Use Of Medical Care Research Articles

Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey.

Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption.

Racial/ethnic disparities in cost-related barriers to care among near-poor beneficiaries in Medicare Advantage vs traditional Medicare.

To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional Medicare (TM) overall and stratified by supplemental insurance enrollment. Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey. Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% of the federal poverty level. We assessed differences in cost-related medical care barriers and cost-related dental care barriers as well as receipt of annual eye exams in MA vs TM. For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities were not statistically significant. MA was not associated with narrower differences in Hispanic-White or Black-White disparities in dental care access. Higher proportions of Black and Hispanic beneficiaries in MA received an annual eye exam vs White beneficiaries in both MA and TM. MA was associated with narrower racial disparities primarily compared with TM without supplemental insurance. Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did not uniformly narrow racial/ethnic disparities in access and use. These findings highlight the importance of maintaining and enhancing features of Medicare coverage that may promote equitable access to care, including additional benefits and lower cost sharing.

Disparities in the utilization of supportive care medications among older adults with metastatic pancreatic ductal adenocarcinoma.

51 Background: Inequities in cancer care delivery can profoundly affect access to high-quality treatments and patient outcomes. Supportive care medication use is important for preserving quality of life in older adults with metastatic pancreatic ductal adenocarcinoma (PDAC). Whether there are differences in supportive care medication use by race and sex is unknown. Our objectives were to assess the racial/ethnic and biological sex inequities in use of treatments for pain, depression, and pancreatic insufficiency-related treatments (PERT) among older adults with PDAC. Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked database, to identify Medicare beneficiaries aged 65 and older diagnosed with metastatic PDAC from January 2008 to December 2019. We included those continuously enrolled in Medicare prescription drug benefits in the 6 months before and month of diagnosis. Any use of opioid pain medications, antidepressants, and PERT was identified from diagnosis to the end of the study period (at death, disenrollment, or 12 months). Multivariable regression was used to compare supportive care medications use by racial/ethnic and biological sex groups. Results: There were 29,509 individuals in our sample, with12.9% Black patients, 3.9% Hispanic patients, and 83.2% White patients. The mean age was 76.5 (SD: 7.4) years. Mean follow-up time was 135.4 (SD:117.7) days overall, with the shortest follow-up among Black patients 124 (SD:111.1) days and longest for White patients 137.5 (SD: 118.8) days. Antidepressants were used by 23.8%, opioids by 60.3%, and PERT by 12.4% overall. Within race groups there were limited differences in medication use by sex. However, we observed differences in supportive care treatment use by race and ethnicity. Specifically, relative to White individuals, those who identified as Black were 20% less likely (adjusted risk ratio [aRR]: 0.8, 95% CI:0.74-0.85) to receive antidepressants, 14% less likely to receive opioids (aRR: 0.86, 95% CI:0.84-0.89), and 41% less likely to receive PERT (aRR: 0.59, 95% CI:0.53-0.65). Similar patterns were observed for patients of Hispanic ethnicity, with those individuals being 12% less likely (adjusted risk ratio[aRR]: 0.88, 95% CI:0.89-0.98) to receive antidepressants, 9% less likely to receive opioids (aRR: 0.91, 95% CI:0.87-0.96), and 42% less likely to receive PERT (aRR: 0.58, 95% CI:0.47-0.70). Conclusions: Our preliminary data showed differences in the uptake of supportive care drugs among Black and Hispanic patients relative to White patients. Specifically, these individuals were less likely to start opioid pain medications, antidepressants, and pancreatic enzyme replacement therapy compared to their White counterparts. These findings highlight potential gaps in treatment use that may better support patients facing life-limiting illnesses.

