Utilization Patterns Research Articles

Patterns of healthcare utilization according to health equity determinants during the first year of the pandemic at Johns Hopkins Medicine.

Rapid telehealth adoption happened at the onset of the coronavirus disease 2019 (COVID-19) pandemic, resulting in a move from in-person predominant to telehealth predominant care delivery. Later, in person visits rebounded with telehealth options remaining. This study aimed to assess differences in healthcare utilization during this changing landscape in terms of health equity determinants. This was an observational cohort study of Johns Hopkins Medicine (JHM) patients. We analyzed utilization of video, telephone, and in-person patient-provider visits by eligible patients between March 16, 2019 and December 31, 2020. Percent changes in average weekly patient-provider visits from pre-pandemic (March 16, 2019-June 30, 2019) to early 2020 pandemic (March 16, 2020-June 30, 2020) and from pre-pandemic (July 1, 2019-December 31, 2019) to late 2020 pandemic (July 1, 2020-December 31, 2020). We used a quantile cut off technique to describe disproportionately smaller or greater drops in visits during the first year of the pandemic among health equity determinant groups and according to visit specialty, when compared to the total population. There was a 39% drop in patient-provider visits from the pre-pandemic to the early 2020 pandemic period, and a 24% drop from pre-pandemic to the late 2020 pandemic period. We discovered 21 groups according to health equity determinates and visit departments with patterns of disproportionately smaller or greater drops in visits during the first year of the pandemic, when compared to the total population: Pattern 1 -smaller drop in visits early and late 2020 (age 45-64, Medicare insurance, high poverty and high unemployment; mental health and medical specialty visits -P < .001); Pattern 2 -greater drop in visits early 2020 only (age 65-84; OB/GYN and surgical specialty visits-P < .001); Pattern 3 -greater drop in visits early and late 2020 (age 0-5, age 6-17, age 85+, Asian race, Hispanic or Latino ethnicity, private insurance-P < .001); and Pattern 4-smaller drop in visits in early 2020 when compared to late 2020. The age 18-44 group showed a smaller drop in visits early 2020 and then visit levels similar to the total population late 2020. Primary care visits were similar to the total population early 2020 and then a smaller drop in visits late 2020 (P < .001). Our study provides evidence of health equity determinant groups having disproportionally smaller or greater drops in visits during the first year of the pandemic. The observed differences may have been influenced by changing telehealth offerings during the first year of the pandemic. Groups with disproportionately smaller drops in visits early 2020 (Pattern #1 and age 18-44 group in Pattern #4), suggests more success with adopting telehealth among those groups. Whereas groups with disproportionately greater drops in visits early 2020 (Pattern #2 and Pattern #3), suggests less success with telehealth adoption. For Pattern #4, more clarification is needed on how changes in telehealth offerings contributed to the downward trend in visits observed from early to late 2020. We describe 4 main patterns to characterize groups with disproportionately smaller or greater drops in visits during the first year of the pandemic. While this work did not specifically study vulnerable populations, these patterns set the stage for further studies of such groups.

The impact of diagnosing provider type on longitudinal care for patients with newly diagnosed Huntington’s Disease

