacerbates the severity and mortality risk of COVID-19 in the South African setting, underscoring the need for early identification and targeted management of hypertensive patients. This study contributes to the understanding of the interplay between hypertension and COVID-19 outcomes, emphasising the importance of considering comorbidities in the management and treatment strategies for COVID-19. Enhanced pandemic preparedness and healthcare resource allocation are crucial to mitigate the compounded risk presented by these concurrent health crises.

Mental Health Among Hypertensive People and its Associated Factors: Findings From RISKESDAS 2018 Data

This study aims to investigate the complex relationship between general mental health issues, specifically depression, and hypertension, and to identify associated factors among individuals affected by these conditions in Indonesia. Using data from the Indonesia National Basic Health Research (RISKESDAS) in 2018, the study included a large sample of 88,590 individuals aged 30−59 with hypertension from various provinces and districts across Indonesia. The findings show that 11.5% of hypertensive individuals in the 30−59 age range in Indonesia experience general mental health problems, including common mental disorders, while 7.0% exhibit symptoms of depression. Importantly, individuals with multiple coexisting health conditions are more susceptible to mental health issues. Furthermore, factors such as female gender, lower educational attainment, unmarried status, unemployment, physician-diagnosed hypertension, and the presence of other concurrent health conditions are identified as contributors to an increased likelihood of experiencing general mental health problems and depression. Finally, this study emphasizes the importance of addressing mental health concerns among individuals dealing with hypertension and other non-communicable diseases in Indonesia, with a particular focus on those with lower educational levels, unmarried status, and unemployment.

A Matter of Climate Justice: Heat and Air Pollution Combine to Worsen Effects of Homelessness.

Few studies on these concurrent health risks account for individuals without housing, yet they often experience greater exposure than other people-along with exacerbation of existing health issues.

A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas

Models predicting health care spending and other outcomes from administrative records are widely used to manage and pay for health care, despite well-documented deficiencies. New methods are needed that can incorporate more than 70 000 diagnoses without creating undesirable coding incentives. To develop a machine learning (ML) algorithm, building on Diagnostic Item (DXI) categories and Diagnostic Cost Group (DCG) methods, that automates development of clinically credible and transparent predictive models for policymakers and clinicians. DXIs were organized into disease hierarchies and assigned an Appropriateness to Include (ATI) score to reflect vagueness and gameability concerns. A novel automated DCG algorithm iteratively assigned DXIs in 1 or more disease hierarchies to DCGs, identifying sets of DXIs with the largest regression coefficient as dominant; presence of a previously identified dominating DXI removed lower-ranked ones before the next iteration. The Merative MarketScan Commercial Claims and Encounters Database for commercial health insurance enrollees 64 years and younger was used. Data from January 2016 through December 2018 were randomly split 90% to 10% for model development and validation, respectively. Deidentified claims and enrollment data were delivered by Merative the following November in each calendar year and analyzed from November 2020 to January 2024. Concurrent top-coded total health care cost. Model performance was assessed using validation sample weighted least-squares regression, mean absolute errors, and mean errors for rare and common diagnoses. This study included 35 245 586 commercial health insurance enrollees 64 years and younger (65 901 460 person-years) and relied on 19 clinicians who provided reviews in the base model. The algorithm implemented 218 clinician-specified hierarchies compared with the US Department of Health and Human Services (HHS) hierarchical condition category (HCC) model's 64 hierarchies. The base model that dropped vague and gameable DXIs reduced the number of parameters by 80% (1624 of 3150), achieved an R2 of 0.535, and kept mean predicted spending within 12% ($3843 of $31 313) of actual spending for the 3% of people with rare diseases. In contrast, the HHS HCC model had an R2 of 0.428 and underpaid this group by 33% ($10 354 of $31 313). In this study, by automating DXI clustering within clinically specified hierarchies, this algorithm built clinically interpretable risk models in large datasets while addressing diagnostic vagueness and gameability concerns.

Benefits of Personalized Diet, Nutrition, And Exercise Programs for Cancer Survivors

Nutrition, diets, and exercise are critical pillars in fortifying the well-being of cancer survivors. A balanced and nutrientrich diet serves as a linchpin in the recovery process for cancer, providing essential vitamins and minerals crucial for rejuvenating weakened immune systems and promoting overall health. The comprehensive influence of nutritional variables, including weight, food, physical activity, and alcohol use, goes beyond cancer development and affects outlook; the standard of living, concurrent health conditions, reappearances, and the incidence of recurrent malignancies are important factors to consider. However, despite their undeniable importance, a comprehensive understanding of their correlating effects on cancer survivors is hindered by the relatively recent and limited literature. This review aims to address existing gaps in current research, emphasizing recent studies and reviews related to nutrition, diets, alcoholic beverages, obesity, and exercise in cancer patients. This review focuses on specific areas necessitating further investigation by synthesizing and scrutinizing the latest findings. By exploring recent advancements, the goal is to contribute to a profound understanding of tailored nutrition plans, specific diets, lifestyle modifications, and exercise regimens, which can strategically enhance cancer survivors' well-being and long-term outcomes.

A Rare Case of Hairy Cell Leukemia with COVID Infection: A Case Report

Abstract Hairy cell leukemia (HCL) is a distinct subset of chronic lymphoid leukemia, presents with unique features, including the characteristic "hairy" projections seen in neoplastic B cells. We reported a case on hairy cell leukemia (HCL), emphasizing the challenges posed by this rare hematological malignancy, especially in the context of concurrent health crises such as the COVID-19 pandemic. This malignancy, though uncommon, necessitates comprehensive diagnostic methodologies, such as peripheral blood studies, flow cytometry, and bone marrow biopsy. Treatment strategies for HCL involve tailored approaches based on symptomatic presentations. Purine analogs, cladribine and pentostatin, stand as first-line interventions, showcasing efficacy in inducing and sustaining remission. However, the prolonged immunosuppression resulting from these treatments warrants vigilant monitoring for potential infectious complications. Emerging therapies, such as the BRAF inhibitor vemurafenib, provide additional options for refractory or progressive cases. The post-treatment phase demands meticulous follow-up, with an emphasis on regular blood work assessments by an oncology nurse and primary care physician. Our case further highlights the need for heightened awareness among healthcare professionals, particularly in the post-COVID-19 phase, where persistent symptoms led to the discovery of an underlying hematological disorder. Keywords: Hairy cell leukemia, Evan syndrome, Covid-19.