Emotion regulation among adults with asthma: Links with short-acting inhaler medication overuse and utilization of acute medical care

Objective Existing research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion were associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma. Methods The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Sequential binary logistic regression models were used to examine the associations of emotion regulation with short-acting inhaled medication use and acute medical care use, controlling for patient characteristics and comorbid mental health conditions. Results Greater difficulties with emotion regulation were significantly associated with greater odds of short-acting inhaler medication overuse (p < 0.001), emergency department visits (p < 0.001), and hospitalizations (p = 0.001). Conclusions Emotion dysregulation may play an important role in asthma management. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse and acute service use. The current findings should be interpreted in the context of several limitations, including the use of self-report measures. Future research should use electronic medical records or metered dose inhalers to objectively assess short-acting inhaler overuse and acute medical care use.

Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis.

The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed. This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic. Interrupted time series analysis of national medical claims data. Individuals with home medical care use occurring in Japan between April 2019 and March 2022. The declaration of a state of emergency (April 2020) by the Japanese government. The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals). Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43to2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549to1683; 1459 uses/month, 95% CI 612to2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73to209; 215 uses/month, 95% CI 114to317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals. The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

An examination of relationships between transdiagnostic psychological processes and mental health disorders in athletes

IntroductionThe aims of this study were (a) to identify links between transdiagnostic psychological processes and mental health disorder (MHD) symptoms, and (b) to examine differences in MHD and transdiagnostic psychological processes as a function of demographic variables, including, gender, status as an athlete (elite vs. non-elite), number of training sessions per week, previous severe injuries, and use of medical care following severe injuries. MethodsA total of 159 competitive athletes aged between 18 and 40 years old (44 % female; mean age = 24.20 ± 4.88 years) participated in this cross-sectional study. Participants completed a demographic questionnaire along with validated questionnaires evaluating MHD symptoms and transdiagnostic processes including: motivation to practice sport, emotional competencies, self-efficacy, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionist behaviors. ResultsMHD symptoms were positively correlated with controlled forms of motivation, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionistic behaviors; and negatively correlated with emotional competencies and self-efficacy. Gender differences showed that women were more likely to experience MHD, higher levels of repetitive negative thinking, meta-cognitive beliefs, and lower levels of emotional competencies and self-efficacy than men. Finally, elite athletes showed higher personal standards than their non-elite counterparts and those training more than four times per week showed significantly higher perfectionistic behaviors. DiscussionThese results are in line with previous findings in clinical psychology and shed light on the role of transdiagnostic processes and the risk of MHD in a sample of French athletes. Further research on the identification of key risk factors for MHD in competitive athletes is needed.

Spinal fusion surgery use among adults with low back pain enrolled in a digital musculoskeletal program: an observational study

ObjectivesTo compare 12-month spinal fusion surgery rates in the setting of low back pain among digital musculoskeletal (MSK) program participants versus a comparison cohort who only received usual care.Study DesignRetrospective cohort study with propensity score matched comparison cohort using commercial medical claims data representing over 100 million commercially insured lives.MethodsAll study subjects experienced low back pain between January 2020 and December 2021. Digital MSK participants enrolled in the digital MSK low back program between January 2020 and December 2021. Non-participants had low back pain related physical therapy (PT) between January 2020 and December 2021. Digital MSK participants were matched to non-participants with similar demographics, comorbidities and baseline MSK-related medical care use. Spinal fusion surgery rates at 12 months post participation were compared.ResultsCompared to non-participants, digital MSK participants had lower rates of spinal fusion surgery in the post-period (0.7% versus 1.6%; p < 0.001). Additionally, in the augmented inverse probability weighting (AIPW) model, digital MSK participants were found to have decreased odds of undergoing spinal fusion surgery (adjusted odds ratio: 0.64, 95% CI: 0.51–0.81).ConclusionsThis study provides evidence that participation in a digital MSK program is associated with a lower rate of spinal fusion surgery.

Endovascular thrombectomy for acute ischemic stroke with a large infarct area: An updated systematic review and meta-analysis of randomized controlled trials

BackgroundSince the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone. MethodsWe searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs). ResultsOur meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69). ConclusionEndovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.

