Deterioration In Health Outcomes Research Articles

Multiple Myeloma and DALY in the USA: Insights of the Global Burden of Disease

Introduction: In contrast to the global trends, which indicate an escalating incidence and mortality of Multiple Myeloma (MM), the United States presents an inverse scenario. The successful development and deployment of therapeutic interventions have led to an appreciable decrease in mortality by 18%. Among the diverse array of prognostic factors associated with MM, age stands out as a significant element, typically associated with poor prognosis. With these considerations in mind, our study aimed to undertake a systematic analysis of the incidence, mortality, and Disability-Adjusted Life Years (DALY) related to MM over a decade in the United States. Methods: The Global Burden of Disease (2019) offers extensive assessments of the incidence, mortality, and DALY in the United States from 1990 to 2019. The data was gathered using the Global Health Data Exchange query tool. We analyzed the annual percentage change (APC) over this period and compared different age groups to enhance the current trend of incidence, mortality, and DALY in the United States between 2009-2019. Results: Our analysis was structured around three distinct age groups-15-49 years, 50-74 years, and 75+ years, with each category further stratified by gender. For the 15-49 years cohort, males consistently exhibited higher average Disability-Adjusted Life Years (DALYs) at 15.60 per 100,000, as compared to their female counterparts, who averaged at 10.05. Intriguingly, the Annual Percentage Change (APC) displayed a downward trajectory for DALYs, Deaths, and Incidence rates over the period under study, with respective APC values of -1.79, -1.81, and -1.95. This trend indicates a consistent improvement in health outcomes for this age group. On the other hand, the 50-74 years age group revealed a significantly ascending trend in all health measures. Here, females and males recorded average DALYs of 98.13 and 143.33 per 100,000, respectively. The APC values for this group underscored an increasing trajectory-0.72 for both DALYs and Incidence and 0.92 for Deaths-signifying a worsening in health outcomes over the duration of observation. Lastly, in the oldest age group of 75+ years, the DALYs surged to 235.78 for females and 379.87 for males per 100,000. Although the APC values for this age group were positive, they were relatively lower than those for the 50-74 years group, with APC values of 0.62 for DALYs, 0.44 for Deaths, and 0.39 for Incidence. Conclusion: New therapies in MM have decreased the average of DALY in the US over the studied decade. Between the ages 15-49 years, the study's results align with the current data correlating younger age with a better prognosis. However, when divided into age categories, the subgroup from 50-74 years showed a possible rapid deterioration in health outcomes when compared with patients above 75 years old. Additional studies are needed to better understand this underlying pathophysiology to have better results and develop further therapies.

Improved Medication Adherence with the Use of Extended-Release Tacrolimus in Liver Transplant Recipients: A Pilot Randomized Controlled Trial.

Nonadherence to immunosuppression in liver transplant recipients (LTRs) leads to deterioration in health outcomes. Once-dailyextended-release tacrolimus (TAC-ER) may improve adherence when compared to twice-dailyimmediate-release tacrolimus (TAC-IR). We conducted a randomized controlled study to evaluate medication adherence, clinical efficacy, and safety of TAC-ER in stable LTR. All patients >18 years who underwent liver transplantation before 6 months were eligible. Patients were randomized 1 : 1 to continued TAC-IR or conversion to TAC-ER. The primary outcome was change in medication adherence from baseline to 9 months, assessed using BAASIS. Secondary outcomes were tacrolimus trough levels, safety, and quality of life. Thirty-one patients were consented and randomized to either of the two groups: conversion to TAC-ER (n = 15) or continued TAC-IR (n = 16). Six patients in the TAC-ER group withdrew after randomization due to apprehension about switching medication (n = 2), unwillingness to travel (n = 2), and increased liver tests after conversion (n = 2, both were acute rejections despite therapeutic tacrolimus levels and were considered unrelated to TAC-ER). We compared the results of nine patients in the TAC-ER group that completed the study with those of sixteen in the TAC-IR group. At baseline, there was no difference in tacrolimus trough levels between groups. Improved adherence was observed in the TAC-ER group as 100% of patients reported at least one period of full adherence during the study period (100% vs. 62.6%, p = 0.035). Tacrolimus trough levels and liver tests were comparable between groups throughout the study. There were no differences in eGFR, HbA1c, or QoL between the groups. TAC-ER improved medication adherence while maintaining comparable trough levels, liver function, and QoL as TAC-IR in LTR.

Does Residing in a Neighborhood of High Social Participation Postpone Deterioration in Health among Middle-Aged Adults? A Multilevel Survival Analysis in Japan.