Aims This study evaluated the association between provider types for patients with newly diagnosed Huntington’s disease (HD) and healthcare resource utilization (HCRU), costs, and treatment patterns. Materials and methods This retrospective analysis used MarketScan® databases (1/1/2017-12/31/21) to identify provider type who diagnosed and managed US adult patients with HD. Patients with continuous enrollment 6 months pre- and 12 months post-diagnosis were included. Outcomes evaluated over 12 months post-diagnosis included hospitalizations, outpatient visits, antipsychotic or vesicular monoamine transporter 2 (VMAT2) inhibitor use, and total healthcare costs. Results 340 eligible patients had a mean age at diagnosis of 49 years. 56.5% were female; 71.5% had a Charlson Comorbidity Index of 0. Patients were diagnosed by neurologists (48.5%), primary care providers (PCP) (35.6%), psychiatrists (3.5%), or other providers (12.4%). Patients diagnosed by PCPs or neurologists received significantly more follow-ups by the same diagnosing provider type (P < 0.05). All-cause and HD-related outpatient visits at 12-month follow-up had more patients diagnosed by PCPs (23.9, 5.1) than neurologists (18.0, 2.4), psychiatrists (16.7, 1.67), or others (15.3, 2.4). HD-related mean costs totaled $2,489 ($1,179 inpatient and $1,310 outpatient). Patients diagnosed by neurologists had significantly lower HD-related total non-medication costs vs those diagnosed by PCPs (−$2,256; P < 0.05). Among patients diagnosed by neurologists vs PCPs, similar proportions received antipsychotics within the first year (55% vs 52%, respectively); more patients managed by neurologists received VMAT2 inhibitors (12% vs 7%, respectively). Limitations Our study includes limitations inherent to retrospective claims studies. Conclusions Patients with HD are most often diagnosed by neurologists or PCPs; the same diagnosing provider type typically manages follow-up. Patients diagnosed by neurologists had significantly fewer HD-related outpatient visits, lower HD-related non-drug costs, and more frequently received VMAT2 inhibitors vs those diagnosed by PCPs. Our findings show an integrated care team may provide evidence-based, personalized care for patients with HD.

DRUG UTILIZATION PATTERN IN INDOOR PATIENT OF RADIOTHERAPY DEPARTMENT AT A TERTIARY CARE HOSPITAL IN SOUTHERN RAJASTHAN

Objective: The study was planned to evaluate on drug utilization pattern of drug use in the indoor of radiotherapy department, using the World Health Organization recommended core drug use indicators, to compare the cost of drug used and to provide feedback to the concerned department to improve rational prescribing. Methods: Four hundred and five newly diagnosed cases of cancer with age more than 18 of both genders were included in the study. The demographic data, diagnosis, group of anticancer drugs, individual anticancer drug, combinations of anticancer drugs, and cost of drug reactions were recorded and analyzed statistically, using descriptive study statistics. Results: Cervical cancer (19.51%) was the most frequently diagnosed cancer, followed by lung cancer (17.04%). Platinum compounds (76.30%) were maximum utilized group of drugs. Carboplatin was the most commonly prescribed drug (53.09). Average number of drugs prescribed per prescription was 8.77. Carboplatin + Paclitaxel combination was the most commonly prescribed combination. Pantoprazole was maximally used adjuvant drug. Conclusion: About 100% of drugs were prescribed by generic name and 86.27% of drugs were prescribed from National List of Essential Medicines of India, 2022 indicates rational prescribing. The cost of anticancer drugs was much less in comparison to other studies.

Self-reported Health Service Utilization and Barriers to Care Among US Adults with a History of Post COVID-19 Condition.

Millions of US adults continue to experience symptoms of post COVID-19 condition (PCC). More data on health service utilization patterns and barriers to care in this population are needed to understand how to care for people with PCC. To evaluate health service utilization and barriers to medical care among individuals with a history of PCC compared with other US adults. Data were analyzed from the 2022 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the US population. US adults. Health service utilization and the presence of financial and nonfinancial barriers to care in the preceding 12 months. There were 24,905 individuals included in the analysis, representing approximately 230 million US adults. The weighted prevalence of those with a history of PCC was 6.9% (95%CI, 6.5-7.3). Compared to other US adults, participants with a history of PCC were more likely to have had an urgent care visit (adjusted odds ratio (aOR) 1.52 [95%CI, 1.34-1.72]), emergency room visit (aOR 1.94 [95%CI 1.71-2.21]), hospitalization (aOR 1.48 [95%CI, 1.24-1.77]), rehabilitation services (aOR 1.35 [95%CI, 1.14-1.60]), home care (aOR 1.55 [95%CI, 1.66-2.26]), mental health counseling (aOR 1.39 [95%CI, 1.17-1.65]), and complementary and integrative medicine services (aOR 1.29 [95%CI, 1.13-1.49]). Furthermore, respondents with a history of PCC were more likely to report at least one financial barrier to care (aOR 1.71 [95%CI, 1.48-1.97]) and at least one nonfinancial barrier (aOR 1.77 [95%CI, 1.56-2.00]). A greater proportion of participants with a history of PCC reported a financial barrier and nonfinancial barrier than adults with most other chronic conditions captured by NHIS. Individuals with a history of PCC were more likely to use a variety of health services and report barriers to medical care. Health systems should consider developing accessible, multidisciplinary care pathways for this population.