한국의 의료 공공성에 대한 인식 격차*

Medical care is an essential social service that supports other valued goods, such as life, health, safety, and the guarantee of social opportunities. In many countries, access to medical care is provided through public health insurance systems. South Korea’s medical insurance system, which has expanded at an unprecedented rate in recent decades, performs very well by several internationally recognized indicators. However, excessive government regulations, a private-centered supply of medical resources, and overuse of the system by patients have led to a misallocation of medical resources. This article examines the supply and use of medical care by the Korean government, the medical community, patients, and citizens, highlighting awareness gaps in the public value and nature of medical care. Recognizing this issue is the first step in building a sustainable medical system that ensures that medical resources are appropriately allocated and utilized.

A Study on the Hospitalization of Inpatients in Daegu Metropolitan City to Medical Institutions in the Seoul Metropolitan Area During the COVID-19 Pandemic

Objectives: This study analyzed the characteristics and factors of medical use in the metropolitan area of hospitalized patients living in Daegu Metropolitan City in unmet medical conditions during the COVID-19 pandemic. Methods: The results of frequency analysis, cross-analysis, and logistic regression analysis using in-depth discharge damage survey data from January 20, 2020 to December 31, 2021, during the COVID-19 pandemic are as follows. Results: Excluding gender, age, residential area, hospitalization route, main diagnosis, presence of surgery, and severity had a statistically significant effect on medical use in the metropolitan area. In particular, patients aged 19-44 had a high impact on medical use in the metropolitan area, and in the residential area, medical use in the metropolitan area was high in all autonomous districts based on the West. In addition, the use of medical care in the metropolitan area was high in the order of factors affecting neurological diseases, neoplasms, health conditions, and contact with health services based on main diagnosis and others. Conclusions: Through this study, it is expected to be used as basic data for improving health medical services system in Daegu Metropolitan City.

The Role of Stigma and Resilience in Healthcare Engagement Among Transgender Latinas in the U.S. South: Baseline Findings from the ChiCAS Study

Research demonstrates that stigma and resilience influence transgender peoples’ healthcare use. Less is known about transgender Latinas in the U.S. South who face multilevel barriers to healthcare access. We used baseline data from the ChiCAS intervention study. Using logistic regression, we examined how stigma (perceived discrimination related to gender identity, race/ethnicity, sexual behavior and perceived documentation status and internalized transphobia), and resilience (ethnic group pride and social support) are associated with two healthcare outcomes (use of routine medical care and medically supervised gender-affirming hormones). We also explored barriers to accessing both types of care. After removing 13 participants with missing data, our sample size was 131 transgender Latinas in the U.S. South. Most participants (74.8%, n = 98) received routine medical care in the past year and 57.3% (n = 75) had ever received medically supervised gender-affirming hormones. Reports of discrimination were highest for gender identity and documentation status. Race/ethnicity-based discrimination was positively associated with accessing routine medical care in the past year (OR = 1.94, p = 0.048). Having more social support was positively associated with care (routine care: OR = 3.48, p = 0.002 and gender-affirming hormones: OR = 2.33, p = 0.003). The most commonly reported barriers to accessing both types of care included cost, insurance, and not knowing where to go. Findings highlight the importance of social support for healthcare use among transgender Latinas. Social support may be especially important when considering the unique experiences of discrimination faced by transgender Latinas in the U.S. South.

Medical Specialist Care Utilization Prior to the Explantation of Cosmetic Silicone Breast Implants: A Nationwide Retrospective Data Linkage Study.

Explantation is the proposed treatment for breast implant illness (BII). Little is known about which medical specialists are visited and what diagnoses are made before explantation is provided as the treatment. This study investigated medical specialist care utilization in women with cosmetic breast implants who underwent explantation compared to women who chose breast implant replacement surgery and to women without breast implants. Retrospective cohort study using data linkage with the Dutch Breast Implant Registry and the Dutch health insurance claims database. Visits to medical specialists were examined over the 3years before explantation. A total of 832 explantation patients were matched and compared to 1463 breast implant replacement patients and 1664 women without breast implants. Explantation patients were more likely to have visited >5 different medical specialties compared to both replacement patients (12.3% vs. 5.7%; p<0.001) and women without breast implants (12.3% vs. 3.7%; p<0.001). Among explantation patients, women who underwent explantation because of BII were more likely to have visited >5 different medical specialties compared to women who underwent explantation because of other reasons (25.0% vs. 11.0%; p<0.001). Women who underwent explantation of breast implants had higher utilization of medical specialist care in the years before explantation compared to women who underwent breast implant replacement surgery and women without breast implants. Medical specialist care use was especially high among women for whom BII was the registered reason for explantation. These findings suggest further research is needed into the link between BII and the use of medical specialist care. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract 4816: Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients

Abstract Background: Beyond its well-known lethality, pancreatic cancer (PC) is associated with a wide variety of physical and psychological complications. These complications collectively lead to an increase in symptom burden experienced by patients with PC, as compared to other cancer types, leading to lower health-related quality of life (HRQoL) and worsened clinical outcomes. Reducing symptom burden is often achieved through the use of supportive care medications (SCM). Racial disparities have been described in the use of pain and psychiatric medications but limited research has explored potential disparities in access to and utilization of other SCM among diverse racial and ethnic groups. The goal of this study was to illustrate the presence of racial/ethnic disparities in the treatment patterns of supportive care medications in end-of-life care of PC patients Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database from 2005 to 2017. Participants were identified using ICD9 and ICD10 diagnostic codes. Patients diagnosed with PC and have died in 2005-2007 with more than 1 year of Medicare enrollment before death were included. Logistic regression models to assess the association between use of supportive care medications and race, adjusting for covariates (sex, race, age, marital status, education, income, residence, CCI, year of diagnosis of PC, cancer stage). Results: After the application of the inclusion/exclusion criteria, 74,309 patients were included in the final analysis (White: 72.53%, Black 11.01%, Hispanic 9.60%, Asian/Pacific Islander 6.58%) Racial and ethnic disparities in the use of multiple SCM drug classes were identified. The results are summarized in Table 1. Conclusion: Disparities in the use of SCM were found in patients with PC. Minorities had significantly less use of sleep aids and headache aids, and increased use of cognitive aids and appetite stimulants. AAs also had lower uses of anti-emetics. AA Hispanic Asian SCM Drug Class aOR 95% CI aOR 95% CI aOR 95% CI Anti-emetics 0.77 (0.73, 0.81) 0.98 (0.93, 1.03) 1.01 (0.95, 1.08) Appetite stimulants 1.06 (1.01, 1.11) 1.01 (0.96, 1.06) 1.28 (1.20, 1.36) Cognitive aids 1.38 (1.25, 1.53) 1.04 (0.93, 1.17) 1.11 (0.97, 1.26) Headache aids 0.68 (0.63, 0.74) 0.81 (0.74, 0.87) 0.85 (0.77, 0.93) Sleep aids 0.71 (0.67, 0.75) 0.87 (0.82, 0.92) 0.87 (0.81, 0.93) Citation Format: Olga M. Trejos Kweyete, Yi Guo, Sherise C. Rogers, Lisa Scarton, David L. DeRemer, Chardae L. Whitner, Diana J. Wilkie, John M. Allen. Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4816.

Les facteurs de risque d’acquisition des infections à BMR: Etude analytique

In recent years, there has been a considerable increase in the prevalence of bacteria increasingly resistant to multiple families of antibiotics, which constitutes a major problem for public health. To determine the prevalence and different risk factors for the acquisition of multi-resistant bacteria. This is an analytical and prospective study including patients hospitalized in the Batna University Hospital during the period from January 2023 to March 2023 presenting a documented infection with isolation of sensitive or multi-resistant strains. An operating sheet based on the different risk factors for acquiring multi-resistant bacteria has been established. We collected 250 patients. There are 160 men and 90 women with an average age of 44 years. Of all the strains that were identified, 100 isolates were multi-resistant bacteria. ESBL-producing Enterobacteriaceae are the most frequently isolated multi-resistant bacteria. Multivariate logistic regression analysis identified four risk factors that are significantly related to the risk of acquiring multi-resistant bacteria infection: prior antibiotic therapy [P = 0,029], use of invasive medical care [P = 0,024], the nosocomial origin of the infection [P = 0,036] and the use of public toilets [P = 0,015]. Our results clearly demonstrate that the inappropriate use of antibiotics, especially broad-spectrum antibiotics, and hand-held cross-transmission play a major role in the spread of multi-resistant bacteria in our hospital.