Social participation (SP) is known to have a favorable impact on an individual's health. This study examined whether residing in a neighborhood with a high SP level would be predictive of delayed deterioration in health outcomes, even after controlling for individual SP. With the 14-wave longitudinal data of 32,388 individuals (15,749 men and 16,639 women) aged 50-59 years residing in 2,477 neighborhoods in 2005, we used multilevel Cox proportional hazards models to examine the impact of neighborhood SP on the onset of problems in activities of daily living (ADL), poor self-rated health, and psychological distress. Residing in a neighborhood with high SP levels modestly postponed the onset of health problems in individuals. The hazard ratio (HR) of ADL problems in response to residing in a neighborhood with above-average SP levels was 0.92 (95% confidence interval [CI]: 0.85-0.99) and 0.93 (95% CI: 0.87-1.00) for men and women, respectively, even after controlling for an individual's SP and other attributes. The results for other health outcomes showed a similar pattern. These findings suggest that high neighborhood SP has a favorable impact on health among middle-aged adults, independent of individual SP. Policy measures to enhance and promote neighborhood SP are thus needed in terms of public health.

Disability, Frailty and Depression in the community-dwelling older adults with Osteosarcopenia

BackgroundThe purpose of this study was to investigate the prevalence of osteosarcopenia in the over 60-year-old community and to evaluate whether osteosarcopenia is associated with disability, frailty and depression.MethodsThis study was performed using the baseline data of Namgaram-2, among the 1010 surveyed subjects, 885 study subjects who were 60 years or older and had all necessary tests performed were selected. The Kaigo-Yobo checklist (frailty), World Health Organization Disability Assessment Schedule (WHODAS) and Geriatric Depression Scale-Short Form-Korean (GDSSF-K) were used. The Asian Working Group for Sarcopenia (AWGS 2019) were applied in this study. Osteopenia was measured using data from dual energy X-ray absorptiometry (DEXA) and osteopenia was diagnosed when the T-score was less than − 1.0.The study subjects were divided into four groups: the normal group, in which both sarcopenia and osteopenia were undiagnosed, osteopenia only, sarcopenia only and the osteosarcopenia group, which was diagnosed with both sarcopenia and osteopenia.ResultsOf the 885 subjects over 60 years old evaluated, the normal group comprised 34.0%, the only osteopenia group 33.7%, the only sarcopenia group 13.1%, and the osteosarcopenia group 19.2%. WHODAS (17.5, 95% CI: 14.8-20.1), Kaigo-Yobo (3.0, 95% CI: 2.6-3.4), and GDSSF mean score (4.6, 95% CI: 3.9-5.4) were statistically significantly higher in the osteosarcopenia group compared the other groups. Partial eta squared (ηp2) of WHODAS (0.199) and Kaigo-Yobo (0.148) values ​​according to Osteosarcopenia were large, and GDSSF (0.096) was mediumConclusionsOsteosarcopenia is a relatively common disease group in the older adults community that may cause deterioration of health outcomes. Therefore, when evaluating osteopenia or sarcopenia in the older adults, management of those in both disease groups should occur together.

The best of both worlds? The economic effects of a hybrid fee-for-service and prospective payment reimbursement system.

Countries seeking to move away from a purely fee-for-service (FFS) system may consider a hybrid approach whereby only some procedures are paid by FFS while others are paid prospectively. Yet little evidence exists whether such a hybrid payment system contains overall costs without adverse influences on health outcomes. In 2003, Japan experienced a reform from FFS to a hybrid payment system in which only some inpatient procedures were paid prospectively. We exploit this reform to test how such a hybrid system affects overall costs and health outcomes. Briefly, we find that healthcare providers responded opportunistically to the reform, moving some procedures out of the bundled inpatient setting to FFS services, leading to no reduction in cost. There was some evidence of a moderate deterioration in health outcomes, in terms of a decline in the probability of symptoms being cured at discharge. In sum, our results suggest that in some cases, a hybrid payment system can be non-superior to either FFS or prospective payment system.

Long-Term Deterioration of Perceived Health and Functioning in Adults With Cerebral Palsy

ObjectiveTo describe longitudinal change in perceived health, presence of health issues, and functional level in adults with cerebral palsy (CP). DesignProspective cohort study. SettingParticipants' daily environment. ParticipantsAdults (N=49) with CP (age range, 35–45y; 27 [55%] men; 36 [75%] spastic) formerly known in pediatric rehabilitation care participated. InterventionsNot applicable. Main Outcome MeasuresPostal questionnaires were completed by the adults or their proxies (n=9). Health outcomes included perceived health (adapted from the 36-Item Short Form Health Survey) and presence of health issues such as pain, severe fatigue (dichotomized), and functional level (Barthel Index; walking performance). ResultsOver a 10-year period, the percentage of adults with CP worrying about their health increased (29%–54%; P=.008) and those indicating that health problems limit their activities increased (19%–45%; P=.002). In the same period, most adults continued to report good general health (93%–86%; P=.148). Presence of some health issues increased over time, such as pain; severe fatigue was a common health issue at follow-up (32%). Over a 14-year period, mobility and self-care deteriorated (Barthel Index, 17.1±4.8 to 16.3±5.6; P=.007). Walking performance, specifically indoors, declined (83%–71%; P=.010). ConclusionsAdults with CP experienced deterioration in health outcomes in the long term. Most notably, perceived health and functional level decreased. Pain and severe fatigue were the most common health issues in adult CP. More research is required to explore the mechanisms at work in the process of aging in persons with CP. Systematic follow-up of adults with CP appears necessary to timely detect and intervene in health problems and functional decline.