Mathematical Models for Smart Grid Load Balancing

Stack adjusting should be exhausted more progressed ways since advanced control lines are getting more complicated and green vitality sources are being included increasingly. "Scientific Models for Keen Lattice Stack Adjusting" looks at how scientific models can be made and utilized to move forward how power loads are overseen and distributed in keen networks. This investigate looks into distinctive ways to create the lattice more solid and effective, such as utilizing optimization strategies, prescient models, and machine learning. Request reaction, real-time stack forecasts, and the combination of disseminated vitality assets (DERs) are a few of the enormous issues that the models attempt to unravel. Lattice supervisors can more precisely foresee vitality request, adaptably dole out assets, and lower crest loads by utilizing these models. This cuts down on vitality squander and running costs. The ponder too stresses how critical it is to include unknown variables like changing green vitality yield and eccentric utilization patterns within the models to create beyond any doubt they are solid and solid. The consider appears the potential of independent strategies, in which individuals in numerous places work together to keep the worldwide framework steady and indeed out the stack in each region. This independent approach makes the lattice more scalable and flexible, so it can way better meet future vitality needs and suit the developing utilize of green vitality. This paper makes a difference update power lines by looking at numerous current models and coming up with other ways to do things. This makes beyond any doubt that the vitality supply is steady, endures a long time, and works well. The think about findings are exceptionally vital for officials, engineers, and specialists who are attempting to make savvy networks that can handle the requirements of the 21st century.

Retrospective evaluation of prescribing pattern and utilization of antiepileptic drugs in pediatric, neurosurgery, and psychiatry wards: A comparative study to the standard treatment guidelines.

Antiepileptic drugs (AED) are progressively utilized for off-label conditions other than epilepsy, like bipolar disorder and migraine. The objective of this study was to evaluate current prescribing patterns and utilization of AED in pediatric, neurosurgery, and psychiatry wards and to compare them to the standard treatment guidelines. A descriptive, cross-sectional study was conducted in Ayyub Teaching Hospital, Abbottabad from December 1st, 2018 to April 2019. Data on demographic and clinical characteristics, utilization patterns of AED, adherence to standard treatment guidelines, and frequency of potential drug-drug interactions were analyzed using descriptive statistics. Among 410 patients, 54.3% (n = 223) were male, 45.6%(n = 187) were female, and 63.7% (n = 261) were from the 1 to 18 years' age group. The majority 47.3% (n = 194) were from the pediatric ward followed by neurosurgery 28.7%(n = 118). Among the studied patients, 96.1% of them had comorbid conditions other than epilepsy alone. With regards to types of seizures unclassified seizures were the most common seizure type (59.8%; n = 245) followed by generalized tonic clonic seizures 23.4% (n = 96). In this study, the most frequently utilized AED was sodium valproate 59.0% (n = 242) followed by antiepileptic first-generation medicines were commonly used (76.3%). Although a total of 77.6% of the patients showed nonadherence to National Institute for Health and Care Excellence guidelines and 87.6% of them showed drug interactions. Findings from this study showed prescription patterns and utilization of AED in patients with epilepsy and non-epilepsy disorders which may help healthcare providers in making accurate clinical decisions.

Assessment of Practices on Purchase of Packaged Foods and Utilization Patterns of Food Labels among Adults in Puducherry