Impact of Diabetes on Heart

Diabetes is sometimes described as the "coronary equivalent." A coronary equivalent refers to a condition or risk factor that increases the likelihood of developing coronary artery disease (CAD), a condition characterized by the narrowing or blockage of blood vessels supplying the heart. Identifying and managing these coronary equivalents is crucial for preventing and mitigating the severity of CAD". These illnesses are regarded as coronary equivalents since they have been linked to a higher risk of CAD and would need the same therapies and management techniques as CAD. Diabetes has the potential to significantly affect the heart and circulatory system. Additionally, diabetes patients are more likely to smoke, be obese, be inactive physically, and have other heart disease risk factors. some diabetic treatments, including insulin, and sulfonylureas, might raise the danger of hypoglycaemia, which can cause heart rhythm problems and even sudden death. The risk of heart disease can be decreased by preventing and controlling diabetes by lifestyle modifications like consistent exercise, a balanced diet, and weight management, as well as with the use of the proper medical care. Diabetes complications, especially impact on heart and circulatory system, must be prevented and managed by closely monitoring blood sugar, blood pressure, and cholesterol levels. Lowering cardiovascular risk factors and treating the illness he high frequency of health issues and death from cardiovascular disease in those at risk for and with diabetes has made this a more crucial and all-encompassing component of diabetes care. Additionally, there are drugs that can aid in lowering risk factors and the prevalence of heart-related illnesses. With precise guidelines, more attention is placed on lowering the likelihood of developing heart and kidney issues and safeguarding these organs from harm. For patients with atherosclerotic cardiovascular disease (ASCVD) and/or those at high risk for heart and kidney disease, heart failure, and chronic kidney disease, the recommendations center on selecting drugs properly. SGLT2 inhibitors or GLP-1 receptor agonists are typically the recommended treatments. More than ever, there are drugs available now that help treat or prevent these additional illnesses as well as blood glucose levels. The Standards synchronized the blood pressure target with other significant organizations that established these recommendations. A systolic blood pressure of less than 130 mmHg or a diastolic blood pressure of less than 80 mmHg (130/80 mmHg) is now considered high blood pressure. For adults with diabetes and risk factors for ASCVD who are 40 to 75 years old, the target LDL-cholesterol level is 70 mg/dL, and for those who already have ASCVD, the target LDL-cholesterol level is 55 mg/dL. In addition, if the goal level is not reached, it is advised to achieve an LDL reduction of 50% or more from the beginning point LDL with a high intensity statin drug and then use a different drug, such as ezetimibe or a PCSK9, if necessary. This emphasizes the significance of managing and preventing cardiovascular disease.

Medical care use and mortality rate after the onset of disability: A 6-year follow-up study based on national data in Taiwan

BackgroundThe onset of disability is a major health challenge, and people with disability can be particularly underserved in the years immediately after the disability onset. ObjectiveTo analyze the excess mortality rate of people with recent-onset disability and their health-care utilization during the period after disability onset (1–6 years after onset). MethodsWe used whole-population claims data from 2015 to 2020 (for approximately 23 million individuals) from Taiwan's National Health Insurance (NHI) system. These NHI claims data were linked to the National Death Records and National Disability Registry. Each individual with a disability was followed until their death or December 31, 2020. The age-standardized mortality rate and outpatient and inpatient utilization were compared between individuals with and without disability. Finally, Cox regressions were estimated to determine excess mortality for the individuals with disability. ResultsThe age-standardized mortality rates for the people with disability and those without disability were 1020.35/10,000 and 463.83/10,000, respectively. The people with disability utilized significantly more medical care under the NHI system. Mortality rates differed substantially among disability types. The Cox regression revealed a hazard ratio of 1.47 (95% CI = 1.46, 1.48) for all-cause mortality for people with disability, and significant sex differences in mortality risk were observed for some causes of death. ConclusionAccording to the excess mortality rates within 6 years of disability onset observed in this study, the NHI may not be sufficient to reduce health disparity between people with and without disabilities. In addition, specific characteristics of each type of disability should be considered.