Abstract Background: There is an increase in the manufacture and consumption of prepackaged foods as a result of widespread urbanization, long working time, and adaption to a sedentary lifestyle. The majority of these prepackaged foods contain food labels. Food labeling is a community-based strategy that informs customers about a food’s nutritional composition, empowering them to choose healthier foods. To assess the practices on the purchase of packaged foods and utilization patterns of food labels among adults in Puducherry. Material and Methods: A cross-sectional survey in the field practice area of a private medical college at Puducherry was carried out for two months including adults residing for &gt; 6 months in selected villages/wards. A sample size of 460 with a multistage sampling technique was considered. Data collection using a semi-structured questionnaire incorporated into Epi-collect software and was analyzed using SPSS16. Ethical clearance was obtained from Institutional Ethical Committee. Written informed consent was sought from participants. Results: Around 271 (58.91%) and 189 (41.08%) respondents were residing in urban and rural regions, respectively. Purchase of packages was seen in 297 (64.57%) people. Only one-fourth of the subjects had the practice of reading the food labels, with urban residents having a better practice when compared with rural population (P value &lt; 0.05). Conclusion: The study reveals a low level of utilization pattern of food labels among consumers of packaged food products. The findings of this study would be helpful for concerned authorities in creating and improving awareness among consumers and ensuring that their usability is improved.

Utilization patterns of glucagon like Peptide-1 receptor agonists prior to bariatric and metabolic surgery: a multicenter study

BackgroundGlucagon-like-peptide-1 receptor agonists (G1RA) have gained popularity as a treatment for weight loss in patients who are overweight or obese, but their utilization patterns and impact on candidates for metabolic and bariatric surgery (MBS) remain understudied. ObjectiveWe aimed to investigate the prevalence, characteristics, and outcomes of patients with a history of G1RA utilization among MBS candidates. SettingFive high-volume MBS centers in Israel. MethodsData were collected retrospectively from February 1st, 2023, to September 30th, 2023. Demographic, clinical, and treatment data were analyzed to assess a history of G1RA use, associated factors, adverse events, and treatment outcomes. ResultsFour hundred thirty-four MBS candidates were included in the study. A history of G1RA utilization was obtained in 275 (63%) MBS candidates, with Liraglutide and Semaglutide being the most commonly used agents. Younger age, type 2 diabetes mellitus, dyslipidemia, and no previous MBS history were associated with a higher rate of G1RA utilization. With these medications, median maximal weight loss was 5.38 kg, and mean duration of use was 19 weeks. Patients using G1RA for ≥6 weeks experienced significantly greater weight loss compared to those using it for shorter periods (6.3 ± 6.43 vs 1.65 ± 1.69; P < .001). GI-related adverse events were reported in 57.8% of patients. Over 95% of patients discontinued G1RA due to insufficient weight loss and/or adverse effects. Patients reaching the maximal recommended dose exhibited significantly greater weight loss versus patients who did not reach it for both Liraglutide (5.9 ± 4.98 kg vs. 3.9 ± 5.53 kg; P = .03) and Semaglutide (6.5 ± 7.8 kg vs. 2.5 ± 3.8 kg; P = .016). ConclusionPre-MBS G1RA utilization and failure are prevalent among MBS candidates. Our study underscores the need for further research to understand the role of G1RA therapy in obesity management and the development of guidelines for its appropriate use in MBS candidates.

The Energetic Saver Profile From Sit-to-Stand Does Not Persist During Very Low-Intensity Physical Activity in Healthy Men and Women.

It is essential to better characterize the energetic profile of individuals during very low-intensity physical activity. The objectives of the present study were to determine whether the saver profile from sit-to-stand persists during light physical activity and characterize patterns in substrate utilization from sit-to-stand and during very low-intensity physical activity in healthy men and women. Sixty-two healthy adults (38 women) performed an experimental sequence that corresponded to 15-minute sitting (SIT1), followed by 15-minute standing (STAND), 15-minute sitting again (SIT2), and finally 15minutes of light cycling. Continuous indirect calorimetry was allowed to calculate energy expenditure (EE) and respiratory quotient through the entire sequence. Savers and nonsavers (<5% and ≥ 5% increase in EE from sitting to standing, respectively) were determined. There was an interaction effect in EE between savers and nonsavers through the whole sequence (P = .008). Only nonsavers (71%) exhibited a significant increase in EE from SIT1 to STAND (P < .001). Nonsavers and savers significantly increased EE during 15minutes of light cycling relative to sitting or standing (P < .001), without any difference between groups. The percentage of change in respiratory quotient from SIT1 to STAND was significantly different between the 2 groups, with increased values in savers and decreased values in nonsavers (P = .03). Significantly lower values in respiratory quotient and EE were found during 15minutes of light cycling in women compared with men (P < .001). It is essential to determine individuals' energetic phenotype to determine those who may benefit more from strategies such as standing or light physical activity. The sexual dimorphism in terms of substrate use during such exercise should be considered.

ID: 333609 Healthcare Costs and Medical Utilization Patterns Associated with Painful and Severe Painful Diabetic Peripheral Neuropathy

ID: 333609 Healthcare Costs and Medical Utilization Patterns Associated with Painful and Severe Painful Diabetic Peripheral Neuropathy

A Novel Spatial-Aware Deep Learning Approach for Exploring the Environmental Context of Terrorist Attacks and Armed Conflicts

The quantitative assessment of terrorist attacks and armed conflicts (TAACs) is a crucial component of global public safety research and is vital for societal stability and national security. This study addresses the spatial dependency of such events, i.e., the relationship between the outbreak of an event and its environment. Based on geographic big data and artificial intelligence (AI), we propose a spatial feature utilization pattern that takes into account the impact of the event environment, and established a deep learning (DL) framework of features within the joint event location and space neighborhood to improve the precision of the quantitative assessment. The results demonstrate that in scenarios under a combination of 14 social, natural, and geographic driving factors, models that incorporate spatial features outperform those that only use location features during both the training and testing phases. Furthermore, models that consider both location and spatial features outperform models using only a single feature across various evaluation metrics. Global attribution analysis further confirms the spatial dependency of events, manifested in the mutual influence on the likelihood of events occurring among adjacent cities and the correlation with various environmental factors, particularly elements related to human activities and living environments. We find that both prosperous urban centers and underdeveloped rural areas are hotspots for TAACs, and that such events more likely to occur in harsh climatic patterns characterized by high temperatures and low precipitation. This enhances our understanding and preparedness for managing and preventing such events.

Oral Contraceptives: Analyzing Effectiveness and Utilization Challenges to Improve Reproductive Health Outcomes

Background: Oral contraceptives (OCs) are widely used for preventing unintended pregnancies and offering various reproductive health benefits. However, their utilization is influenced by numerous factors, including access, education, and cultural beliefs. This meta-analysis aims to systematically review studies from 2019 to 2023 focusing on OC utilization patterns and effectiveness. Methods: A comprehensive search across PubMed, Scopus, and Google Scholar identified 50 relevant articles, from which nine studies were selected based on predefined criteria. Data extraction included demographic factors, adherence rates, side effects, access to OCs, and pregnancy outcomes. Quality assessments were performed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool, followed by statistical analysis using random-effects models. Results: The analysis revealed a pregnancy rate as low as 0.3% among perfect OC users, showcasing their high effectiveness. However, significant barriers persist, including poor adherence, discontinuation due to side effects, and disparities in access, particularly in low-income regions. Cultural perceptions and insufficient education further hinder optimal OC utilization. Conclusion: While OCs represent a reliable contraceptive method with substantial health benefits, ongoing challenges impede their optimal use. A multifaceted approach focusing on improved education, enhanced healthcare provider counseling, and targeted access initiatives is essential to increase OC utilization and reproductive health outcomes globally. Addressing these challenges will empower individuals to make informed family planning decisions, ultimately reducing unintended pregnancies and enhancing quality of life.

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Utilization and patient characteristics for the trastuzumab reference and biosimilars, and other human epidermal growth factor receptor 2 inhibitors in the United States.

Trastuzumab is an antihuman epidermal growth factor receptor 2 monoclonal antibody used to treat breast and other cancers. Trastuzumab biosimilars were approved in the United States beginning in 2017. Utilization information on these biosimilars is limited. To examine utilization patterns and characteristics of patients treated with trastuzumab (biosimilars and reference) and other human epidermal growth factor receptor 2 products. We evaluated health care claims data from the Biologics and Biosimilars Collective Intelligence Consortium distributed research network, representing a large, geographically diverse US population of commercially insured individuals. We queried 4 distributed research network health plan partners to capture product usage data and patient information from October 1, 2016, to October 31, 2022. Patients were required to be continuously enrolled in their health plan for at least 365 days before their first observed trastuzumab utilization date in this study period. Data were aggregated across data partners. More than 16 million eligible health plan members representing more than 31 million person-years of data were evaluated. We identified 5,984 incident treatment episodes; 3,878 (64.8%) episodes were with the reference trastuzumab. The mean ages were consistent across trastuzumab products (60.2 to 65.1 years) and at least 80% of the episodes were among female patients. The mean comorbidity index score was 1.2 (SD = 1.9) among users of the reference vs the biosimilars (range 1.2-2.5). Other clinical characteristics (eg, diabetes, hypertension) were comparable across products. The proportion of total incident episodes of the reference trastuzumab decreased substantially over time (96% in 2016 vs 28% in 2021) as utilization of the biosimilars increased (eg, use of trastuzumab-anns increased from 2% [2019] to 36% [2021]). Similar utilization trends were seen among patients with and without metastatic breast cancer. Trastuzumab biosimilars utilization has grown since their introduction to the US market. Exploration of these biosimilars' comparative effectiveness and safety to their reference product is warranted.

Utilization pattern of Kisan Credit Card (KCC) among the farmers of Prayagraj district of Uttar Pradesh (U.P.)

Utilization pattern of Kisan Credit Card (KCC) among the farmers of Prayagraj district of Uttar Pradesh (U.P.)

Weight management medications for chronic use in 37 veterans affairs medical centers-A medication use evaluation.

Controlled trials have demonstrated successful weight loss associated with certain weight management medications (WMMs). However, there are limited real-world data on prescribing patterns and efficacy and safety profiles of WMMs in Veterans Affairs (VA) patients. To evaluate: utilization patterns of WMMs liraglutide, naltrexone/bupropion, orlistat, phentermine, phentermine/topiramate, and semaglutide; weight loss at three, six, twelve, and more than 12 months; safety; and treatment barriers. A retrospective, cross-sectional medication use evaluation (MUE) was conducted using electronic health records of outpatient Veterans newly initiated on WMMs at 37 VA Medical Centers between 1 March 2020 and 31 March 2022. Chart review was used to identify WMM utilization and capture rates of clinical response, defined as 5% and 10% or greater weight loss at the final weight, adverse drug events (ADEs), non-adherence, and discontinuations. Site-specific surveys evaluated local practices and barriers. Among 1959 eligible Veterans, semaglutide, phentermine/topiramate, and orlistat were most frequently prescribed. The clinical response was highest among phentermine/topiramate, liraglutide, and semaglutide. Naltrexone/bupropion and phentermine demonstrated the highest and lowest ADE rates, respectively. Potential barriers to WMM utilization and successful treatment by site reports were drug shortages, patient perceptions of therapeutic course, personal preferences, and VA WMM use criteria. Smaller weight loss and higher discontinuation rates were observed relative to clinical trials. The MUE data allow for better assessment of benefits and risks for Veterans prescribed WMMs.

Exploring disparities: A comparative analysis of insulin-naïve, regular users, and inertia patients among type 2 diabetes mellitus outpatients in India

ABSTRACT Introduction: Insulin utilization pattern varies greatly in type 2 diabetes mellitus (T2DM) patients. Clinical inertia in treatment intensification hinders glycemic control in T2DM management. This study investigated insulin prescription trends and various predictors among insulin naive, user, and insulin inertia (II) patients in T2DM. Methodology: A retrospective analysis of T2DM patient records from the diabetes clinic at a tertiary care center was conducted. Data on socio-demographics, anthropometry, disease characteristics, comorbidities, adherence, and medication prescribing patterns were collected. Analysis was done using tests of significance, odds ratio (OR), and multivariate logistic regression. Results: A total of 950 records were analyzed, with 17.3% of patients identified as insulin users (IU), 70.9% being insulin-naïve (IN), and 11.8% having II. IUs had significantly higher glycemic levels including HbA1c, fasting, postprandial, and random blood sugars compared to the other groups. Higher HbA1c levels were associated with significantly increased odds of insulin usage (OR: 3.46, confidence interval (CI): 1.94–6.16), while individuals taking sulfonylureas had lower odds of insulin usage (OR: 0.27, CI: 0.08–0.91). A significant association was also seen with the total number of oral antidiabetic drugs prescribed (four drugs; OR: 15.6, and five drugs; OR: 9.1). Other factors did not show a significant association. The regression model showed HbA1c level as low as 7.9% could indicate a future insulin requirement in 22% of patients. Conclusion: The study outlines differences in characteristics and parameters among T2DM patients who require or do not require insulin and highlights the challenges in insulin initiation in Indian T2DM patients. Findings on II underscore the need for timely treatment intensification.

Changes in Healthcare Utilization After the 2022 Seoul Metropolitan Flood: Applying a Generalized Synthetic Control Approach.

Floods can have adverse health effects and impose a burden on healthcare systems. However, the potential consequences of floods on specific medical causes in densely populated metropolitan cities has not been characterized yet. Therefore, we evaluate the changes in healthcare utilization patterns after the 2022 Seoul flood using nationwide health insurance data. Based on the flood inundation map, districts within the flooded municipalities of Seoul were classified as severe-(n=12), mild-(n=22), or non-(n=38) flood-affected districts. Capitalizing on the timing of the flood as a natural experiment, a generalized synthetic control method was applied to estimate changes in the number of disease-specific hospital visits in flood-affected districts during 2weeks after the flood. We found excess hospital visits for external injuries (20.2 visits, 95% CI: -6.0, 45.2) and fewer visits for pregnancy and puerperium (-3.0 visits, 95% CI: -5.1, -0.5) in residents of flooded districts. When comparing severe- and non-flood districts, the increase in hospital visits for external injuries (56.2 visits, 95% CI: 17.2, 93.2) and a decrease in hospital visits related to pregnancy and puerperium (-5.3 visits, 95% CI: -8.4, -1.6) were prominent in residents living in severe-flood affected districts. Disease specific analysis showed an increase in hospital visits for injuries to the elbow and forearm, ankle and foot injuries, and chronic lower respiratory diseases in severe-flood-affected districts. However, these impacts were not observed when comparing the mild- and non-flood-affected districts. Our study suggests an immediate and substantial change in medical demand following flood exposure, highlighting the importance of public health responses after flood events.

59 Comparative Analysis of Emergency Department Utilization Patterns During the COVID-19 International Pandemic: Frequent Users vs General Population

59 Comparative Analysis of Emergency Department Utilization Patterns During the COVID-19 International Pandemic: Frequent Users vs General Population

Influence of habitat utilization strategies on trace element signatures in egg contents of green turtles nesting on Xisha Islands, South China Sea

Habitat utilization significantly influences the accumulation of chemical pollutants, including trace elements (TEs), in the tissues of large marine organisms. Previous research has demonstrated that sea turtles nesting in the same location may employ distinct foraging strategies. This study investigated the influence of habitat use strategies on the concentrations of 16 TEs in the eggs of green turtles (Chelonia mydas) nesting on the Xisha Islands. The analysis incorporated stable carbon (δ13C) and nitrogen (δ15N) isotopes, as well as characteristic elements. Additionally, inter-relationships between TEs were examined. The nesting female green turtles were categorized into two foraging groups based on isotopic signatures, namely oceanic (δ13C values: −21.5 to −17.0 ‰; δ15N values: 7.10 to 12.5 ‰) and neritic (δ13C values: −14.4 to −9.95 ‰ and δ15N values: 5.10 to 10.0 ‰). Different TE patterns were observed in the egg contents of these two groups. The neritic group exhibited elevated levels of V and Cu, which positively corrected with δ13C values. Conversely, the oceanic group displayed higher levels of Zn, Cd, Se, Sn, As and Hg, which positively associated with δ15N values. This distribution pattern is attributed to variations in background TE concentrations in the respective foraging habitats. Additionally, prey items and trophic levels of green turtles may contribute to the observed inter-group differences in TE concentrations (e.g. Zn, As, Se, Sn) found in their eggs, warranting further research. This study provides valuable information about habitat utilization patterns and TE distribution in green turtles nesting on the Xisha Islands. The findings enhance our understanding of TE accumulation mechanisms in turtle tissues and eggs, which is significant for the conservation of this endangered species, the green sea turtle.