Sex and gender differences in health and disease. Part II. Clinical and medical-social

An important condition for providing quality and safe care is to understand the differences between men and women in epidemiology, pathophysiology, risk factors, clinical performance of diseases, response to treatment and use of medical care. The first part of the review was devoted to the evolutionary mechanisms of differences in life expectancy and potential strategies for increasing life expectancy in men. The second part of the review examines sex and gender differences using the example of 3 groups of diseases, which, according to the World Health Organization, are the main causes of death in the European Region, in the programming of health and disease, as well as the reasons for the male-female health-survival paradox.

Antibiotic resistance: current challenges and ways of their solution

The use of antibiotics in various spheres of human life and in various sectors of society has led to the emergence of antibiotic resistance. Pandemics and military conflicts around the world, including in Ukraine, also leave their mark on the evolution of pathogens and their antibiotic resistance, which is associated with the limitation of people’s health needs by the lack of adequate medical care, large-scale migration and uncontrolled use of antibiotics. This article discusses the main actions of microorganisms aimed at protecting themselves from antibiotics, depending on their species. A number of publications have been analyzed to study and highlight the main necessary steps proposed by various authors to overcome this problem both in the healthcare sector and in society.

The Percentage of Patients Experiencing Financial Strain Depends on the Screening Measure: Evidence From a Cross-Sectional Survey of Adult Members of an Integrated Healthcare Delivery System.

Financial strain has important consequences for patients, providers, and health care systems. However, there is currently no gold standard measure to screen for financial strain. This study compared the performance of 3 single-item screeners using a composite measure of financial strain as a "gold standard." We conducted a secondary analysis of unweighted data from a 2021 survey of Kaiser Permanente Northern California health plan members comparing the percentages of adults who experienced financial strain based on 3 general single-item screeners, a screener specific to medical and dental health care use, and a composite financial strain measure. The study sample was comprised of 2734 non-Medicaid insured adults who answered all financial strain questions. Kappa statistics evaluating agreement of the 3 general screeners with the composite measure were calculated for the sample overall, by age group, and within age group, by 4 levels of income and 4 racial/ethnic subgroups. Among 947 adults aged 35 to 65, 30.7% had just enough money or not enough money to make ends meet, 23.3% had a somewhat hard or hard time paying for basics, 18.8% had trouble paying for ≥1 type of expense, 20.5% had delayed/used less medical/dental care, and 41.5% had experienced financial strain based on the composite measure. Among 1787 adults aged 66 to 85, the percentages who screened positive on these measures were 22.7%, 19.4%, 12.9%, 19.8%, and 34.4%, respectively. Across the sample, by income categories and racial/ethnic groups, the making ends meet screener identified higher percentages of adults experiencing financial strain and performed better when compared with the composite measure than the hard to pay for the very basics and trouble paying for expenses screeners. Overall, substantial decreases in the percentages of adults who screened positive on the financial strain measures were seen as level of income increased. Within income categories, middle-aged adults were more likely than older adults to have experienced financial strain based on the composite and general single-item screeners. As social risk screening becomes part of the standard of care, it will be important to assess how well different brief screeners for financial strain perform with diverse patient populations.

Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states.

Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. A two-way fixed-effects model was used to analyze serial cross-sectional observational data. Seventeen metro areas in 13 US states took part in the study. Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. State-level Medicaid expansion was measured using Kaiser Family Foundation data. Individual-level self-report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two-thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage-point increase in the probability of insurance coverage, and a 9.0 (95% CI = -15.0, -0.2) percentage-point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). US Medicaid expansion may curb drug-related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non-financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample.